Stressed Out: Occupational Therapy’s Role in Promoting Self-Care

for Family Caregivers of People with Dementia

Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

FRAMEWORKS TO GUIDE CAREGIVER TRAINING

Competence-Environmental Press Framework (Lawton & Nahemow, 1973)

 Educating family caregivers to obtain that “just-right fit” between personal capabilities and environmental
demands results in positive behaviors and enhanced quality of life for both the caregiver and the individual
with dementia.

Cognitive Disabilities Model (Allen & Blue, 1998)

Level 6 Planned Actions  Six Allen Cognitive Levels (ACL) that describe the
complex and dynamic interaction between a
person’s cognitive abilities and functional
Level 5 Independent Learning performance.

 Based on the ACL, occupational therapists can

Level 4 Goal Directed
Level 3 Manual Actions
Level 2 Postural Actions
 Teach caregivers how to match abilities with
tasks.
 Provide suggestions that facilitate the
person’s best ability to function within the
least restrictive environment.

Level 1 Automatic Actions

 Stressed Out: Occupational Therapy’s Role in Promoting Self-Care
for Family Caregivers of People with Dementia
Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

Need-Driven Behavior Model (Algase et al., 1996)

 Persons with dementia have difficulty expressing their needs.

 Behavior is the result of an attempt to meet a basic a human need that is not currently being
met.
 Background factors cannot be controlled, where current factors may be, but awareness and
understanding of both help with behavior guidance.


Progressively Lowered Stress Threshold [PLST] (Hall & Buckwalter, 1987)

Potential for Catastrophic Reaction or

High Withdrawal from Under-stimulation
Amount of Stimulation

Med
Comfort z

Zone

Low
Potential for Catastrophic Reaction or
Withdrawal from Under-stimulation

Normal Early Early-Middle Late-Middle Late

Stages of Dementia

 Stress threshold is lower in persons with dementia.

 Behavior is a result of excess environmental stress and caused by increasing anxiety.
 A person’s stress threshold shrinks both during the course of dementia and over the course
of the day.


 Stressed Out: Occupational Therapy’s Role in Promoting Self-Care
for Family Caregivers of People with Dementia
Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

ABC Model (Teri & Logsdon, 2000)

 The ABC model can be used to teach the caregiver to identify the stimulus (antecedent) that triggers a
specific behavior and clearly define and analyze the potential consequences. This includes both positive
and negative behaviors.
 Caregivers can learn to evaluate each behavior and identify the specific antecedent(s) that can be
enhanced, modified or eliminated.
 The process is cyclical, and the consequence can become a new antecedent for behavior.

Problem Solving Process Model (Gitlin, 2009; Yura & Walsh, 1983)

Evaluate Assess

Implement Plan

Teaching the problem solving process offers caregivers a skill to use when new situations occur after
occupational therapy service or training is complete.
 Stressed Out: Occupational Therapy’s Role in Promoting Self-Care
for Family Caregivers of People with Dementia
Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

RESOURCES

Administration for Community Living, www.acl.gov. Government agency concerned with issues affecting older
Americans. This site offers information about older Americans, legislation, and programs.

Alzheimer's Association, www.alz.org. Information about cognitive issues, problems and solutions, research
and medical advances, public policy issues, caregiver support, and resources.

Alzheimer's Disease Education and Referral Service (ADEAR), a service of the National Institute on Aging,
www.nia.nih.gov/alzheimers. Information and referrals, publications, database and resources about dementia.

Alzheimer’s Navigator,
www.alzheimersnavigator.org/?utm_source=DM&utm_medium=email&utm_campaign=navigator. Guide to
answer questions by creating a personalized action plan and linking to information, support, and local resources.

Alzheimer’s Store, www.alzstore.com. Wide variety of products for people with dementia and their caregivers.

American Geriatrics Society,

https://geriatricpain.org/sites/geriatricpain.org/files/wysiwyg_uploads/pain_in_dementia.pdf
Resource on assessing pain in a person with dementia who may not be able to communicate effectively.

American Psychological Association, Caregiver Briefcase for Psychologists

http://www.apa.org/pi/about/publications/caregivers/index.aspx

Caregiver Action Network, caregiveraction.org/. Education, peer support and resources free of charge.

Centers for Medicare and Medicaid Services (CMS), www.medicare.gov. Overview of Medicare and Medicaid
policy and regulations, and consumer literature about health-related services and benefits.

Eldercare Locator, www.eldercare.gov. Connection to local services for older adults anywhere in the US.

Family Caregiver Alliance, www.caregiver.org. Support services for those caring for people with Alzheimer’s
disease and other neurocognitive disorders, as well as other conditions.

National Institutes on Aging, www.nia.nih.gov. Reliable health and resource information for consumers and
professionals. Relevant topics include changes in intimacy and sexuality, wandering, bathing, grooming and
dressing, and incontinence.

National Resource Center on Supportive Housing and Home Modification, www.homemods.org. Information
and strategies about home modifications and their importance in supporting safety and independence.

Next Step in Care Toolkit for Working with Family Caregivers offers tools and guidance for health care providers
to create better care transitions: https://www.nextstepincare.org/providers/toolkit/

Rosalynn Carter Institute, www.rosalynncarter.org, offers information about caregiver assessment,

interventions, including a caregiver intervention database, applying evidence to programs, making interventions
effective, and related resources.
 Stressed Out: Occupational Therapy’s Role in Promoting Self-Care
for Family Caregivers of People with Dementia
Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

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Alzheimer’s Association. 2018 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2018; 14(3):367-429
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 Stressed Out: Occupational Therapy’s Role in Promoting Self-Care
for Family Caregivers of People with Dementia
Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

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 Stressed Out: Occupational Therapy’s Role in Promoting Self-Care
for Family Caregivers of People with Dementia
Ann O’Sullivan, OTR/L, LSW, FAOTA
2018 AOTA Annual Conference & Expo  Salt Lake City, UT

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CONTACT INFORMATION: annotr@yahoo.com