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Indirect treatment for dementia

- Indirect treatment to Dementia involves treating individuals indirectly through environmental modifications, development of therapeutic routines and activities, and caregiver training.

- Appropriate for individuals in all stages of dementia severity, particularly the caregiver training in communication strategies

- Likely to be used with direct intervention as well


Benefits of indirect treatment

- Caregiver-centered

- Broadens quality-of-life

- Functional maintenance of skills

- Prevents helplessness

- Promotes independence


Staying at home for treatment

- 70% of persons with early-to-moderate dementia live at home in the U.S. (van Hoof et al., 2010)

- Good care in an institution is costly

- Care services are not available for some

- Most patients want to remain at home


Modifying the environment

- World Health Organization says that “environmental factors may support or hinder the person with a (chronic) disease”

- For patients with dementia, it is no longer possible to easily adapt to new conditions. The environment must therefore be adapted to the individual’s specific needs.

- Environmental interventions have a direct impact on the functioning and participation, which are affected by dementia.


Modify the home to be

- Safe

- Structured

- Simple

- Familiar environments that provide cues and privacy to the residents

- Familiar décor (from their early adulthood)

- Have quiet spaces for both pt. and caregiver to have breaks


Environmental Intervention

- Object modification: modifications to furniture, utensils, equipment, and other items

- Home modification: modifications to one’s dwelling

- Assistive devices: assistive aids or technologies that specifically address a given health problem

- Task simplification: remaining modifications that support independence at home


Examples of Environmental Interventions

- Eliminate the many choices in the selection of clothing (visual search and attention are hindered by additional visual information)

- Visual cues: Red light at restroom door, colored line on floor leading to restroom, Put (picture) sign on the door, Leave access door open to enhance visibility *not suitable for severe dementia

- Label items in the house (text or pictures) : “hot” “cold” on taps, “mail”, kitchen cabinets or drawers

- Lighting for the pt to see what they are doing, but not overwhelming or glaring

- Make doorhandles large and distinct

- Decrease background noise

- People with dementia have problems with: perception, orientation, and memory.

- When labeling things in the home, avoiding patterns that are distracting or confusing, and using see-through materials and items


Caregiver Training

- There are many specific caregiver training programs

- They vary in design: classroom instruction, CD-ROM, caregiver’s manual

- By counsel of SLP: giving tips, advice, strategies, and referral of other resources


Educate the caregiver to:

- Speak Slower

- Multimodal input

- Limit number of conversation partners

- Use pleasant tone of voice

- Simplify syntax and vocabulary

- Talk about the Here and Now

- Replace pronouns with proper nouns

- Revise and Restate something misunderstood

- Ask multiple choice or yes/no questions

- Use Direct speech instead of Indirect

- Avoid figurative lanaguage


SLP role in caregiver support group 1

- Facilitator

- Caregiver support group can provide caregivers with information, strategies, and encouragement

** Data suggests that Better caregiver = Better patient

- ASHA states that SLPs: are qualified to work with the Dementia population and their families.

- have knowledge of the disease process, the cognitive decline, assessment and treatment.

- are in perfect position to provide support as they have witnessed first-hand the burden on caregivers


SLP role in caregiver support group 2

- Educate caregivers on disease process, cognitive decline

- Answer questions

- Counsel on their transition of new role

- Offer Encouragement

- Refer Caregivers

- Give Compensatory strategies, environmental modifications and tips for routines


Using routines

- Takes advantage of procedural memory that may be somewhat intact despite deficits in recent memory.

- Honor a loved one by keeping their rituals and preferences of their everyday life the same, as much as you can

- Allows the pt to still do activities of interest


Benefits of routines

- Maintains Functioning: Practicing an activity regularly = increased likelihood of that ability remaining

- Decreases Caregiver Stress: Routines can lessen the stress for those caring for people with dementia, by making the day more organized and less challenging

- Allows for Some Independence: Activities that have been practiced regularly, such as folding laundry, can increase self-esteem and confidence because the person can perform it independently.

- Reduces Anxiety: The predictability of a routine can decrease anxiety, the pt can know what to expect.


Types of routines

- Bathing

- Meal-time

- Getting ready for bed

- Morning walk

- Crossword puzzles

- Watering the flowers


Tips for making routines easier

- Break the task down in sections

- Remove distractions and limit choices

- If help is needed, then allow the pt to complete the final step

- Reminders or verbal instructions should be be simple (short sentences, with gestures)

- Do tasks together

- Be aware of your tone of voice, as you don’t want to sound like you are criticizing

- In advanced dementia, try demonstrating, pointing, or gesturing in lieu of verbal cues


Computer technology

- Assistive technology for cognition (ATC) supports orientation, prospective memory, communication, executive functioning, and ADLs.

- Provides reminders

- Alerts caregivers to problems

- Cues and monitors performance

- Exposes patients to virtual environments

- Stimulates communication

- Helps to compensate for sensory loss


COGKNOW software

- Simple, self-explanatory icons on a touch screen

- Reminders from wake-up time in the morning until bed time

- Can be recorded in a friend or relative's voice, and give instructions for all sorts of activities:

--- picking up the morning newspaper, brushing teeth, preparing or warming pre-prepared meals, laundry and dish washing and myriad other daily activities.

--- Can link to video presentations showing how to operate, for example, the stove, microwave oven or washing machine.



- Reduces agitation, loneliness, and depression

- Stimulates participation in activities

- Can reduce noisemaking behaviors in some pts

- Use music that the pt likes