Habilitation Therapy for dementia

Dementia changes the brain and researchers are making great efforts to increase our understanding of it’s the effects and changes. With increased understanding of dementia, we as caregivers are modifying the ways in which we manage the various symptoms of dementia. The aim is to identify and understand the techniques through which caring can be optimized.

Habilitation Therapy (HT) is one such technique. It had been introduced as a care approach in 1996 by Paul Raia and Joanne Koenig Coste of the Massachusetts Chapter of the Alzheimer’s Association.

Here are some features of Habilitation Therapy:

The main goal is to ensure that the person feels loved and appreciated
Focuses on developing the elderly’s current abilities
Enhances their independence
Improves their morale
Helps elderly maintain positive emotional states throughout the day
Helps in reducing the difficult symptoms, even as the illness progresses

Rehabilitation v/s Habilitation

When an elderly has a hip replacement, post the surgery he or she goes to a clinic or hospital for rehabilitation therapy. The goal of rehabilitation is to get better and reach a previous level of functioning.

Alzheimer’s or any other type of dementia is a progressive disease and those who suffer from it are unlikely to reach a previous level of functioning. Thus rehabilitation is not possible. The goal of habilitation is not for the elderly to reach a previous level of functioning but to maintain as much of functioning as possible. The primary focus is on the remaining abilities and not what is lost to the disease.

Through habilitation, we can identify what all tasks the person with dementia can still do such as writing, reading, folding clothes, gardening, filling forms or even listening to a story. With activities, caregivers can promote positive emotions, maximize the skills and abilities that remain, and reduce problem behaviors of people with dementia.

Key Components of Habilitation Therapy

People with dementia hang on to emotions (i.e. feeling emotions, reacting to others’ emotions) longer than their many other skills as the disease progresses. Some key areas have been identified to promote positive emotion.

Communication

The goal is to improve the person’s capacity to understand and be understood. This leads to positive emotions as it reduces frustration felt by the person with dementia while communicating.

Asking ourselves the following questions will help us realize how we falter in our communication with people with dementia.

Do you greet the person from front so they can see you? Did you startle them?
Did you say the resident’s name and then your name?
Were you mindful of your body language and tone of voice?
Are you smiling and using a friendly tone of voice?
Are you speaking slowly, loud enough and clearly so that you are understood?
Did you assume that the elderly could change his/her behavior by telling him/her not to do it again? Did you use the word “no” or say “don’t do that” or “you can’t do that”?
Did you try to correct the resident when he/she thinks something is true but you know is not true or accurate – like time, place, and person?

Functional Assistance

The goal is to decrease excess disability. This leads to positive emotions as the person with dementia feels more independent.

Was the water warm enough to bath with? Are the shower fixtures convenient to use?
Do you break down the steps of dressing so that the person can do it on their own?
Is the food presented in a way to increase appetite? It is to their liking?
Do you restrict liquid intake late night to avoid incontinence in bed?
In grooming are you providing assistance only when the person needs such help and letting them do the tasks independently rest of the times.

Social

The goal is hold on to cognitive and social skills longer via practice. This leads to positive emotions as it gives them a sense of purpose.

Asking yourself the following questions would help you modify your approach:

Have you tried engaging them in personally meaningful activities that are interesting?
Does the elderly excessively nap during the day?
Do you arrange activities in the late afternoon to distract from dimming light?
Do you try an activity later in the day when an agitated resident may be more cooperative?
Do you know what kind of music the elderly likes and do you play that music for them?
Do you spend time to reminiscence with the person?

Physical

The goal is that the environment should direct cognition without the elderly’s awareness. This leads to more positive emotions as the persons feels in control of their environment.

The following are examples of questions that we must consider.

Is there sufficient lighting? Is there any glare that may be disturbing?
Is there some noise that could be disturbing for the elderly?
Is it easy for them to find their way around the house? Are there color cues that help?
Do you use light colored dished with dark colored foods and dark colored dishes with light colored food?
Is the bathroom door easily accessible and identifiable?

Perceptual

The goal is that the elderly receive sensory cues more easily. This leads to positive emotions as it leads to less confusion.

The following questions will help you assess the perceptual domain.

Are you aware of any sensory loss that the elderly is facing?
Is the elderly been given any physical therapy for sensory loss?
Do you use a little pressure in the area where motor function is needed such as gently pressing the area behind the knee to signal folding the knee to sit?
Do you ensure that the elderly is able to read the print size when doing an activity?

Behavioral

The goal is to reduce unsafe and difficult behavior. This will lead to them having more positive and less negative interactions with family, attendants, etc.

Some examples of questions that assess this domain are given below.

Is medication in any way contributing to the behavior?
Is the behavior harmful or is it causing a nuisance?
Are you tracking the behavior to check for any patterns that may be the cause?
Are you making sure that no one is blaming the elderly for the behavior caused by their disease?

Therapy in practice

A 70 year old dementia patient has wandering issues and gets very anxious in the mornings to go to office. According to the habilitation therapy the family members can give him a sense of purpose by asking him to assist with small office activities like stamping or stuffing envelopes.

Another 90 years old elderly is easily agitated especially post lunch time. She is engaged in music and playing the piano that help create an enjoyable activity for her engagement.

As the disease progresses the loved one loses some of his abilities. Focusing on what is already lost gives pain and stress to both the patient and the caregiver. Habilitation therapy works around what is still left and focuses on that.

Since people with dementia are unable to communicate their discomfort, assessing that becomes the responsibility of the caregivers. It aims to create an environment where the elderly can be most comfortable and can continue to live their years with dignity. The central concern is to ensure that people living with dementia feel loved and appreciated.

We at Samvedna Care aim to help seniors live happy, active and independent lives, in the comfort of their home and community through interactive caregiving.

Samvedna Care was established in October 2013 with two complementary goals – firstly to provide quality home care services to seniors with limited mobility or dementia and hence social interaction, and secondly to facilitate stimulating community interaction and participation.

Our Dementia Care services are –

At-home services –
Dementia intervention activities by trained Care Specialists (already mentioned above). These services are available in Delhi NCR
More – Dementia Care
Please call us for more info – Delhi NCR – 98184 21446, 124 4229659

Dementia Support Group –
Our Dementia Support group in Delhi NCR is a platform for caregivers to share feelings and support each other.
Please call us for more info – Delhi NCR – 98184 21446, 124 4229659

Cognitive Wellness Programme, Sector 57 Gurgaon –
Samvedna’s Cognitive Wellness Programme is designed for seniors with mild cognitive impairment, early dementia or Parkinson’s, and elderly lacking in enthusiasm and motivation. The aim is to stimulate the mind of the elderly to slow the progression of the disease or impairment. The sessions are 3 days a week, 11AM-1PM.

General Wellbeing:

With our General Well Being Services we aim to raise the quality of life of seniors, specially those who may have limited mobility and social interaction due to various constraints. Our interactive programme keeps them active and engaged through physical, mental and social activities, all in the comfort of their home.

More – Elder Care