During the COVID-19 pandemic, I was contacted by Alan’s daughter, asking for help to identify specialist equipment that could help to help her dad up from the floor and to recommend reputable trustworthy care agencies to help Alan with personal care tasks, including showering, washing and dressing. After sharing COVID-19 information, completing a risk assessment and accessing full personal protective equipment (ppe). I had the pleasure of meeting Alan*. Alan was an 85 years old man with a diagnosis of dementia with some awareness that he felt confused and forgetful at times. Alan experienced reduced mobility, walked with a walking frame, and had a long history of falls.
Barriers to motivation?
- Falls – fear of falling, loss of confidence
- COVID-19 – self-isolation leading to lower mood, reduced social and environmental stimulation
- Environment – steps leading down into garden, difficulty accessing the shower room and dim lighting in the hallway
- Reduced mobility – limited space indoors and a lack of confidence to walk outdoors
Alan spent most of his time on his favourite spot on the sofa. Only getting up to access rooms within the bungalow. Alan was not motivated to exercise.
Alan was having frequent falls when he got up from the sofa to go to use the toilet in a hurry. He had a tendency to overreach when using his walking frame and appeared to misjudge space in the hallway leading to falls. Alan was missing out on the therapeutic benefits of exercise.
What is motivation?
“Motivation is an internal drive or a need. It is something inside us that desires a change, either in the self or the environment. Motivation gives the person with the focus and direction needed to connect with the environment in an open and problem-solving sort of way.” (Reeve, 2018)
Occupational Therapist Recommendations
- Specialist equipment to help with lifting Alan up from the floor including a demonstration with the equipment at home
- Reputable carers recommended to relieve carer strain and enable personal care tasks to be completed
- Environmental modifications, such as contrasting paint to highlight the corners in the hallway and increased lighting
- Assistive technology, such as bed sensor and a chair sensor to alert Alan’s wife to provide verbal prompts to encourage to slow down, take smaller steps and look towards the direction of travel.
- Meaningful activity, to explore access to existing activities within the home, garden, such as reading and board games and access to the local park.
- Reablement program, a leisure and interest checklist was completed to identify hobbies that were meaningful to Alan with a personalised intervention plan to enhance motivation to achieve goals.
- Housing adaptations, adapting the steps at the back door and altering the shower room layout would make it easier for him to access his home and garden.
- Graded intervention to increase exercise. Alan loves reading and board games, setting a table with a suitable chair in the garden with his favourite book or a board game and a cup of tea, at 20-metres would create a visual prompt and enhance Alan’s motivation to walk towards the chair. The distance was increased at each intervention session, eventually achieving Alan’s goal to walk around the park, at this time 1-hour exercise duration was permitted with COVID-19 regulations. Prior to each intervention session, Alan’s power, strength, ability to stand and range of movement were assessed. Alan’s general mood, confidence and motivation levels were assessed before and after each intervention.
Alan responded well to verbal praise and encouragement. Alan demonstrated his feelings through verbal and non-verbal communication. It was essential to notice subtle cues in Alan’s body language and tone of voice. I worked closely with Alan’s wife who knew him best and engaged in active listening.
Alan responded well to the positive changes. Increasing Alan’s level of exercise resulted in universal benefits including the release of feel good hormone releases which can have a calming effect. Physical activity can improve appetite, sleep and mood as well as reduce stress and anxiety. Alan’s slept well after the intervention sessions. The benefits of sleep are known universally to include improving attention, concentration, keeping a healthy immune system and supporting emotional wellbeing. Regular intervention through his reablement program helped Alan to maintain his skills and independence.
Occupational Therapist self-reflection
Working with Alan has reminded me once again how important it is to adopt a person-centred approach with the effective use of communication skills. It has been a pleasure and a privilege to have had a significant impact in Alan’s life.
If you would like to have a person-centred Occupational Therapy assessment and a reablement program, please contact 07341265564 or contact me via the contact form. I would love to hear from you and explore all the ways in which I could help you and your loved one.
*name altered to maintain confidentiality
References: Reeve, J. (2015). Understanding motivation and emotion (6th ed.). Hoboken, NJ: Wiley.