SIGNIFICANCE: Productive aging is a timely concern for occupational therapists (OTs), particularly for those who work with clients with Alzheimer’s disease in a variety of practice settings. Current practice guidelines and intervention research for clients with dementia emphasize the early to middle disease stages but are not well-defined for advanced dementia. In this exploratory study, we describe the current role of occupational therapy with clients with advanced dementia for a subset of practitioners.

INNOVATION: In this study, we break new ground by beginning to articulate the state of occupational therapy practice with a burgeoning but understudied population: clients with advanced dementia. Research questions included the following: (1) What occupational therapy interventions are currently in use, and what is their perceived effectiveness for clients with advanced dementia? (2) What are perceived barriers to occupational therapy practice for clients with advanced dementia?

Dementia is developing as a 21st century public health crisis, with new cases of Alzheimer’s disease (the most common form of dementia) projected to double by 2050. Clients with dementia require increasing levels of care as the disease progresses; yet, current dementia care management has been described as variable, substandard, and largely reactive. Occupational therapy, with its holistic approach to client care, is suited to address the needs of this population throughout the disease course. However, current occupational therapy research emphasizes the mild to moderate disease stages, whereas the OT’s role with clients in the advanced stage is not well-defined.

METHOD: In this study, we used a survey design, gathering and analyzing data with a web-based platform. Questions addressed demographics (e.g., practice setting, years of practice), interventions currently in use (type, frequency, perceived effectiveness, and priorities), and perceived barriers to practice with this population. Participants included OTs and occupational therapy assistants with U.S. practice experience with clients with advanced dementia. Participants were recruited through e-mail and online discussion board postings. We analyzed survey responses (N = 95) using descriptive statistics (e.g., frequency and percentages).

RESULTS: The majority of respondents were OTs with about 10 yr of practice experience who held dual roles of therapist and administrator/fieldwork educator in long-term-care settings. Most respondents reported spending minimal time per week providing one-to-one interventions for clients with advanced dementia. A gap existed between reported intervention frequency and effectiveness as well as between therapist and facility intervention priorities. The most frequently reported barrier was limiting client factors. Other reported barriers were primarily institutional (e.g., productivity and documentation requirements).

CONCLUSION: Current occupational therapy practice with clients with advanced dementia is being carried out on a part-time basis by well-experienced therapists who simultaneously hold multiple roles. Therapists practicing with this population are constrained by perceived limiting client factors and system-wide barriers, such as workload requirements, current staffing structure, and differing intervention priorities between therapist and facility.