Occupational Therapy’s Role in Dementia Care: What Is It?

Let’s discuss the true impact of Occupational Therapy (OT) in dementia, and how we make an outstanding difference in the lives of individuals living with dementia. I’ve lost count of how many times I’ve been questioned why OT needs to work with individuals with dementia. When people think of therapy, they picture exercises, balance training, and pain relief. But our role goes far beyond strengthening arms and legs (don’t even get me started on that misconception!).

Now, let's start with discussing the definition of dementia. According to the National Institute on Aging, dementia is an umbrella term for describing neurological conditions that affect the brain, leading to a decline in cognitive function (2022). This loss of cognition results in the loss of abilities to complete daily tasks. While some tasks may seem routine, this just isn't always the case. When an individual transitions from their home environment to assisted living, familiar activities can become more challenging. The sequencing of tasks is often harder to manage and can be highly dependent on the surrounding environment. We play a crucial role in promoting safety, independence, and meaningful tasks that are client-centered.

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Environmental Modifications

Whenever I am referred to work with someone experiencing cognitive decline, I assess several different factors, beginning with the setup of their environment. I often meet individuals for the first time shortly after they move into assisted living, making this an important period for modifying the space and educating family and staff about how the change in environment may affect function. In all rooms, my goal is to reduce clutter and visual overstimulation. Encouraging organization of clothing, moving boxes, decorations, and laundry baskets is typically one of the first areas I address. Once the room is organized, we can more effectively address the individual’s specific needs.

To support daily routines, I provide labels for dresser drawers to clearly identify where different clothing items are stored, improving independence during dressing and laundry tasks. For some individuals, I also create a designated space for next-day clothing so staff or caregivers can lay out an outfit in advance, reducing confusion during the morning routine. This can be especially helpful for those who have transitioned to incontinence briefs or require the use of call-bell lanyards. Additionally, visual instructions can be placed near dressing areas to support task sequencing and further promote independence.

When modifying or adapting a bathroom for someone with dementia, one of the first steps I take is removing any unnecessary items from the sink counter. Reducing visual clutter is essential, as it helps the individual focus on the items needed for the task and decreases confusion. I typically place a toothbrush and toothpaste in a holder, which ideally is one that contrasts with the white sink surface to improve visual processing. I also label drawers containing items such as hairbrushes, shaving tools, hairspray, and lotions to support recognition and task initiation. Near the toilet, written sequencing cues may be added to guide the individual through the toileting process.

For example, I once worked with an individual who was referred to me due to difficulty transferring on and off the toilet. After evaluation, it became clear that the issue was not her physical ability, but her confusion with the bathroom’s setup. With low-contrast walls, floors, and grab bars, she struggled to orient herself and determine proper positioning. To support her, I provided visual written instructions on the wall, added contrast coloring to the grab bar, and placed left and right foot cues on the floor to help her align herself directly in front of the toilet before transferring. Although we were unable to change the overall layout of the bathroom, these environmental modifications significantly improved her independence and success with toileting tasks.

Environmental modifications play an important role in supporting individuals with dementia, as the surrounding space significantly impacts independence and safety, and thoughtful changes can improve functional outcomes in therapy. OTs often begin by reducing clutter and minimizing visual overstimulation to create a calmer, more navigable environment. They may also enhance lighting and increase contrast to improve safety and visual clarity, making key objects easier to identify. Labeling drawers and doors, adding clear signage, or incorporating memory aids can help with orientation and task initiation. Additionally, OTs thoughtfully arrange furniture and frequently used items in ways that promote independence, simplify routines, and support overall engagement in daily activities.

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Social and Activity Participation

As I previously discussed in my blog post “Social Participation in Older Adults: The Effects of Social and Leisure Participation on Cognitive Processing”, social participation plays a key role in cognitive processing. OTs help individuals with dementia stay engaged in meaningful activities through evidence-based therapy activities adapted to their current abilities and interests. We encourage social participation, fostering connections with family, friends, and peers to support emotional well-being (Smallfield & Molitor, 2018). Additionally, OTs work to maintain the individual’s familiar roles and daily habits for as long as possible, promoting a sense of identity, purpose, and continuity in their lives.

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Caregivers and Education

While I could go into every ADL and how OT can step in and modify, there are so many more ways that OT can play a key role in dementia care. Equally important is the support OTs provide to caregivers. We offer education on effective communication strategies, behavior management, and ways to structure activities that reduce frustration for both the individual and the caregiver. When an individual is experiencing cognitive decline, their confusion may lead to aggression, feelings of anger, and occasional combativeness. Educating caregivers and staff on how to mitigate these behaviors and best support the individual can create better communication and task completion, further decreasing burden on the caregivers. What I have seen in the field is that caregivers do not always understand the process and symptoms of cognitive decline. Therefore, they feel unprepared and unsure of how to help their loved one. Providing education to caregivers through written handouts, verbal instruction, and hands-on demonstrations is an effective way to improve their understanding of dementia, ultimately leading to better care outcomes and more positive daily experiences. By adapting the environment, simplifying tasks, and fostering meaningful engagement, OTs help individuals with dementia maintain dignity and quality of life throughout the progression of the condition. 

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Overview

OTs play a crucial role in supporting individuals with dementia. As holistic practitioners, we provide care and intervention to every aspect of the person- though those listed in this blog post are those that I have the most experience with in assisted living. We assess a person’s abilities, challenges, and environment to help maintain function for as long as possible. This often includes breaking tasks into simpler steps, establishing consistent routines, using visual cues, and adapting activities to match the person’s current cognitive level. OTs also identify safety risks, such as fall hazards, wandering, or difficulties with dressing or toileting tasks, and provide strategies or environmental modifications to reduce these risks. Participation in leisure and social activities plays a key role in cognitive processing and providing the individual with meaningful interactions and daily task participation. Caregiver education is a vital component of dementia care, equipping caregivers and assisted living staff with the knowledge and strategies needed to provide the best possible support. Through training in effective communication, task assistance, and promoting meaningful participation, caregivers can better meet the needs of individuals with dementia and enhance their overall quality of life.

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About the Author

Ashley Denny, OTD, OTR/L, CDP, is a geriatric Occupational Therapist for FOX Rehabilitation. She is a graduate of Chatham University, receiving her Doctorate in Occupational Therapy in 2023. She is a Certified Dementia Practitioner (CDP) working with older adults in assisted living and community settings. She has received her First Response Low Vision Certification from the Pennsylvania Occupational Therapy Association (POTA) and her Low Vision Micro-Credential from the American Occupational Therapy Association (AOTA). She also works as a content developer for FOX Rehabilitation digital platforms, creating content for clinicians across the United States on topics such as low vision and dementia modifications, arthritis, stroke rehabilitation, and home safety for older adults.

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References

Martínez-Campos, A., Compañ-Gabucio, L.-M., Torres-Collado, L., & Garcia-de la Hera, M. (2022). Occupational therapy interventions for dementia caregivers: Scoping review. Healthcare, 10(9), 1764. https://doi.org/10.3390/healthcare10091764

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National Institute on Aging. (2022, December 8). What is dementia? Symptoms, types, and diagnosis. U.S. Department of Health and Human Services. https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis

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Pimouguet, C., Le Goff, M., Wittwer, J., Dartigues, J.-F., & Helmer, C. (2016). Benefits of occupational therapy in dementia patients: Findings from a real-world observational study. Journal of Alzheimer’s Disease, 56(2), 509–517. https://doi.org/10.3233/JAD-160820

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Smallfield, S., & Molitor, W. L. (2018). Occupational therapy interventions supporting social participation and leisure engagement for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72(4), 1–8. https://doi.org/10.5014/ajot.2018.030627

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