LeadingAge New York Adviser Fall 2015 Vol. 1 | Page 17

Therapy’s Role...

(Continued from page 15)

often focus on the psychiatric and behavioral symptoms associated with dementia and as a
consequence they neglect to implement evidence-based intervention techniques to help affected
residents complete their Activities of Daily Living/Instrumental Activities of Daily Living (ADL/
IADL). Additionally, provider overcompensation often has
A recent RAND report urges providers and
the provider completing activities for the residents to save
time and reduce frustration which can diminish a resident’s
policymakers to revitalize efforts toward dementia
sense of independence, autonomy and overall quality of
education and care to accommodate the
life and can often lead to adverse outcomes such as falls,
weight loss or behavioral issues. Providers must shift away
impending shift in American demographics and
from thinking about “losses” and begin to develop resident
increasing number of residents with dementia.
“strengths.” Providers equally must shift away from resident
interactions that focus solely on care needs and address
residents’ interests, background, culture, hobbies, values and roles in establishing effective,
meaningful and engaging communication and activities.
This is the right time for care facilities to partner with the therapy department to achieve this
goal. The therapist’s role in dementia management is to evaluate the resident’s current cognitive,
linguistic and behavioral functioning, identify a stage of dementia, identify barriers to function
and determine remaining or “spared skills.” These are used to develop individualized, residentcentered plans of care including compensatory strategies and environmental modifications to
enhance function and decrease behaviors.
Behaviors such as catastrophic outbursts, wandering and agitation are often a result of an
inability to communicate wants and needs, difficulty with multi-step directions or tasks or an
over stimulating environment. Through therapeutic interventions related to pain management,
communication, ADL, swallowing/feeding and activities, therapists can help facilities reduce
unwanted behaviors without relying on medications. Specifically, therapists can offer the
following strategies:
Pain management
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Establish a therapeutic exercise program to maintain Range of Motion (ROM), normalize
muscle tone and promote flexibility
Establish compensatory strategies for communicating pain and implement a residentspecific pain scale
Utilize modalities such as neutral warmth to manage pain
Analyze the environment for things causing distress that may be misinterpreted as pain

ADL
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Complete an activity analysis to determine which components of the ADL task the resident
can complete
Use task simplification principles to make ADL more manageable for residents and staff
Determine a cueing hierarchy and daily routine that directs the resident toward goal
achievement
Modify the environment for function and safety considering task set-up, lighting, noise and
distractions
(See Therapy’s Role on page 17)

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