Connecting People, Connecting Support is a new AHP dementia policy in Scotland and shares how allied health professionals (AHPs) in Scotland CAN support people with dementia, their families and carers to live positive, fulfilling and independent lives for as long as possible.
The policy presents an evidence-informed case to support a biopsychosocial approach to practice for ALL AHPs in Scotland when working with people living with dementia – what we call the AHP approach.
The fundamental understanding driving the AHP approach is that people living with dementia CAN benefit from AHP-led interventions. In this week’s blog we are sharing the AHP contribution to maximising physical wellbeing.
The AHP approach
Maximising Physical Wellbeing
What do we mean by physical wellbeing?
This is about encouraging people to be more active, with the aim of preventing the potential negative outcomes of dementia. The primary focus is factors such as mobility, physical activity and fitness, falls reduction, foot care, identification of previously undetected pain or discomfort, management of pain, diet, nutrition and hydration, and swallowing, and inclusion in physical rehabilitation approaches delivered by AHPs.
Why is physical wellbeing important?
- Physical activity benefits people with dementia in many ways, including enhancing activities of daily living, independence and reducing feelings of loneliness and isolation.
- A positive connection has been shown between physical activity and improvements in balance and muscle strength.
- Diet, nutrition and hydration play an important role in maintaining health and wellbeing.
- What we eat and drink can also be used to celebrate life events and helps define who we are.
- Sensitive and inclusive design of dining rooms, kitchens, furniture, lighting and tableware can all make important contributions.
3 ways allied health professionals CAN maximise physical wellbeing?
1. Keeping physically active
AHPs have the knowledge, skills and expertise to promote physical activity for people with dementia through providing advice, signposting, referring on and delivering specific interventions. They can advise on how physical activity can be incorporated into people’s routines, realising benefits such as prevention of muscle wasting and mobility problems, and improving sleeping routines, mood and social participation.
Exercise is a more structured form of physical activity, often with a specific goal such as increasing strength, flexibility, balance, co-ordination or cardiovascular fitness. AHPs, primarily physiotherapists, have the relevant expertise to give general advice to people living with dementia and design personalised exercise programmes to best meet needs.
Physiotherapists and occupational therapists play a crucial role in maintaining and improving people’s mobility through interventions such as assessing function and activities of daily living, providing equipment and walking aids and offering gait re-education. AHPs, primarily specialist physiotherapists, have the knowledge and skills to use manipulation, acupuncture, mobilisation and electrotherapies to combat pain. Other non-pharmacological interventions used by AHPs in advanced dementia (usually physiotherapists and occupational therapists and often in partnership with families and carers) include passive movements, positioning, splinting of contractures and pressure care.
2. Falls reduction and fracture prevention
AHPs play a crucial role at all stages of falls reduction and management pathways by supporting self-management of falls and fracture risk, identifying people at risk and delivering prevention interventions, such as strength and balance programmes.
Multifactorial programmes based on individual risk assessment are key evidence-based interventions to prevent and reduce falls. While these programmes can be delivered by a range of health and social care professionals, physiotherapists and occupational therapists are key to implementation. Effective interventions include individualised strength and balance exercise programmes, environmental assessments and home modifications, and use of telecare.
Good foot care can impact positively on a person’s ability to self-manage and can reduce falls, lessen the risk of infection, increase independence and participation in social activities and boost psychological wellbeing. Podiatrists have the skills and knowledge to help prevent and treat foot ulceration, but can also provide evidence-based self-care advice on foot health and support people with dementia to maintain their mobility and independence. Podiatrists will also provide support to others who may be providing foot-care services.
3. Eating well
AHPs, particularly dietitians and speech and language therapists, use their expertise to help people maintain adequate nutrition and hydration. Dietitians can identify, assess and, where appropriate, provide practical advice to maintain nutritional health (Molyneux, 2016) and address issues arising as a result of the dementia, including taste changes, weight gain (weight-management advice) or loss (nutritional support), hydration issues, constipation and making the eating environment more suitable.
Dietitians offer nutritional assessments, support and therapeutic dietary advice, translating evidence into practical advice. Speech and language therapists assess changes in swallowing function and, with dietitians, advise on compensatory strategies, including alternative ways to support nutrition when needed. The aim is always to balance risk against quality of life and the continued enjoyment of the social activity of eating. Appropriate specialist advice increases independence, helps to maintain eating skills and can reduce the risk of undernutrition, dehydration, chest infections and aspiration.
Thank you for taking the time to read this blog and we would like to know
- As an AHP, how do you currently support people living with dementia to maximise the persons physical wellbeing?
- As person living with dementia, what support would you like to receive from allied health professionals to maximise your physical wellbeing?
- As family carer, what support would you like to receive from allied health professionals to maximise your physical wellbeing?
We look forward to hearing from you
There are references supporting this text which you will find in the original policy document and can be viewed here https://www.alzscot.org/assets/0002/7356/AHP_Report_2017_WEB.pdf with all the evidence informing the policy available at www.alzscot.org/ahp