Environmental issues like cluttered living space can impact behavior, Piersol explains. Clutter is distracting and unsettling and can lead to a lot of the agitated behavior seen in some people with Alzheimer’s. Occupational therapists do a lot of caregiver education about improving processes to make daily life safer and easier, such as installing bed rails, shower grab bars, removing throw rugs and teaching proper transfers in and out of wheelchairs.
Elizabeth Oloo, a Human Resources Manager in Washington, D.C., says she learned a number of enormously helpful lessons from the occupational therapists who helped her mother. Among them were how to make her home safer, how to effectively move her mother from the bed to a chair, and how to help her bathe and dress.
“They were wonderful and very encouraging and patient,” she said. “The OTs also matched their approach to her mental status and ability on the days they came to our home. If she was a little more confused or agitated, they handled her in an incredible way and worked with her to keep her calm and focused.”
Working with What Works
"Our process is to educate the family to relax the rules. We help figure out what will work for them, and develop new routine that is easier to follow," says Piersol, who is also the Clinical Director of the Jefferson Elder Care program.
They help caregivers learn to “reframe,” something she calls errorless learning. Nothing is wrong.
“For example, if mom thinks it’s Thursday but it’s Monday, it’s not that big a deal,” she says. “We teach the caregiver to understand it’s not about being right, it’s all about engagement.” Many families say they want their loved one to feel as independent as possible, so they tend to correct rather than just roll with it. Relish the interactions you have, she advises.
"Families tell us that a lot of the psychological stresses are related to self-care issues," says Piersol, co-author of a guide for caregivers, A Caregiver's Guide to Dementia: Using Activities and Other Strategies to Prevent, Reduce and Manage Behavioral Symptoms, published by Camino Books, Inc. "For example, don't say, 'It's time to shower' and get 'no'. She may be saying no just because it's a word she knows, but may not understand what 'shower' means any longer. Do it in stages, like 'let's sit up and walk to the bathroom'."
While many people with Alzheimer’s and other dementias are capable of walking in the later stages of the disease, they often have balance and coordination problems, which lead to falls.
A physical therapist (PT) can train the muscles to "learn" to respond to changes in the environment, such as uneven or unstable surfaces, according to the American Physical Therapy Association. PTs also teach family members how to safely move, lift, or transfer the person with Alzheimer's disease to prevent injury to the caregiver as well as the person being cared for and how to use adaptive equipment and devices.
Physical therapy can provide a person with an activity that he or she can perform successfully and it can help to improve breathing, mobility, and endurance. Exercise has been shown to help reduce the restlessness and wandering common in many people with Alzheimer’s and other dementias.
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About this article: The Key Therapists is one of an 8-part series provided to the ajc.com by Alzlive.com - a distinct voice in the online caregiver landscape, devoted to family who are caring for those with Alzheimer's or other dementia.
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