Occupational Therapy skills, can they be imparted to other health service professionals and social care workers?
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
Director
Dementia Services Information & Development Centre,
St James Hospital Dublin & Trinity College Dublin Ireland.
References
Kitwood, T., (1998). Dementia reconsidered: The person comes
first. Maidenhead, Open University Press.
Competing interests:
None declared
Competing interests:
No competing interests
12 December 2006
Suzanne M Cahill
Director Dementia Services Information and Development Centre
Rapid Response:
Occupational Therapy skills, can they be imparted to other health service professionals and social care workers?
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
Director
Dementia Services Information & Development Centre,
St James Hospital Dublin & Trinity College Dublin Ireland.
References
Kitwood, T., (1998). Dementia reconsidered: The person comes
first. Maidenhead, Open University Press.
Competing interests:
None declared
Competing interests: No competing interests