Lori Letts, Mary Edwards, Julie Berenyi, Kathy Moros, Colleen O’Neill, Colleen O’Toole, Colleen McGrath; Using Occupations to Improve Quality of Life, Health and Wellness, and Client and Caregiver Satisfaction for People With Alzheimer’s Disease and Related Dementias. Am J Occup Ther 2011;65(5):497-504. doi: 10.5014/ajot.2011.002584.
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© 2018 American Occupational Therapy Association
An evidence-based review was undertaken to answer the question, “What is the evidence for the effect of interventions designed to establish, modify, and maintain activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, and social participation on quality of life (QOL), health and wellness, and client and caregiver satisfaction for people with Alzheimer’s disease and related dementias?” A systematic search of electronic databases and application of inclusion and exclusion criteria guided the selection of 26 articles. Limited high-level evidence on ADL interventions was identified. IADL interventions for people living in the community showed promise. Tailored and activity-based leisure interventions were common and seemed to have positive impacts on caregiver satisfaction, and some interventions had positive results for client well-being and QOL. Social participation interventions focused on people with dementia still able to engage in verbal social interactions; these interventions had at least short-term positive effects.
Assistive devices that are either physical or cognitive can be considered to support ADLs in people with AD or related dementias, but their usefulness may need to be monitored as the condition progresses.
In the community, a home-based occupational therapy intervention that includes IADL assessment and recommendations to promote abilities may be beneficial in improving QOL and health of clients with AD and related dementias and their caregivers.
Leisure interventions that are individually tailored or selected from a range of activity kits may promote improved satisfaction for caregivers of people with AD or related dementias. Occupational therapy practitioners could be involved in designing such activities or kits.
Social participation interventions that structure conversations may be useful for people with AD or related dementias who continue to be verbal.
Occupational therapy students need to have a good understanding of the ways in which occupations change over the course of AD and related dementias and the impact that these occupational changes have on caregivers.
Skills in home assessment and IADL activity modification may be valuable for students in occupational therapy programs to acquire.
A good understanding of leisure and social participation as occupations is needed; understanding activity and occupational analysis would be beneficial to optimize the ability of future occupational therapy practitioners to design and modify occupational interventions for people with AD and related dementias.
Studies of higher-level design are needed to guide occupational therapy practitioners in assessing, planning, and implementing interventions in the area of ADLs.
More study is needed to establish the minimum number of community-based or home visits required to have positive, long-term effects.
Therapeutic cooking groups and adapted telephones showed promise in skilled nursing facilities, although more rigorous research is needed to test these interventions.
Research is needed on how social participation can be maintained when verbal abilities decline in the later stages of AD. Little evidence is available that describes or evaluates such interventions even though social participation is an important occupation for people with limited verbal abilities.
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