Dementia and the role of occupational therapy

Carlie Whittle
Occupational Therapist
ORA service (Wellington Community)
Community ORA service
Comprised of multi disciplinary team (OT,
geriatrician, liaison nurse, social work,
psychologist, family therapist, physio, SLT,
rehab assistants).
 Assessment, treatment and rehabilitation.
 People (16 yrs. +) who have experienced a
health event or health condition which is
significantly impacting function.
 3 community ORA teams (Wellington,
Kenepuru, Kapiti).
Problem with managing or home situation
 Safety concerns.
 Perceived unsafe behaviour.
 Level of care / support need decisions.
 To assist with providing diagnosis.
What role does OT have?
Enabling optimal health and well being
through engagement in meaningful activity.
Advocating a person’s right to autonomy.
 Using meaningful activity to enable optimal
participation in daily life activity.
Process of intervention
Information gathering.
 Battery of assessment (e.g. Allen’s
Cognitive Level, COGNISTAT, RBMT,
Assessment of Motor and Process skills).
 Functional assessment.
 Support and education.
How is this useful?
Helped me to understand what is happening
to me.
 Helped me to understand what the diagnosis
actually means for us as a family.
 Given me hope.
 Your support has been crucial.
 You have helped me to manage as well as I
David J (false name)
57 years.
 Alcohol related dementia.
 Dementia specialist care facility.
 Referred to team for medication review.
 Assessed by geriatrician.
 Referred to OT re; challenging behaviour.
Facility: To have David medicated to stop
the challenging behaviour.
David: To return to community living.
Initial hypothesis
? Behaviour caused by:
 Lack of contact with other people
functioning at a similar level.
 Lack of cognitive stimulation.
 Absence of meaningful activity.
 Lack of opportunity to function at his
optimal ability.
 Loss of freedom and autonomy.
OT Ax revealed
Global cognition – areas of impairment and
areas of STRENGTH.
 Functioned at reasonable level.
 Basic routine activity well established.
 New learning possible (slowly by rote).
So why in DSC?
Placed directly from community.
 Involved with 4 separate hospital
departments leading to placement.
Two themes emerged re placement decision:
1. Impairment focused.
2. The influence of risk on clinical reasoning.
Reside at RH level?
More enriched environment.
 Opportunity for autonomy and greater level
of freedom.
 Access to required cognitive assistance.
 Able to participate in meaningful activity.
 BUT no locked doors!!
Moved to RH level care.
Carefully chosen environment.
Residing with people functioning at a
similar level.
 Able to function at his best ability.
 Participate in activity of enjoyment.
 No challenging behaviour!
 Still there!
Useful reminder......
Powerful influence of the environment (the
problem is often not a problem with the
person but with the human / non-human
 Focus on STRENGHTS!
 Don’t underestimate the potential for new
 Trial of least restrictive option first.
 Manage our feelings around risk.
How can you refer to ORA
/ for OT
Anyone can refer!
 Referrals faxed via Care Co-ordination
 F: 2382022
How to contact me
Carlie Whittle
PG Dip Occupational Therapy
[email protected]
T: 04 9185261

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