Occupational Therapy helps people to develop, recover, or maintain participation in the meaningful occupations, that are important to individuals, groups, or communities.

Occupations are……..

'the various every day activities people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things that people need to do, want to do, and are expected to do'.

International Society of Occupational Science, 2009

Occupational therapists specialise in teaching, educating, and supporting participation in any activity that occupies an individual's time.  By supporting people to engage in their occupations, Occupational Therapists can have a positive effect on their health and wellbeing.

Occupational Therapy and Dementia

Everyone experiences dementia differently but Occupational Therapy aims to maintain a persons participation in occupations for as long as possible. Working together is important to produce practical solutions that aim to reduce the impact of the condition.  Examples may include:

• Techniques to help people continuing to complete everyday activities such as personal care and meal preparation.
• Identifying and providing equipment and/or adaptations to help with around the home environment.
• Memory, orientation, risk management strategies.
• Modifying activities to enable a person to participate in meaningful occupations.

What is Dementia?

Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.

Dementia is more common in people over the age of 65 but it can also affect people in their 30s, 40s, or 50s.

With treatment and early diagnosis, you may be able to slow down the progression of dementia and maintain mental function for a longer period of time.

There are over 100 different forms of dementia.  The most well-known one being Alzheimer's disease which is the most common cause of dementia.

How Dementia Affects Daily Life

• Common every day challenges for people with dementia can include washing, dressing, eating  and bathing.
• Dementia is a progressive condition. As the diseases that cause dementia advance, the symptoms change and someone is likely to need more help carrying out tasks that they may have once taken for granted.
• At first, people may need reminding to bathe or need help with tasks such as hair washing, while in the later stages of dementia, a person may not be able to bathe independently.
• Some other examples of ADL’s (activities of daily living) someone with dementia may struggle with are going to the shops, remembering appointments, and managing bills.

Facts about Falls and Dementia

Whilst falls are not an inevitable part of Dementia, there are some symptoms of the condition  which can increase the risk of falls.

Listed below are some statistics that highlight how severe the risk of falls can be, therefore highlighting the importance of preventing falls.

• 1 in 3 older adults (aged 65+) fall at least once a year.
• 1 in 2 people (age 80+) fall at least once a year.
• People living with dementia are at a greater risk of injurious falls, than those who don’t have dementia.
• People living with Dementia are three times more likely to fracture their hip when they fall, this leads to a decline in a person's mobility and an overall deterioration.
• Once someone has had a fall, their anxiety over having another one normally increases, which may lead to the person not wanting to partake in any physical activity. The decline of this physical activity can lead to them feeling weaker, creating muscle loss and potentially worse injuries from falls if a person were to have another.
• Falls are the leading cause of injury related death in older adults.

These factors all show the importance of learning about preventing falls, this package will endeavour to look into the safety precautions as well as consider ways you can educate people about the topic.

Dementia and Falls

The following aspects of dementia may increase a persons risk of falls:

Memory – allows people to retain important information. A person may forget information or training about the use of equipment or forget where they have put important items.  They may forget to take certain risks into consideration.

Strategies that can support a person with a poor memory

• Simplify instructions.
• Reminders and prompts to assist recall of information.
• Technology Enabled Care e.g. reminders, medication prompts/alarms
• Environmental adaptations

Concentration – when attention is distracted there is more risk of a fall.  A person may ignore risks if they are not concentrating. They may be distracted or interrupted from a task and therefore at risk of accidents Pain and low mood can also affect attention and concentration.

In practical terms, a person who is not concentrating may be more likely to over-reach, lose their balance, or when moving around they may not notice obstacles in the environment.  Poor concentration can also affect the safe use of items/equipment.

Strategies that can support a person with a poor concentration:

• Simplify instructions.
• Break tasks down into manageable parts
• Avoid multi-tasking.
• Use reminders and prompts.
• Manage distractions and reduce noise
• Try to eliminate related issues, such as pain or tiredness
• Use cues to draw attention to the environment, risks, etc.
• Make adaptations to the environment.

Insight – reduced insight may mean that a person is less careful about looking after themselves.  They may take inappropriate risks.  A person may not appreciate the risk or understand their own limitations, and as a result may not take precautions.  A person may not adjust their behaviour based on the apparent risk, resulting in them not approaching or planning ahead to keep themselves safe.

Strategies that can support a person with a poor concentration:

• Increase supervision.
• Promote awareness and self-care.
• Remind the person of their need to look after themselves and the potential consequences of they don't.
• Introduce additional care or support if required.
• Long team, consider whether the person has the capacity to understand and make decisions.

www.fallssenseforthvalley.scot.nhs.uk