Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain

Abstract

Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6 years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5 months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.

Cognitive stimulation and activities of daily living for individuals with mild-to-moderate dementia: A scoping review

“…Two articles studied an occupational therapy-based CS intervention (Ávila et al, 2018; Jiménez-Palomares et al, 2021). A double-blind RCT ( N = 58) evaluated the effect of an occupational therapy programme based on the training of ADL through CS (Jiménez-Palomares et al, 2021).…”

“…Sessions were conducted for 5 weeks. While CS was central to Jiménez-Palomares et al’s (2021) study, Ávila et al (2018) incorporated CS into a wider multi-component occupational therapy approach consisting of CS, meaningful activities, psychomotor and sensory skills activation, caregiver counselling and ADL training. Ninety-minute sessions were delivered for 12 weeks, twice weekly, with an additional 8 weeks of sessions implemented after a 1.5-month intervention withdrawal.…”

“…Both programmes consisted of typical CS activities like discussion and reality orientation, incorporated with motor activities, ADL training and cognitive exercises. Two occupational therapy-based multi-component interventions also yielded promising results for ADL outcomes, through the incorporation of ADL-focused tasks into a typical CS programme (Jiménez-Palomares et al, 2021), or the provision of CS and ADL training as part of a broader occupational therapy intervention (Ávila et al, 2018).…”

“…The application of these studies to community settings may therefore be limited, due to the limited time and resources available for Irish community occupational therapists (McGrath et al, 2014). While Ávila et al’s (2018) occupational therapy programme and Olazarán et al’s (2004) implementation of CMSI with community-dwelling adults demonstrated benefits for ADLs, further studies are needed to evaluate the feasibility and effectiveness of community-based, multi-component CS interventions. Therefore, the results of this review will align with the results of a pilot CS ADL group currently underway to inform a research proposal for a larger trial of a community-based, multi-component CS group for people with mild-to-moderate dementia aimed at improving ADL outcomes.…”

Therapeutic Potential of Photobiomodulation In Alzheimer’s Disease: A Systematic Review

“…9,10 Despite the advanced findings in AD, there is still no treatment that can cure the disease. However, some nonpharmacological treatments such as cognitive therapy, [11][12] occupational therapy, 13 and physical exercise [14][15] have provided benefits to cognitive and behavioral impairments. Recently, photobiomodulation has been of interest to the scientific community because it is a noninvasive therapy that provides interesting results for several tissues, such as wound healing, inflammation in various diseases and tendonitis.…”