Occupational therapists can help raise the standards of care given to the elderly, writes Meera Murugesan
AGEING is not a disease but we often view it as such. It’s assumed and accepted that the elderly will lose the ability to do certain things or have to cut back on their regular activities.
But growing old shouldn’t mean giving up on things that add value to our lives or not being able to participate in meaningful activities.
Despite illness or injury, or dealing with the challenges of ageing, the elderly can still lead full, independent lives and occupational therapists play an important role in assisting this process.
QUALITY OF LIFE
Occupational therapy is the difference between life and living because it focuses on issues that surround the quality of life, says Marilyn Pattison, president of the World Federation of Occupational Therapists.
When it comes to the elderly, the services of an occupational therapist (OT) can cover a wide spectrum, ranging from seniors who are healthy but may need some assistance to those who are injured or physically, or mentally impaired.
For example, the elderly are more prone to falls and it can be very dangerous.
In such situations, the job of the OT is to run a “Fall Prevention Programme”. This means the OT will go to the home of the senior citizen and look out for risk areas and recommend some modifications.
“For example, if they have steps in front of their home, we may recommend installing a handrail to keep them steady when going up the steps. If there are rugs, the OT may recommend removing them to avoid tripping,” says Pattison.
The OT may also assess the client/elderly person. For example, she may examine the shoes they are wearing to ensure they can walk safely in them.
The OT may also look into activities to help the client improve his balance or recommend a gentle exercise programme to improve his core strength.
REHABILITATION AND RECOVERY
For those who have sustained injuries, have had hip or knee replacements, or suffered a stroke, the OT will work as part of a multi-disciplinary team that consists of other health professionals such as doctors, physiotherapists or speech pathologists to implement an overall intervention programme to assist the person into rehabilitation.
The OT will also look into the patient’s home environment to ensure he can be safely discharged from hospital.
“We would make recommendations about equipment to be installed at home or modifications to be done within the house, depending on the level of the person’s disability.”
MIND MATTERS
Dementia care is another major area involving the elderly and the OT is also involved in such situations.
Pattison says in the UK, “memory clinics” have been set up with an OT and other health professionals to provide patients with strategies to cope with memory loss.
“In the early stages, we may suggest things like leaving notes around the house to remind themselves to do something or to have a whiteboard in the kitchen, or notebook to write down where certain things are.”
But as dementia progresses, family members have to be roped in. Pattison says it’s crucial that the OT work with the family because the carers must be educated on how to cope with the situation.
“We work on a client-centred model so one could argue that it’s all about the client but the environment also consists of the client’s family and we have to take them into account, particularly if they are the primary carers.”
Family members can be taught techniques to “wake” the memory such as going through old photo albums with the client.
In cases involving Alzheimer’s, family members must understand the importance of maintaining consistency in the person’s daily routine, says Professor Nathan Vytialingam, dean of the School of Occupational Therapy at Perdana University and president of the Asia Pacific Regional Group of Occupational Therapists.
“If you have an Alzheimer’s patient, you can’t change her daily routine. If, for example, she always takes breakfast and then shower, you can’t one day make her take a shower followed by breakfast. It will confuse her,” he says.
When someone else besides the regular carer has to take over for some reason, he or she must also be made aware of these things and the OT can assist in handling such matters.
CARING FOR THE CARER
Pattison says dementia is a terrible diagnosis to receive and the emotional impact of it is massive so the therapist must help and support the client through that very difficult phase.
But as the disease progresses and the client loses awareness, the therapist also has to counsel and support the carer and find ways to help them cope with the responsibility.
Otherwise “compassion fatigue” can happen, especially when a person is a carer to someone who requires a significant amount of time and attention.
Pattison says it’s a condition that is quite well documented and can lead to the carer abusing the person he looks after.
“The carer can become unrealistically angry with the person he’s taking care of and it’s particularly difficult if that person is also a family member. It’s almost like a post traumatic type stress disorder,” she says.
It’s because of this that the OT may also work with the carer to train another person who can occasionally step in to give the carer a much needed break.
Nathan says that carers need to acquire certain skills and the OT can play a valuable role in teaching them.
Often, it’s taken for granted that family members will know how to care for an elderly person but things can get very challenging and overwhelming for the carers if they don’t have certain skills.
“Many carers don’t even know how to change a diaper, how to lift an immobile person or to transfer him/her from a wheelchair to a normal chair.”
In such situations, it’s highly stressful both for the carer and the person he’s looking after, and the quality of care is compromised.
MEETING THE NEEDS
AT the moment there are only about 1,400 qualified occupational therapists in the country with almost 90 per cent of them based in hospitals.
Dean of the School of Occupational Therapy at Perdana University and president of the Asia Pacific Regional Group of Occupational Therapists, Professor Nathan Vytialingam says this number is extremely low given that we are becoming an ageing population.
According to the United Nations, Malaysia will become an ageing nation by 2035.
In comparison, Australia has 15,000 occupational therapists, Japan, 37,000 and the US, 120,000.
Nathan says occupational therapists in this country should move from hospitals to work in community settings so they can conduct outreach programmes. In Australia, most therapists work that way. Only 35 per cent are employed by hospitals.
“Therapists should set up their own centres and serve the community or even provide their services through our Klinik Kesihatan (community clinics).”
Nathan says that another option is for the government to set up daycare centres for the elderly in community settings where health professionals, including occupational therapists can provide services. It has been done successfully in other countries.
Such centres will also provide an opportunity for senior citizens to socialise with like minded people and participate in meaningful activities. They can be dropped off in the morning and picked up by a family member or carer at the end of the working day.
Nathan adds that at the moment, many elderly people spend the entire day at home with just the maid or the television for company, while other family members are at work. They feel lonely and isolated, and depression can set in.
Daycare for the elderly will also help in situations where people are forced to consider a nursing home for their aged relative because care within the family is no longer possible.
In a Malaysian setting, this can be particularly difficult given the stigma attached to such a move and the lack of well run nursing homes.
Nathan says most homes just provide room and board without therapeutic services or even proper planning of meals based on the nutritional needs of the elderly.
President of the World Federation of Occupational Therapists, Marilyn Pattison says, daycare centres ensure that elderly people get the help they need but can continue to live at home.
“Our primary objective is to keep people as well and as healthy as they can be in their own homes where they are most comfortable,” she says.