On my fieldwork, my supervisor and I were called out to the home of a lady with dimensia. She seems to have no serious physical problems, but is having problems remembering to do her ADLs and is doing them in a less-than-safe manner. She has fallen twice in the bathroom, resulting in minor head trauma (just bumps and bruises). The family is concerned (with much reason) that she is going to eventually hurt herself badly.
The thing that I noticed first and most predominantly is that this lady does not see that anything that she is doing is unsafe and does not appreciate the fact that someone is invading her house and telling her how to do something that she's been doing for the past 80 or so years.
There were tell-tale clues of the problems that she is having with sequencing. She did not gather her towel/under clothes until she was finished with her shower. She also did not test the temperature of the water before entering the shower.
She is an avid reader, so we left her with several visual cues on things that she needed to do before entering the shower. Her family had also put carpet in the bathroom so that she is less likely to fall in there. We went over with her the things that she needed to do to be safer, but I'm not sure that she will comply. She resented the fact that we were there.
I'm not sure what we could do different to make her more compliant with things that she needs to do to be safe. Any suggestions?
I found these assessments and interventions for those with the early signs of dimensia.
Dementia is a really difficult thing to watch someone suffer with. Although there are things that modern medicine can do to slow or temporarily halt its progression. There isn't a cure, so we as OT practitioners are left with adaptive and compensatory measures to help our clients cope. When we are treating this type of client, we have to evaluation the areas of concern and address these specifically, but we must also recognize that their current level of functioning is only temporary and will ultimately decline. We can give them adaptive equipment, visual cues and good advice, but ultimately will have to make the decision about when we feel they need further assistance. I believe that we should involve the client's family and even authorities when we feel the client has declined to the point of being unsafe living alone. That is part of our job, though surely a difficult aspect. I personally know of several situations that were caused by an elderly person with dementia who was trying to live alone. They included starting the microwave on fire, falling and being knocked out, and accidentally overdosing on meds. These were sure signs that additional living assistance was needed and I know that we as OTAs will surely be faced with situations and decisions like this too.
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