Research shows occupational therapy may be less effective than we think.
Given that Alzheimer's and most dementia-related conditions do not have a cure or a disease-modifying treatment, most patients live with the disease and are cared for in their home by a family member.
In fact, 70 percent of patients with Alzheimer's live at home, and they receive 75 percent of their care from an informal caregiver.
Over 15 million people in the U.S. work as unpaid caregivers, their efforts amounting to hundreds of billions of dollars each year.
Most of the care provided involves assisting with daily activities, such as household chores, shopping, cooking, or providing transportation.
Helping patients do their day-to-day activities, with the aim of recovering physical or mental abilities and regaining a sense of independence, is commonly referred to as occupational therapy.
New research - published in the journal Annals of Internal Medicine - examines whether occupational therapy actually helps slow down cognitive and functional decline in patients with Alzheimer's.
Assessing the effect of occupational therapy on Alzheimer's patients
A team of researchers from the Indiana Center for Aging Research and the Regenstrief Institute in Indianapolis, IN, wanted to see if collaborative care combined with 2 years of home-based occupational therapy delays functional decline.
The team was led by Dr. Cristopher M. Callahan, the Cornelius and Yvonne Pettinga professor of medicine at Indiana University's School of Medicine, and the founding director of the Indiana University Center for Aging Research.
Fast facts about Alzheimer's
- In the U.S., someone develops Alzheimer's every 66 seconds
- Family caregivers spend more than $5,000 annually caring for a relative with Alzheimer's
- This year, Alzheimer's and other dementias with cost the U.S. around $236 billion.
Researchers designed a randomized, controlled clinical trial involving 180 patients with Alzheimer's disease and their informal caregivers.
Participants were divided into two groups. All 180 participants received collaborative care for dementia from the Healthy Aging Brain Center, in collaboration with the primary care practices from the Eskenazi Health Center.
The researchers at Indiana University and the Regenstrief Institute had previously shown that their primary care practices reduced caregiver stress and improved behavioral symptoms for patients. However, their practices were not shown to stop functional decline.
In this new study, one of the two groups also received occupational therapy for 24 months, in addition to collaborative care. The intervention group had 91 participants.
Over the 2 years, an occupational therapist traveled to the home of the patient and family caregiver.
The occupational therapy was tailored to the needs of each patient and focused on issues identified by the caregiver, such as bathing safely or getting in and out of cars. Therapists also helped patients resume activities they used to enjoy before the disease, such as gardening.
Participants remained seated for the majority of the sessions.
At the end of the 24 months, researchers measured the ability to function in daily living for both groups.
Occupational therapy did not reduce functional decline
Both groups showed a similar decline in functional living scores, the researchers found.
"Persons with dementia face a steady decline in function that we found is not slowed by home-based occupational therapy," says Dr. Callahan.
The tailored therapy did not delay the loss of everyday functions, such as walking, eating, bathing, and toileting.
"The participants in the study declined both mentally and functionally as the neurodegeneration of the brain continued. This is a disappointing outcome because previously published, but shorter-term studies had suggested these interventions might be able to slow the physical decline that leads to nursing home placement."
Dr. Cristopher M. Callahan
Given the imminent and irreversible cognitive decline in dementia and the lack of drug-based therapies, treatment options are limited. As Dr. Callahan points out, this makes caregiving extremely important, as well as the decisions we make regarding our use of resources.
"There is a limited amount of money that we - families and society - have available for these patients and their caregivers and we should spend that money on things that patients and families find the most helpful," Dr. Callahan says. He also emphasizes the importance of making a wider range of options available to support family caregivers.
Dr. Callahan suggests that making home adjustments, such as removing risks for falls, making bathrooms more easily accessible, and making kitchens safer, may keep Alzheimer's patients out of an institution and help them enjoy the comfort of their home for longer.
As the authors of the study conclude:
"Given the burden of caring for persons with dementia, which largely is shouldered by family members, research must focus on identifying strategies to support caregivers in the home to provide care to persons with dementia.
If the gradual functional decline attributable to Alzheimer's disease is irreversible, a new generation of assistive devices, home modifications, community services, and technologies is needed to make longer-term support in the home a practical reality for patients and families."