Occupational Therapy Helps Those With Dementia

Improvement was seen in both patients and their caregivers, study says

THURSDAY, Nov. 16, 2006 (HealthDay News) -- Occupational therapy -- training to do simple things around the house -- improved the lives of people with dementia such as Alzheimer's disease, as well as the people who care for them, a Dutch study found.

The results of the study, reported in the Nov. 18 British Medical Journal, could help change the attitude of health insurance companies and Medicare about paying for occupational therapy for persons with dementia, one expert said.

"I like the validation of what I knew instinctively," said Elicia Dunn Cruz, an assistant professor of occupational therapy at the University of Texas Medical Branch, Galveston.

Medicare sometimes refuses to pay for such therapy because of a belief that people with dementia "don't have a good rehabilitation potential," Cruz said, an attitude also shared by some, but not all, health insurers. "I think this article counters that," she said.

In the study, researchers at the University Medical Center Nijmegen divided 135 people 65 and older who'd been diagnosed with mild to moderate dementia into two groups. One group received 10 home-based sessions with experienced occupational therapists over five weeks who taught the patients to use various techniques to cope with mental decline. The people looking after them were taught methods of coping as well.

Assessments six weeks and three months after the therapy found that 75 percent of the patients who had the training showed an improvement in motor skills, and 82 percent needed less assistance in day-to-day tasks. The same sort of improvement was seen in only 10 percent of those who did not get the training.

Nearly half the caretakers who received the training felt more competent to do their duties, compared to a quarter of those who did not.

"Because outcomes such as improvements in activities of daily living and sense of competence are associated with a decrease in need for assistance, we believe that in the long term, occupational therapy will result in less dependence on social and health-care resources and less need for institutionalization," the researchers wrote.

Mary Mittleman, director of the psychosocial research program at New York University's Silberman Aging and Dementia Research Center, said she knew of no previous controlled study on occupational therapy for dementia patients.

Mittleman herself just reported a long-term study showing that spouses of Alzheimer's patients are less likely to place their loved ones in a nursing home if the spouses receive enhanced counseling and caregiver support.

The study of 406 spouses/caregivers found that those who received sessions of individual and family counseling, access to telephone counseling and participation in a support group delayed placing a loved one in a nursing home by about 18 months, compared to those who did not.

As for occupational therapy, Cruz said that training families to use adaptive techniques using familiar objects such as clocks and calendars can help people in the early stages of dementia. "It makes Alzheimer's disease less of a death sentence," she said.

Families can consult their primary-care physician about a referral to a rehabilitation clinic that provides in-home services, Cruz said: "There is a huge home industry, and occupational therapy is very much a part of it. The rub is that if a patient has a diagnosis of dementia that makes it difficult to get coverage. The insurers want to cover only people who are going to get well again. This study may help to change that."

More information

A professional's look at occupational therapy for dementia patients is provided by the University of Texas Medical Branch at Galveston.

SOURCES: Elicia Dunn Cruz, Ph.D., assistant professor of occuptional therapy, University of Texas Medical Branch at Galveston; Mary Mittleman, Ph.D., New York University; Nov. 18, 2006, British Medical Journal
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