Dementia Rehabilitation Interventions
The impacts on a person’s daily functioning that limit their ability to live independently should immediately signal the need for rehabilitation.
We now know a rehabilitative approach to dementia care leads to improved:
functional independence/ self-care abilities
However, rehabilitation is often not seen as suitable for people living with a diagnosis of dementia.
Until recently, people living with dementia and other memory problems were often excluded from rehabilitation research.
In order for people to live well with their dementia, key services and best care practices are needed that recognise and maximise their capacity and capabilities to engage in daily, physical, and social activities.
Rehabilitation is an essential building block in the dementia care pathway, not an ad hoc intervention.
We also know that more research about how to implement rehabilitation interventions for people living with dementia is needed.
The World Health Organization (WHO) Package of Interventions for Rehabilitation (PIR) in Dementia
There continues to be a large unmet need for rehabilitation across the world.
The WHO PIR outlines the most essential rehabilitation interventions for 20 health conditions, including dementia, that have high prevalence and high levels of associated disability. It also includes information on the workforce needs, and the assistive products, equipment and consumables required to deliver these interventions.
Access the WHO PIR for rehabilitation in dementia here.
Dementia-specific rehabilitation programs in Australia
In order to provide rehabilitation for the person living with mild cognitive impairment or mild-moderate dementia, a dementia-specific, integrated model of care is required.
The model of care should:
- actively engage the person with establishing goals and priorities for rehabilitation
- optimise functional and social independence
- recognise the impact of the environment on the person and include environmental modifications/ assistive devices and technology
- be contextualised across multiple settings and providers
- offer role and structures, care management, and referral processes to support dementia rehabilitation in routine practice, service delivery, and policy.
Translating well-established evidence into everyday practice is key to improving care quality and requires multipronged approaches, engaging various stakeholders.
Dementia specific rehabilitation programs in Australia include the Care Of People with dementia in their Environments (COPE) Program – an occupational therapy and nursing program for people living with dementia and their families. It is designed to improve their quality of life and enable the person with dementia to remain in their community for as long as possible.
As well, two interdisciplinary dementia programs have been developed at the University of Sydney. These are the Interdisciplinary Home bAsed Reablement Program (I-HARP) and the Interdisciplinary Care Home bAsed Reablement Program (I-CHARP). Both are delivered by registered nurses and occupational therapists. I-HARP helps older people living with dementia to remain healthy and independent in their own homes, while I-CHARP applies the principles of I-HARP in residential care settings.
Both I-HARP and I-CHARP use evidence-based, biobehavioural-environmental interventions:
- Goals are older person directed, personally tailored to their needs, wishes and preferences
- Goal setting and care planning are facilitated by the principles of motivational interviewing and interdisciplinary teamwork of registered nurses and occupational therapists, who work with other allied health professionals as needed
- Tom Kitwood’s Personhood in dementia care is followed
- Health is a dynamic interplay, throughout life, between opportunities and limitations affected by external conditions such as social and environmental factors
- Reablement approaches to care maximise the health and wellbeing of older people through engagement in daily, physical, social and community activities
- Underpinning theories are person-environment fit theory, disablement processes, lifespan theory of control and resilience.