Dementia care and occupational therapy.
Article Type: Editorial
Subject: Dementia (Care and treatment)
Occupational therapists (Practice)
Author: Andrews, June
Pub Date: 04/01/2010
Publication: Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 College of Occupational Therapists Ltd. ISSN: 0308-0226
Issue: Date: April, 2010 Source Volume: 73 Source Issue: 4
Topic: Event Code: 200 Management dynamics
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 224520522
Full Text: There is an increase in cognitive impairment in populations in the developed and developing world as populations age, with over half the cases being caused by Alzheimer's disease. The number of people with dementia is increasing globally, in line with the ageing profile of the population in each country. In the United Kingdom, it has been established that dementia costs more than cancer, heart disease and stroke put together (Dementia UK 2007). The recent report from the Alzheimer Society of Canada (2009) has reached a similar conclusion, which is that we need to do more. Very many countries are generating their national dementia strategies in response to this challenge. From my work internationally with health and social care workers, I have come to the conclusion that the most significant action we can take is to improve the personal effectiveness of each and every practitioner. Every occupational therapist needs to be thinking carefully of his or her own potential contribution.

If the role of the occupational therapist in care for dementia is crucial, this requires a response from universities and colleges to increase the educational elements on dementia in undergraduate and pre-registration programmes. A Scottish survey indicated that there is not much practical input into programmes (Cunningham et al 2006). For example, on one issue alone, occupational therapists need to know much more about dementiafriendly design and technology, so that they can advise people with dementia and their carers on how to maximise their independence at home. Simple measures such as increasing the light levels can make a huge difference, but carers tell me: 'We were never told ...'

The journey of two people with dementia, even with the same level of underlying pathology, can go in completely different ways. One can maintain independence till right before the end of life, and another can be ushered towards a level of dependence that is unpleasant for him or her and more expensive for the health and social care system. We know what makes the difference. The level of evidence ranges from research done with people with dementia, extrapolation from other sensory and physical impairment research and examples of best practice, gathered internationally where there is some consensus about what works. You may recoil at the low level of some of this evidence. However, much of what I see in clinical practice has no evidence base at all. In some cases, the evidence suggests that what is done to people with dementia is actually harmful.

If I have one plea, it is this. We know a good number of research-based non-pharmacological responses to the common problems of dementia, including agitation, wandering, aggression, anxiety and sleeplessness (Dementia Services Development Centre 2009). We know that physically dementia is catastrophically exhausting. Every occupational therapist needs to be able to describe a range of simple measures for carers to use and to be able to use the measures in his or her practice. The time is gone when we could say, We did not know.' You need to do better than that.

Alzheimer Society of Canada (2009) Rising tide: the impact of dementia on Canadian Society. Toronto, ON: Alzheimer Society of Canada.

Cunningham C, Archibald C, Rae C (2006) The need to know: a survey of course input at pre-registration/undergraduate level on dementia. Stirling: Dementia Services Development Centre.

Dementia Services Development Centre (2009) Ten hints for carers. Stirling: Dementia Services Development Centre.

Dementia UK (2007) A report into the prevalence and cost of dementia: the full report. Prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King's College London. London: Alzheimer's Society.

DOI: 10.4276/030802210X12706313443820
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