Dementia – problem statement

The World Alzheimer’s Report 2009, suggest there would be 35 million people worldwide with dementia by 2010. That number is set to almost double every 20 years to 65.7 million in 2030 and 115.4 million in 2050. What’s worse, almost 60% of people with dementia in 2010 will be from low and middle income countries like India, rising to 70.5% by 2050. This is a 10% increase over the earlier estimate made in 2005 - meaning that the estimates made earlier for India will also increase. The report had earlier said that by 2020, around 10 million Indians above the age of 65 would suffer from dementia. By 2040, the number would increase to around 22 million. WHO declare dementia a health priority, and countries including India should develop a plan for dealing with the greater numbers of dementia patients.

Dementia refers to the progressive decline of cognitive, social, and physical functioning due to damage or disease of the brain beyond that of the normal aging process. Although the exact epidemiological profile of dementias primarily Alzheimer’s Dementia (AD) has not been established; various estimates indicate a virtual dementia epidemic in India that needs urgent attention. Unfortunately-there is no definite medical management to reverse the disease, rather rehabilitation through occupational therapy, to improve-the quality of life (QOL) and  functional status would be a sensible goal.

Occupational therapy in Dementia

The need for developing a comprehensive strategy to improve the quality of life of patients with dementia in the community is not difficult to comprehend. In such a strategy, concepts and interventions of occupational therapy need to be included as a complement to standard drug therapy. The important steps in occupational therapy intervention must include an awareness of the occupational identity, and balance between self-care (the ability to look after oneself), productivity (contribution to social and economic environments) and leisure (the fulfillment and enjoyment of life).previous studies have found that there is relationship between cognition on occupational participation and performance. It is important that occupational therapists to develop interventions in this areas.  Occupational therapy interventions often aim at supporting people with dementia to maintain an optimal level of performance in the everyday occupations that they desire to do. Though cognitive impairment is the primary disability in dementia, they also suffer from others significant impairment related to the ageing process which affect their autonomy and independence in basic, intermediate and advanced activities of daily living; thereby affecting quality of life. Apart from this, family members feel problem in accepting new role as a care giver and sometimes they are unable to stimulate patient performing daily activities and feel helpless. Disruptive behavior like wandering and aggressive behavior can put excessive burden on caregiver, especially in terms of poor emotional health and quality of life. The degree of behavioral problems in people with dementia causes depression in caregivers and eventually they feel higher degree of burden. The method of assessment used by a therapist is based on two patient centric models: the model of human occupation and the Canadian model of occupational performance, where as the interventions for cognitively impaired patients is based on biomechanical and cognitive disability framework of reference.

Research Questions

1.   Development of new occupational therapy intervention for patients with dementia.

2.  Whether the newly developed occupational therapy intervention is effective for improving physical, cognitive, social, behavior, functional, and psychological domain  in patients with dementia.

Rationale of Study

Unfortunately, drugs are not yet effective in improving the symptoms of dementia, and non-pharmacological strategies are generally more time consuming and not widely available. A systematic review found non-pharmacological interventions to produce effect sizes in behavior similar or larger to those seen with cholinesterase inhibitors, the currently available drug treatment, but without any side effects. The primary focus of occupational therapy was to improve patients’ ability to perform activities of daily living and hence promote independence and participation in social activities and to reduce the burden on the care giver and ultimately improve their quality of life.

Aims and Objectives

1.      To develop a novel occupational therapy program for mild-moderate dementia.

2.      To study the effectiveness of newly develop therapeutic regime on Physical, Functional, social, behavior, Cognition and psychological health of dementia patients.

3.      To improve the productivity and quality of life of dementia patients.

Hypothesis

Novel occupational therapy program is effective in patients with dementia.