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Occupational Therapy skills, can they be imparted to other health service professionals and social care workers?
- Suzanne M Cahill (12 December 2006)
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Persons with dementia need access to skilled occupational therapists
- Mcintyre Anne, Anita Atwal, Christine Craik, Joanna Friedman (14 December 2006)
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Occupational Therapy an essential ingredient in dementia services
- Dr Elizabeth A. McKay, Katie Robinson and Alison F Warren (20 December 2006)
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Suzanne M Cahill, Director Dementia Services Information and Development Centre St James Hospital James Street Dublin 8
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Graff and colleagues have this week provided a very impressive and powerful overview of the beneficial effects, a programme of occupational therapy (OT) can have, when delivered to people with dementia and to their family caregivers still living at home. After 10 OT sessions delivered over five weeks, persons with dementia functioned significantly better in their daily lives than those who did not, and primary caregivers trained in coping skills, felt significantly more competent at managing the care role that those in the control group. The approach empowered the individual diagnosed with dementia, offering real choice in terms of personal preferences for meaningful activities and customising his or her environment to compensate for the complex cognitive disabilities experienced. The approach also empowered the family caregiver, providing tailor-made psycho-social supports, thereby reducing caregiver burden. The authors conclude that the programme is worth introducing into clincial practice due to its high efficacy and its likely cost effectiveness. Interestingly the study was funded by the Dutch Alzheimer Association along with the Dutch Occupational Therapy Association and a local University. Clearly the roll out effect of approaches such as the one outlined in this paper is profound, not just for Occupational Therapists but for all those involved in the hands-on delivery of dementia care services including, public health nurses, home help staff, community social workers, community mental health nurses, speech and language therapists, physiotherapists, voluntary workers, health care assistants and care attendants. The interventions trialled also have important implications for those organizations involved in the design and delivery of training programmes in dementia care, such as Dementia Services Development Centres across the UK and Ireland and the Alzheimers Associations across the world. Best practice in dementia care is all about upskilling all those involved in service delivery and the breaking down of boundaries - professional, organizational and hierarchial (Kitwood, 1997). In no way attempting to devalue the professional content of the programme as detailed in this excellent scientific paper, its core components - treatment in compliance with OT dementia-specific guidelines, client-centred principles and the learning of compensatory and environmental strategies to promote independence in those cognitively impaired are common-sense intervention techniques which in my view need to be promoted in the training of all health service professionals and all social and health care staff responsible for the care of persons with dementia. In countries like the Republic of Ireland where in the absence of community care legislation, basic community services are scarce and where domiciliary Occupational Therapy for those with a cognitive impairment might well be considered “the icing on the cake”, we need to demystify the therapies and upskill those often low paid and untrained domiciliary care workers by sharing with them some basic principles and learning about what works and what does not work in dementia care. The home help or in-home respite support worker, by virtue of the front line nature of her role and the innumerable contacts often built up over time with clients and family caregivers is often in a strategic position to advise, counsel and effect change. Once adequately trained and sensitive to the disabilities associated with dementia he/she can do a lot more than vacuum the floor, keep the fridge topped up or in the case of the respite worker monitor the individual's behaviour. Clearly if we are to promote best practice in dementia care, (including fostering the dignity of the individual diagnosed and the well-being of his or her primary caregiver), the training of all health and social care staff in intervention techniques known to work for people with dementia, and their family caregivers, must become a key priority. Dr Suzanne Cahill
References Kitwood, T., (1998). Dementia reconsidered: The person comes first. Maidenhead, Open University Press. Competing interests: None declared |
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Mcintyre Anne, Lecturer in occupational therapy Brunel University, School of Health Science and Social Care, UB8 3PH, Anita Atwal, Christine Craik, Joanna Friedman
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We acknowledge that Cahill (2006) does not wish to undermine the professional content of occupational therapy educational programmes but we content that it is essential to understand the scope of the education that occupational therapists undergo to acquire such skills and the time that students spend in understanding the underlying theoretical principles of occupational therapy practice, pathology, client centred practice, autonomy etc. Evidence from an RCT carried out with a well elderly population (Clark et al 1997) identified that there were significant improvements in outcome for clients within an occupational therapy programme as opposed to a programme carried out by activity organisers or a control group. Although this study was with a well population, as opposed to clients with dementia, one can hypothesise that the rationale for occupational therapy could be applied. What is needed is not to ' demystify ‘therapies’ but to work towards ensuring that all persons with dementia have access to skilled occupational therapists. F. Clark, S. P. Azen, R. Zemke, J. Jackson, M. Carlson, D. Mandel, J. Hay, K. Josephson, B. Cherry, C. Hessel, J. Palmer and L. Lipson (1997) Occupational therapy for independent-living older adults. A randomized controlled trial. JAMA, 278(16)1321-1326. Competing interests: None declared |
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Dr Elizabeth A. McKay, Head, Department of Occupational Therapy University of Limerick, Ireland, Katie Robinson and Alison F Warren
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Congratulations to Graff and colleagues for completing such a significant RCT for both people with dementia and the occupational therapy profession. They should be applauded for highlighting the impact of community based occupational therapy intervention. This study serves to bolster the expanding evidence base of occupational therapy, thus promoting and enhancing best practice in this field. While we value the debate raised regarding imparting skills to untrained staff, it is erroneous to liken occupational therapy practice to ‘only common sense’. In support of our colleagues at Brunel University, we agree that more understanding is required of the education undertaken by occupational therapists at both an undergraduate and postgraduate level. Occupational therapy is best conceptualised as a complex intervention (Creek et al, 2005), the occupational therapy process is centred on occupation and is inherently not formulaic. The expertise and clinical reasoning of occupational therapists is well highlighted in the case study paper which describes in more depth the intervention which this RCT measured (Graff et al 2006). Where multidisciplinary teams work effectively with families and people with dementia it is inevitable that occupational therapists will support other health and social care staff by sharing information and skills. Thus teams can support an older person’s occupational performance and ultimately satisfaction with life. The Bacon Report (2001) emphasised the severe shortage of occupational therapists in Ireland and led to the establishment of three new occupational therapy courses in Ireland. The arrival of these graduates in clinical practice heralds a new and exciting age of occupational therapy in Ireland. Coupled with this, investment in education is the government’s commitment to increasing funding for services for older people. Occupational therapists should no longer be viewed as the ‘icing on the cake’ but rather an ‘essential ingredient’ when working with people with dementia and their carergivers in the community. Bacon Report Current and future supply and demand conditions in the labour market for certain professional therapists. Department of Health and Children: Dublin Stationary Office 2001 Creek J, Ilott I, Cook C., and Munday C. Valuing Occupational Therapy as a Complex Intervention. British Journal of Occupational Therapy, 2005 68(6) 281-4. Graff MJL, Vernoooij- Dassen MJ, Zajec J, Olde Rikkert MGM, Hoefnagels WHL, Dekker J How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver? A case study. Dementia 2006;5:503-32 Competing interests: None declared |
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