Chapter 2: Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition 4 CCUs
By: Julie D. Ries, PhD, PT Learning objectives
Describe movement disorders associated with Alzheimer’s disease and the principles for facilitating motor learning and optimizing interactions with individuals who have Alzheimer’s disease. Describe evidence-based rehabilitation interventions for individuals with Alzheimer’s disease and appropriate outcome measures. Implement strategies to facilitate optimal therapeutic success with individuals with Alzheimer’s disease. therapists working with individuals in long-term care settings who have dementia, Buddingh et al. (2013) identified patients’ dementia-related cognitive, emotional, and motor issues and the facility’s time and staffing constraints as the top perceived barriers to providing the best care. Both studies identified the therapists’ perceived need for further education related to working with older adults who have dementia. Existing evidence shows that the needs of individuals with Alzheimer’s disease are different from the needs of those without cognitive deficits. Observation of and respect for special considerations related to personal interaction, communication, cueing, and motor learning can substantially impact the success of rehabilitation with this population. Given the prevalence of Alzheimer’s disease in those older than age 65, any rehabilitation professional working with older adults is likely to work with patients who have dementia, including those working in the typical orthopedic outpatient setting. Physical and occupational therapists who address the unique needs of this population will have greater success in their rehabilitation efforts, and their patients will reap the benefits of their knowledge and skill. Each of the following scenarios presents unique challenges. This course should provide the knowledge and confidence to address these scenarios and facilitate the best possible outcome: A physical therapist is consulting with a local adult daycare program for individuals with Alzheimer’s disease. The therapist has been hired to implement and oversee an ongoing exercise program with the primary goals of increasing balance and decreasing falls. How should the therapist proceed? A staff occupational therapist at a subacute facility is working with an 83-year-old woman with a diagnosis of Alzheimer’s disease who is 3 days post-op for open reduction internal fixation of hip fracture secondary to a fall. The primary occupational therapist who has been following her for the two previous visits writes, “Patient is confused and unable to follow commands or actively participate in therapy. Low priority.” How should the staff occupational therapist proceed? A physical therapist at a skilled nursing facility is interested in developing a program of regular physical activity for a group of residents on the memory unit. The medical director of the facility is not convinced of the value of the program. How should the therapist proceed?
After completing this course, the learner will be able to: Define Alzheimer’s disease and other neurocognitive disorders. Describe the brain changes, stages, etiology, and risk factors of Alzheimer’s disease. Identify diagnostic methods and pharmacological interventions used with individuals who have Alzheimer’s disease. Course overview Alzheimer’s disease is the most prevalent cause of dementia, accounting for 60% to 80% of all cases with current estimates suggesting that 5.5 million older adults in the United States are living with Alzheimer’s dementia (Alzheimer’s Association, 2018a). According to the Alzheimer’s Association (2018a), one in 10 older Americans has Alzheimer’s dementia, and almost two-thirds of them are women, likely due to the fact that women live longer than men. According to the U.S. Census Bureau, currently more than 48 million adults aged 65 years and older make up 15% of the population; by 2050, the older population is expected to exceed 88 million, comprising more than 22% of Americans (He, Goodkind, & Kowal, 2016). Because age is the primary risk factor for Alzheimer’s disease, the number of people with Alzheimer’s disease is projected to nearly triple by 2050, reaching 14 million. The incidence of Alzheimer’s disease is expected to climb sharply around 2030, when all baby boomers (people born between 1946 and 1964) will be older than 65 years. The likelihood of rehabilitation professionals treating individuals with Alzheimer’s disease increases year by year. The purpose of this course is to provide useful, pragmatic information to rehabilitation therapists to facilitate successful rehabilitation for individuals with Alzheimer’s and other dementias. Too often, those with dementia are excluded from rehabilitation opportunities based on the assumption that they will not benefit, or they are given a brief trial of rehabilitation that does not take into consideration the special needs of this population and, as a result, they do not make gains. This course will provide an overview of Alzheimer’s disease and its medical management, practical information on optimal interactions with individuals who have Alzheimer’s disease, research findings related to motor learning in this population, existing evidence on rehabilitation with individuals with dementia, and strategies to facilitate successful outcomes. This is an intermediate-level course for rehabilitation professionals working with the geriatric population. Physical and occupational therapists who have limited knowledge of Alzheimer’s disease and other dementias often manage these individuals within the same theoretical framework and strategies with which they approach their cognitively intact clients, which may result in limited success. Staples & Killian (2012) surveyed physical therapists in skilled nursing facilities and found that these professionals felt they would benefit from increased training and resources to effectively manage older adults with dementia, particularly those with late-stage disease. Negative beliefs and attitudes related to working with individuals who have advanced dementia were revealed in their study, suggesting the presence of therapeutic nihilism (disbelief in any benefit of therapy). In a survey of physical and occupational
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