ABC’s of OT: NOVELTY and NEW LEARNING within the SNF

When you have dementia, just about everything seems novel and new. A typical day is filled with new faces, new routines, new environments, and new expectations.

So how do we as the OT help these patients adjust to a new routine, environment, and community?

The answer: repetition. Studies have shown that new learning can occur in older adults with dementia if the task to learn is repeated 100 times. You read that right; ONE. HUNDRED. TIMES. This sounds like a lot, but it can be done.

I’ll give you a real-life example that I personally encountered last year.

We had a patient on our long-term unit who, at admission, had a mild to moderate onset of dementia, but was able to retain most new information with ease. She adjusted well to the environment and her overall routine. Fast forward six months. Her dementia had progressed, which meant that new learning had become more challenging. But she was still able to locate her room within the facility and get herself to and from the community areas and the dining area.

Then some census changes occurred, and her room was relocated down the hall. This rocked her world. 

So I added her to caseload, and we worked extensively on environmental orientation. Together we created a decorative sign to hang on the wall outside her doorway. We trialed keeping a cue card in her pocket with her room number written in large print. We ambulated from her room to the community area and back repeatedly. We paced the same route back and forth, and by the end of about two weeks, we had not only traveled that route 100 times, but the patient went from requiring maximum verbal and visual cues to locate her room, to independently recalling its location.

This was a breakthrough for her.

Now, I’m not going to lie; many of the nurses and nursing assistants looked at us like we were crazy. But it worked. This patient was not only able to independently locate her room within the facility, but she was then able to learn how to complete a simple job role on the unit to further maximize her social engagement and quality of life.

The moral of the story? When we show our patients and our nursing staff that we are willing to put in the work, we can make great strides towards patient independence, even among those populations that seem beyond help.

This is one of the oh-so-special qualities of occupational therapy. We see beyond the surface. We look at people and see potential, independence, and purpose. We are innovative, creative, intuitive, and dedicated, and we are not afraid to put in the hard work in order to reap the therapeutic benefit.

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