The Impact of Occupational Therapy-Directed Home Modifications for Persons with Dementia.

June is Alzheimer’s and Brain Awareness Month.

Dementia presents profound challenges for individuals and their families, particularly as symptoms progress and daily activities become increasingly difficult. Occupational therapy (OT), especially when delivered in the home, has emerged as a vital intervention to support both people with dementia and their caregivers. This blog explores the impact of OT-directed home modifications, drawing on recent evidence and best practices.

Understanding Occupational Therapy in Dementia Care

Occupational therapy for dementia focuses on enabling people to participate in meaningful activities, maintain independence, and optimize safety within their living environments. Home-based OT interventions are tailored to the unique needs of the person with dementia and their caregivers, often including:

• Assessment and modification of the home environment
• Training in activities of daily living (ADLs)
• Caregiver education and support
• Strategies to manage behavioral and psychological symptoms
• Promotion of meaningful and enjoyable activitie

Key Impacts of OT-Directed Home Modifications

1. Improved Functional Independence

Multiple studies demonstrate that OT interventions in the home significantly improve the ability of people with dementia to carry out daily activities. Compared to usual care, individuals receiving home-based OT show greater performance in both basic and instrumental activities of daily living (ADLs and IADLs)14. These improvements are attributed to environmental modifications (such as installing grab bars, removing tripping hazards, or using visual cues) and tailored activity training.

2. Enhanced Quality of Life

Quality of life (QOL) for people with dementia is often compromised by functional decline and behavioral symptoms. OT-directed home modifications, combined with activity engagement and caregiver support, have been shown to improve QOL for both individuals with dementia and their carers. This includes better mood, increased participation in meaningful activities, and reduced distress.

3. Reduction in Behavioral and Psychological Symptoms

Behavioral and psychological symptoms of dementia (BPSD), such as agitation, anxiety, and wandering, can be distressing for both patients and caregivers. OT interventions that include environmental adaptations and caregiver education can reduce the frequency and severity of these symptoms, making home life safer and less stressful.

4. Caregiver Outcomes: Less Distress and Improved Well-Being

Caregivers of people with dementia often experience high levels of stress and burden. Home-based OT interventions have been shown to reduce the number of hours caregivers spend assisting with daily tasks, lower their distress related to challenging behaviors, and improve their overall quality of life. Education on dementia, training in safe care techniques, and support in problem-solving are key components of these interventions.

5. Fall Prevention and Safety

Home modifications led by occupational therapists are effective in reducing the risk of falls, a major concern for people with dementia. Adjustments such as improving lighting, removing loose rugs, and rearranging furniture can significantly enhance safety and reduce the likelihood of injury.

What Makes OT-Directed Home Modifications Effective?

Comprehensive and Individualized Approach

Effective interventions are those that are comprehensive and tailored to the needs of the individual and their caregiver. This typically involves:

• Thorough assessment of the person’s abilities and the home environment
• Collaborative goal setting with the person and caregiver
• Implementation of modifications and training
• Ongoing reassessment and adaptation as needs change.

Intensity and Professional Expertise

Evidence suggests that higher-intensity interventions—those involving multiple sessions and follow-up—are more effective. Occupational therapists’ expertise in both environmental assessment and activity adaptation positions them as the most effective professionals to deliver these interventions.

Challenges and Future Directions

While the evidence for OT-directed home modifications is promising, several challenges remain:

• Determining the most cost-effective models of delivery
• Ensuring access to OT services for all who need them
• Addressing variability in intervention intensity and duration
• Conducting further research to strengthen the evidence base and explore long-term outcomes

Conclusion

Occupational therapy-directed home modifications offer substantial benefits for people with dementia and their caregivers. These interventions improve daily function, quality of life, and safety, while reducing caregiver burden and distress. As the population ages and the prevalence of dementia rises, integrating OT into dementia care at home will be increasingly important for supporting independence and well-being in the community.

“Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.” (Bennett, et al., 2019)

REFERENCES:

Bennett, S., Laver, K., Voigt-Radloff, S., Letts, L., Clemson, L., Graff, M., Wiseman, J., & Gitlin, L. (2019). Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis. BMJ open, 9(11), e026308. https://doi.org/10.1136/bmjopen-2018-026308

Schmid, A. A., Spangler-Morris, C., Beauchamp, R. C., Wellington, M. C., Hayden, W. M., Porterfield, H. S., Ferguson, D., & Callahan, C. M. (2015). The Home-Based Occupational Therapy Intervention in the Alzheimer’s Disease Multiple Intervention Trial (ADMIT). Occupational therapy in mental health, 31(1), 19–34. https://doi.org/10.1080/0164212X.2014.1002963

Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the
participation of community-dwelling adults with health conditions: A systematic review. American Journal
of Occupational Therapy, 71, 7102290010. https://doi.org/10.5014/ajot.2017.018887