As our life expectancy continues to increase, so does our likelihood of developing dementia. Dementia is a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain. Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia, are just a few diseases that fall under this large umbrella. Dementia affects our ability to carry out activities of daily living (ADL’s). Once a diagnosis of dementia has been determined, does this mean that the individual is no longer able to live alone, safely? The answer is complicated. Please listen to learn more about this topic.
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[00:00:00] Janet: Hi, everyone. I know it's been a while since you've heard from me and I want to apologize. My son is now on summer break and I am at home doing most of the caregiving. So it's become a little bit complicated and my routine has changed a little bit, which. There aren't any excuses, but I just have to get used to my new routine for this summer, but I promise I am going to come out with more podcasts.
[00:00:34] Janet: I have several interviews already scheduled. The next one I am very excited about it is with Louis tendon bomb. He is really the first person to ever have. An aging and place business. And now he is in Congress passing a bill to have aging in place renovations be funded by the [00:01:00] government. So I am very excited to interview him tomorrow.
[00:01:04] Janet: Now, this is the first type of podcast that I'm doing, where I don't have someone to interview. And I have been thinking about doing this format for a little while. I wanted to bring up topics that are of interest to people and that I can speak to intelligently from the sole perspective of an occupational therapist.
[00:01:30] Janet: So one subject that I really have wanted to have for a while is answering the question. How long can someone live with dementia alone, safely? So I recently wrote a blog article, which you can find on my website, home designs for life.com. I just published it over this weekend. and I am going to be talking about that [00:02:00] article and referring to it.
[00:02:02] Janet: So as our life expenses, expectancy continues to increase. So does our likelihood of developing dementia? Well, what is dementia? It is a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking. And often with personality change resulting from organic disease of the brain Alzheimer's disease, vascular dementia, Lowy, body dementia, and frontal temporal dementia are just a few diseases that fall under this large umbrella.
[00:02:42] Janet: Dementia affects our ability to carry out activities of daily living. So what are activities of daily living? I got asked this question time and time again, when I was an occupational therapist working in home health. So we use the term [00:03:00] ADLs and what it means is, or what ADLs are. Are activities like bathing, dressing, grooming, personal hygiene, toileting and then instrumental activities of daily living are activities like preparing a meal or paying your bills, cleaning your house, doing laundry driving, going out into the community.
[00:03:27] Janet: So when you have a diagnosis like dementia, your ability to perform these tasks are going to be affected, especially the more complex tasks that require executive function such as going out into the community, driving, paying your bills. So how long can someone live alone by. By themselves once they have a diagnosis of dementia.
[00:03:55] Janet: Well, the answer's complicated. So the way that we can [00:04:00] best get to this answer is using a standardized screening tool. Like the Allen cognitive levels. Also known as the ACL. When I was working as an OT in home health, I used the ACL. Probably at least three times a week, it's a, a great tool to test cognition.
[00:04:21] Janet: It was developed by Claudia Allen. She's an occupational therapist, also an educator, and it was developed with her colleagues. It is an assessment used to help providers spot cognitive conditions like dementia. And it is also used to determine how much help a person may need with ADLs and their ability to safely live alone.
[00:04:47] Janet: So the ACL is different from other cognitive tests. It does not test memory or verbal answers to questions. Instead, it uses fine motor skills, [00:05:00] ability to follow directions and learning. The person is asked to use a needle and a leather string to perform three different types of stitches. One stitch builds on the other to create a more complex stitch.
[00:05:15] Janet: The person is rated on the number of mistakes they make, as well as their ability to recognize and fix a mistake and their ability to learn the stitch from the occupational therapist, administering the test and to replicate it correctly. The ACL is also an effective measure of an individual's functional abilities.
[00:05:40] Janet: Their score is directly related to their ability to prepare a meal safely, bathe get dressed, perform personal hygiene tasks, and ultimately live by themselves. So the ACL has six levels. Level six being the highest and [00:06:00] level zero being the lowest. So level zero is a comatose state, meaning the person is unaware of themselves or their environment.
[00:06:10] Janet: Level one, the person can move around a little bit, but requires total assistance from a caregiver for all ADLs level two, the person may be able to perform large body movements. However, continues to need 24 hour assistance to complete a daily routine. Level three, a person operating at a level three is recommended to have help and supervision and some level of assistance with all ADLs.
[00:06:44] Janet: So again, this is dressing bathing, toileting level four. Now this is a gray area. So at a lower level four, a person may have difficulty with problem solving. May need a strict routine and frequent [00:07:00] checks to live alone safely. So for example, they may be able to get in the shower, but. Don't realize that they have to use soap to wash their bodies or shampoo to wash their hair, or they may wash one part of their body, but completely ignore another part of their body.
[00:07:25] Janet: So this is when someone requires supervision and assistance in order to complete a task. Well, and to complete it safely, because if they're having trouble remembering whether they have to wash their arms and their legs, then I would also question their ability to be able to get into the bathroom safely.
[00:07:53] Janet: For example, using the grab bars or turning on the water and making sure that the [00:08:00] water isn't too hot for them, where it will burn their skin. So now at a higher level four, then the person is able to get by with frequent checks safely. Now this is where. For example, you'll have a caregiver that comes in maybe one to three times a week and just make sure that there is food in the fridge that there is.
[00:08:30] Janet: Electricity running water that the person is eating on a daily basis because that's another thing that happens with dementia is people forget to eat, or they will only eat their absolute favorite things. So maybe they're only eating. Sweets all the time and maybe the only drink they're drinking is coffee or soda.
[00:08:56] Janet: And so obviously this is not [00:09:00] safe for a person to have this routine on a daily basis for their health. So this is where you would need someone to come in several times a week and make sure that. The clothing that they're wearing is clean. That they're clean, that they're taking their medications and taking them correctly and that they are eating a balanced diet.
[00:09:27] Janet: So then we have level five. This is characterized by mild cognitive impairment. The person is still able to perform a daily routine safely and learn new things. And right there, those are the keywords. They are able to learn new things once. The stage of dementia advances into a level four, especially a low level four people are no longer able to learn new things [00:10:00] unless there is a lot of repetition and special teaching methods used to help that person learn that new task.
[00:10:11] Janet: For example, Someone that never used a Walker. Okay. But now their gate is impaired. They're having balance issues and the occupational therapist or physical therapist wants to teach them how to use a Walker. Well, if that person is at a high level four, there's a good chance that they will learn to use the Walker safely and also adopt it into their daily routine.
[00:10:42] Janet: But if it's a level low four or a level three, it is going to be difficult for that person to ever start using the Walker because it wasn't something that they were already doing. So you will not get them to [00:11:00] learn how to use it correctly. Number two, they will not remember to use it. So that's why it's very important to identify when someone has dementia at what stage they're at, because you'll wanna do as much as you can at the beginning to teach them good habits and good routines, because if they learn these routines, At an earlier stage of dementia, it is much more likely that they're going to continue to carry on these routines and these healthy habits and safe habits.
[00:11:38] Janet: Well into the later stages of dementia. So now we go on, well, I wanted to explain a little bit more about level five. Something that I thought was amusing when I started using the ACL is that teenagers are considered to be at a level five. And level five, it's [00:12:00] considered mild cognitive impairment. So it, when I learned about this, I thought, oh this explains a lot, because I have a daughter.
[00:12:08] Janet: Well now she's 22. But at the time when she was younger and I was using the ACL, I said, oh, that's why she is able to do this one task, but then. Fails at the very end or why they make certain decisions. So it's because the brain isn't fully developed until age 25. And so that's when we're considered to be able to perform executive functions well, and that is where level six comes in.
[00:12:42] Janet: So this is the highest level. There's no cognitive impairment. And our ability to perform executive functions is intact. And when I'm talking about executive functions, I mean, like being able to plan being able to plan a [00:13:00] trip, for example, a vacation that requires executive function being able to plan meals for the whole week that requires executive function.
[00:13:10] Janet: So I am going to move on. and I'm going to just say that if you have a loved one that has been diagnosed with dementia, The best thing that you can do is have them evaluated by a, an occupational therapist, preferably to use the ACL because we are the professionals that are trained to use the ACL.
[00:13:36] Janet: However other professionals can also be trained such as a psychologist or a neurologist. But this is a great cognitive test and it was my preference to use this screening tool as opposed to using the mini mental, which is Where you ask the person questions and you have them remember words and you have them [00:14:00] count backwards and you have them draw a diagram.
[00:14:03] Janet: And the reason that was not my preferred screening tool was because. The patients were able to figure out that you were testing their memory. And eventually just a few minutes into the test, they would get very irritated and that affected my ability to connect with them. My ability to engage their trust.
[00:14:29] Janet: And frankly, they didn't wanna participate in it anymore. And with the Allen cognitive level tests, because you use string and it's actually an activity, people enjoy it and they continue to try to figure it out and they participate and they don't realize that you are testing their memory. So it's a great tool.
[00:14:58] Janet: Now I want people to keep [00:15:00] in mind that occupational therapists. This is a service that is covered by private insurance. It's also covered by Medicare and Medicaid insurance. So cost should not be a reason why people do not receive occupational therapy services, and you can find an occupational therapist at an outpatient clinic.
[00:15:25] Janet: They are at schools. Of course we wouldn't be using this screening tool at a school, but they can, occupational therapists are in acute care. They're in rehab hospitals. If your loved one is in a rehab hospital and they're going to be an assess by an occupational therapist. And there is a question of whether or not there is a diagnosis of dementia.
[00:15:52] Janet: This would be a great time. To have your loved one being assessed and have [00:16:00] the OT do this test OTs in the home care environment. They also do these tests. That's also a great place. That was where I would do it. And basically as long as the person is between a level five and a level four. , it will be useful to determine if someone is able to continue to live alone safely and what support should be in place.
[00:16:34] Janet: In order to ensure that. So if you like this podcast, please write to me. I love receiving emails from listeners. My email is email@example.com and I always reply. If you have suggestions for future topics that you [00:17:00] want me to cover, whether it be. A podcast like this one where it's just me and I talk about a topic from an OTs perspective or whether it is a topic that I would require me to have someone to interview.
[00:17:18] Janet: Just write me a note. I will try to make it happen. I will do the research and try to make it happen, or I will try to get the person to get on my show. So as I said, I have a series of interviews that are scheduled. They're going to be really interesting. I'm very excited about it. And I'm going to try my best to put out two podcasts per week.
[00:17:45] Janet: So I hope that you're listening. Thank you so much for being with me today. Bye.