Importance: For a person with mild cognitive impairment (MCI) or early-stage dementia, driving is important for independence. However, driving presents safety concerns for both the person and family members. It is important to determine whether occupational therapy interventions can prolong safe driving for this population. Objective: To determine the effectiveness of occupational therapy interventions to improve driving performance in older people with MCI or early-stage dementia. Data Sources: We conducted a search of MEDLINE, PsycINFO, CINAHL, and gray literature using Google Scholar. Study Selection and Data Collection: Studies were included if they evaluated interventions that (1) aimed to improve the driving performance of older people (M age ≥60 yr) with MCI or early-stage dementia and (2) could be designed or delivered by an occupational therapy practitioner who specializes in driving. Citations were reviewed independently by two authors, and quality appraisal was conducted using the Cochrane risk-of-bias guidelines. Findings: One Level I randomized controlled trial (RCT) and 4 Level III quasi-experimental studies were included; these studies had 231 participants in total with reported M ages of 65.6–72.5 yr. One study evaluated a compensatory approach, whereas the others evaluated a remedial approach. The studies used different measures to assess outcomes and reported mixed effects. Conclusions and Relevance: Low strength of evidence suggests that occupational therapy interventions may improve the driving performance of older people with MCI or early-stage dementia. More RCTs are needed that include long-term follow-up measures and address clinically important outcomes. What This Article Adds: In the absence of conclusive evidence from research studies and best practice guidelines, occupational therapy practitioners must rely on their clinical experience and their clients’ abilities. Development of evidence and guidelines in this area is critical. It is also important for practitioners to work closely with clients, families, and interdisciplinary team members to carefully monitor fitness to drive.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Community-dwelling adults with mild cognitive impairment or dementia participated in this mixed-methods study. Assessment of sensory processing and observations of environmental factors were conducted. Results describe adaptations between the person and their environment in terms of sensory processing patterns. Implications highlight opportunities for OTs to assess and intervene in environmental adaptation using a sensory-based approach. Primary Author and Speaker: Elizabeth Rhodus Additional Authors and Speakers: Elizabeth G. Hunter Contributing Authors: Graham Rowles, Shoshana Bardach, Gregory Jicha

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Older adults with mild cognitive impairment or dementia demonstrate behaviors characteristic of autism spectrum disorder (ASD). This study correlates behaviors of ASD and behavioral and psychiatric symptoms of dementia in an older adult cohort. Results indicate significant similarities in these behaviors and opportunity for OT intervention across these neurological conditions. Primary Author and Speaker: Elizabeth Rhodus Contributing Authors: Justin Barber, Erin Abner, Shoshana Bardach, and Gregory Jicha

Date Presented 04/21/21 This study examined the relationship of clinical and road portions of Vanderbilt University Medical Center's driver evaluation. Data were collected retrospectively on adults with mild cognitive impairment or dementia. Findings revealed a significant relationship between the driving recommendation and the road assessment scores but not the clinical scores. Results indicated a need for OT practitioners to explore clinical assessment methods to more accurately predict road performance for determining fitness-to-drive recommendations. Primary Author and Speaker: Susan L. Iliff Contributing Authors: Patricia Bowyer

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The presented research offers an introduction to the use of root-cause analyses in the Veterans Health Administration for identification of falls in veterans with dementia who were referred to or receiving OT. Results identify specific areas for improvement that may be immediately implemented by OTin all health care systems. Such improvements to care may drastically improve patient safety and decrease fall risk in older adults with dementia. Primary Author and Speaker: Elizabeth Rhodus Contributing Authors: Elizabeth Lancaster, Mary Duke, and Andrew Harris

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This qualitative, interview-based research project explores the views of adults with early-stage dementia and their care partners about technology. We describe the participants' acclaim for, expectations of, and frustrations with current technology as well as recommendations for future, helpful digital technology. This important information relates to incorporating smart assistive technologies into effective OT practice, especially for those with cognitive impairments. Primary Author and Speaker: Regula H. Robnett Additional Authors and Speakers: Susan Wehry Contributing Authors: Cory Breidt, Taylor Gallant, Kathryn Maiato, and Haley McOsker

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of this research was to examine the efficacy of a 9-week equine-assisted program named "Horse in the Moment." Mixed-methodology research was conducted to explore the effectiveness of equine-assisted activities on quality of life (QOL) and relational skills for individuals diagnosed with dementia. Pre and post scores on World Health Organization QOL showed significant difference. Families of the participants also reported improvements in communication and socialization. Primary Author and Speaker: Charmaine Lim Additional Authors and Speakers: Manisha Sheth

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This mixed-methods exploratory study provides an overview of witnessed events of paradoxical (unexpected) lucidity displayed by people with major cognitive decline who were often close to death. Fifty respondents shared their stories. Gaining an understanding of the antecedents of paradoxical lucidity, such as music or other sensory stimulation, could lead to interventions that promote these emotional and often meaningful events of re-engagement near the end of life. Primary Author and Speaker: Regula H. Robnett Additional Authors and Speakers: Thomas Meuser, Claire Michael Contributing Authors: Mary Garside, Brandon Gibson

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This presentation will characterize our experiences integrating stakeholder engagement into a multisite pragmatic clinical trial focused on optimizing care for nursing home residents with dementia. We will discuss our methods for building OT capacity to conduct research that includes the voices of stakeholders. Primary Author and Speaker: Jenny Martinez Additional Authors and Speakers: Catherine Piersol Contributing Authors: Lauren Terhorst, Sherrie Holloway, Felicia Chew, and Natalie Elizabeth Leland

Importance: When in-person rehabilitation is not feasible, interventions delivered in remote telephone-based sessions may be an option. Objective: To determine whether telephone-based reality orientation therapy (T–ROT) can improve cognition, mood, and neuropsychiatric symptoms among patients with major neurocognitive disorders (NCDs) who are forced to isolate and also whether T–ROT can relieve the burden of distress among their caregivers. Design: Nonrandomized interventional comparison study. Setting: Individual telephone calls between practitioners and patients and their caregivers. Participants: Twenty-seven patients (14 in the experimental group, 13 in the control group) with a major NCD and their primary caregivers. Intervention: Ten T–ROT sessions and a pretest–posttest neuropsychological evaluation over 4 wk. Outcomes and Measures: Outcomes measured included cognitive and behavioral symptoms of patients with major NCDs and correlations between changes in patient clinical condition and caregiver stress. Primary outcome measures were two measures of depressive symptoms, the Neuropsychiatric Inventory Questionnaire and the Telephone Mini-Mental State Examination, administered at baseline and program discharge. Results: T–ROT significantly outperformed nontreatment on all measures of depression, behavior, cognition, and caregiver burden. Conclusions and Relevance: T–ROT combined with emotional support appears to be an effective intervention for monitoring and managing the behavioral symptoms of patients with major NCDs who are forced to isolate. What This Article Adds: Occupational therapy practitioners can use T–ROT or similar procedures not only during a pandemic but also when it is not possible to treat patients in person at a hospital or at home. Telephone-based treatment may also represent a good practice to be integrated into traditional rehabilitation programs.

Importance: The Assessment of Quality of Activities (A-QOA) is an observation-based tool for assessing the strength of engagement in an activity by the person performing it in a natural context. By quantifying the quality of engagement, the A-QOA can help occupational therapy practitioners be better able to select meaningful activities and more clearly understand the effectiveness of various choices. Objective: To examine use of the A-QOA as a valid unidimensional scale and to clarify preliminary results on its internal scale validity and item reliability using the Rasch model. Participants: One hundred thirty-one participants with dementia performing 262 activities. Outcomes and Measures: We used the Rasch model to clarify the psychometric properties of A-QOA’s measurement quality. Results: Rasch analysis revealed that 21 of the 25 items reached an acceptable level of fit, and 4 did not. After eliminating the 4 misfitting items, the resulting A-QOA was determined to have both acceptable internal scale validity and item separation reliability, which are fundamental psychometric properties of a clinical observational instrument. Conclusions and Relevance: The A-QOA can be used to quantitatively assess the strength of engagement in an activity by the person performing it by using the observational method. What This Article Adds: In clinical settings, the A-QOA can be used both to select activities for clients with dementia and to quantitatively show the effects of occupational therapy interventions.

Importance: People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles. Objective: This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients’ performance of daily occupations and reduced caregiving burden and improved caregivers’ sense of competence. Data Sources: Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers. Study Selection and Data Collection: Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process. Findings: From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments. Conclusions and Relevance: Combining individualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers’ sense of competence. Further research on leisure and home management occupations is warranted. What This Article Adds: The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.

Importance: Neuropsychiatric behaviors of persons with dementia, including agitation, aggression, and rejection of care, are almost universal; occur throughout the disease process; and have negative consequences for both persons with dementia and their caregivers. Nonpharmacological approaches are now recognized as first-line treatment to address these behaviors. One promising approach is activity tailored to the person’s interests, abilities, and physical and social environment. An evidence-based program, New Ways for Better Days: Tailoring Activities for Persons With Dementia and Their Caregivers (TAP), draws on occupational therapy principles (person–environment–occupation fit, activity analysis) to meaningfully engage persons with dementia. Objective: This case report describes the TAP protocol and clinical reasoning processes underlying use of tailored activities as a therapeutic modality to address dementia-related neuropsychiatric behaviors. Design: This is a case study of an African-American woman in her 60s caring for her father, age 92, who has severe dementia and multiple behaviors. Outcomes and Measures: Primary outcomes in this case report include the person with dementia’s engagement in an activity and the reported neuropsychiatric behaviors. In addition, the caregiver’s confidence in using activities is reported. These and other measures from the TAP protocol are described in full. Results: After working with an occupational therapist for eight sessions, the person with dementia’s engagement in activity increased by 50% and his frequency of vocal disturbance decreased, and the caregiver felt more confident in using activities with her father. Conclusion and Relevance: This case report illustrates how occupational therapists working with families of persons with dementia can use the TAP protocol to help them manage neuropsychiatric behaviors by tailoring activities. What This Article Adds: Occupational therapists are uniquely qualified to systematically assess the cognitive functioning of persons with dementia, caregivers, and home environments and to integrate this information to derive and implement activities tailored to the person’s capacities and context, thereby reducing neuropsychiatric behaviors and increasing engagement in meaningful activity.

This systematic review examines the efficacy of yoga as a neuromuscular intervention for community-dwelling populations at risk for falls to determine its utility for use in occupational therapy intervention. Populations included older adults and adults with traumatic brain injury (TBI), cerebrovascular accident (CVA), dementia and Alzheimer’s disease (AD)–type dementia, multiple sclerosis (MS), and Parkinson’s disease (PD). Benefits of yoga include improved posture control, improved flexibility of mind and body, relaxation, and decreased anxiety and stress. A systematic review of the literature was conducted to understand the salutary benefits of yoga for clients who are at risk for falls because of neuromuscular issues. Moderate evidence supports the use of yoga to decrease the risk for falls for community-dwelling older adults and people with CVA, dementia and AD-type dementia, and MS. Studies involving people with TBI and PD did not include strong enough evidence to be able to make a clear classification.

OBJECTIVE. We describe the development of a questionnaire, Participation in Activities and Places Outside Home (ACT–OUT), for older adults with cognitive impairment and align it to people with mild- to moderate-stage dementia. METHOD. ACT–OUT was developed in a cross-cultural collaboration in combination with three rounds of cognitive interviews in Switzerland with 26 older adults without cognitive impairment and five older adults with dementia. Qualitative data from the interviews were analyzed using a constant comparison approach. RESULTS. The final ACT–OUT Version 1.0 consists of three parts: (1) questions targeting places older adults visit; (2) questions on aspects influencing participation, such as transportation, familiarity, and risk perception; and (3) questions on perception of self. CONCLUSION. The development of an instrument such as ACT–OUT is more a cyclical than a linear process. This study is a first step toward a more systematic evaluation of out-of-home participation among older adults with and without dementia.

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities’ residents’ needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

The Cognitive Performance Test (CPT) is a standardized occupational therapy assessment that examines cognitive integration with functioning in an instrumental activities of daily living context. Conventional cognitive measures provide diagnostic utility but do not fully address the functional implications. Ninety-one veterans diagnosed with cognitive impairment were evaluated. We compared the predictive value of the CPT with the Large Allen Cognitive Level Screen (LACLS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) for the need to retire from driving versus ability to pass an on-road exam. Measures were also analyzed by diagnostic classification. CPT correctly classified a mild versus major neurocognitive disorder, whereas MMSE, MoCA, and LACLS did not differentiate the groups. A CPT cutoff score of <4.7/5.6 showed 89% sensitivity for failing the road exam and 75% specificity for ability to pass. CPT discriminated functional level in neurocognitive disorders and had better predictive value for fitness to drive compared with conventional cognitive measures.

Safety is an issue for older adults with dementia because they are at risk for various incidents. Intelligent assistive technology (IAT) may mitigate risks while promoting independence and reducing the impact on the caregiver of supporting a relative with dementia. The aim of this scoping review was to describe IATs and to identify factors to consider when selecting one. A systematic search was performed of the scientific and gray literature published between 2000 and 2015. A total of 31 sources were included. Four types of IATs were identified as addressing safety issues in dementia: monitoring technologies, tracking and tagging technologies, smart homes, and cognitive orthoses. Characteristics of the device and ethical considerations emerged as key factors to consider when selecting one. IATs yield promising results but pose various challenges, such as adapting to the evolution of dementia. Further research on their actual impact is needed.

OBJECTIVE. The authors mapped the literature on animal-assisted therapies (AATs) and institutionalized adults with dementia onto the Lived Environment Life Quality (LELQ) Model as a guide for future services and research. METHOD. Refereed literature addressing AATs and institutionalized people with dementia was comprehensively gathered, described, categorized, and synthesized in this systematic mapping review. RESULTS. From 1,342 screened records, the authors included 10 research articles that incorporated dogs in therapy for institutionalized adults with dementia. These canine-assisted therapies offered occupational opportunities and environmental supports conducive to experiences of relative well-being, occupational engagement, and optimal functioning. CONCLUSION. The findings offer proof of the concept that canine-assisted therapies are feasible and can elicit positive quality-of-life experiences in institutionalized people with dementia. Researchers and practitioners need to elucidate the theoretical foundations of AATs. The LELQ Model may serve as a guide for client-centered, occupation-focused, and ecologically valid approaches to animal-assisted occupational therapy.

OBJECTIVE. We investigated how everyday technology use related to activity involvement over 5 yr in people with mild cognitive impairment. METHOD. Thirty-seven older adults with mild cognitive impairment were evaluated regarding everyday technology use and involvement in activities over time. Information on diagnostic changes was collected from medical files. Linear mixed-effects models were used in data analysis. RESULTS. Ability to use everyday technology showed a significant effect on activity involvement (p = .007) beyond the effects of time, diagnostic change, and age. Decreases in number of everyday technologies used (p < .001) and share of accessible and relevant everyday technologies used (p = .04) were associated with decreasing activity involvement. However, these two aspects did not reinforce each other. CONCLUSION. When monitoring activity involvement in clients with cognitive decline, health care professionals should take into account clients’ ability to use everyday technologies and the amount of everyday technologies they use.