Our next tweetchat is on Monday 6th December at 8pm GMT. It is guest hosted by @AGILECSP and will look at the topic of physiotherapy for people living with dementia.
Dementia is an umbrella term for a range of conditions including Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia and mixed dementia. There are currently 50 million people living with dementia and approximately 10 million new cases diagnosed each year (1)
While dementia is not a normal part of aging, older age is the primary risk factor for dementia.(1) Therefore, for physiotherapists working with older people in hospital, community and residential settings, it is highly likely that their caseload will include people with dementia. Dementia poses challenges to the individual, as well as both health and social care systems, and physiotherapists working with those with dementia due to the complex nature of its clinical presentation.(2) Symptoms include memory loss, difficulties with visuo-spatial awareness and reasoning or problem-solving, confusion, communication difficulties, and changes in personality and behaviour.(3)
People with dementia are also at increased risk of other complex health conditions e.g. those with Alzheimer’s disease are almost three times more likely to sustain a hip fracture compared to those with normal cognition.(4) There is a growing body of evidence to support the use of exercise and physical activity in the care of people with dementia. (5, 6).Working with people with dementia may require physiotherapy skills including promoting physical activity, prescribing exercise, gait assessment and education, pain management, and falls prevention, but also requires knowledge and confidence in managing both the presenting clinical problem as well as any co-existing symptoms of dementia (7).
We appreciate that physiotherapists specialising in mental health may have a wealth of experience working with people with dementia and would really like to have their input into this tweet chat. However, we are also really interested to hear about the experiences of physiotherapists working in more generic older person’s care settings – what strategies or techniques have you found work well in your care of people with dementia.
Q1. What kind of referrals do you receive for people living with dementia i.e., is it usually for another health problem or is it for directly for their dementia?
Q2. Have you received any kind of training (formal or informal) on working with people with dementia?
Q3. What are the challenges of working with patients with dementia in hospital and community settings?
Q4. What strategies or techniques have you found that work when providing treatment/care for people with dementia? Are these strategies/techniques evidence based?
Q5. Do you find it easy to differentiate between delirium and dementia?
Q6. Do you routinely assess for delirium/dementia, or do you have access to any specialist staff in different settings to support any training needs
Your chat hosts
AGILE is a Professional Network of the Chartered Society of Physiotherapy and is for therapists working with older people – whether qualified physiotherapists, assistants, students or associate members of an allied profession.
AGILE’s mission is ‘To deliver the highest possible physiotherapy practice with older people’ by:
- promoting high standards in physiotherapy with older people through education, research and efficient service delivery
- providing a supportive environment for its members by facilitating the exchange of ideas and information
- encouraging, supporting and co-ordinating relevant activities regionally and nationally
World Health Organization. Global action plan on the public health response to dementia 2017–2025. Geneva: World Health Organization; 2017;Available from: https://www.who.int/publications/i/item/9789241513487
Quick SM, Snowdon DA, Lawler K, McGinley JL, Soh SE, Callisaya ML. Physiotherapists’ and physiotherapy students’ attitudes and beliefs about working with people with dementia: a mixed methods systematic review protocol. JBI Evid Synth. 2021 Feb 26;19(8):1971-1976. doi: 10.11124/JBIES-20-00303. PMID: 34400598.
Yeh SW, Lin LF, Chen HC, Huang LK, Hu CJ, Tam KW, Kuan YC, Hong CH. High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis. Clin Rehabil. 2021 Feb;35(2):169-181. doi: 10.1177/0269215520961637. Epub 2020 Oct 11. PMID: 33040592.
Brett L, Stapley P, Meedya S, Traynor V. Effect of physical exercise on physical performance and fall incidents of individuals living with dementia in nursing homes: a randomized controlled trial. Physiother Theory Pract. 2021 Jan;37(1):38-51. doi: 10.1080/09593985.2019.1594470. Epub 2019 Mar 26. PMID: 30912690
1. Prince M, Guerchet M, Prina MA. The epidemiology and impact of dementia: current state and future trends WHO Thematic Briefing 2015 [Available from: https://www.who.int/mental_health/neurology/dementia/dementia_thematicbrief_epidemiology.pdf.
2. NHS. Dementia 2021 [Available from: https://www.england.nhs.uk/mental-health/dementia/.
3. Alzheimer’s Association. What is Dementia? 2021 [Available from: https://www.alz.org/alzheimers-dementia/what-is-dementia.
4. Melton LJ, Beard CM, Kokme E, Atkinson EJ, O’Fallon WM. Fracture risk in patients with Alzheimer’s disease. J Am Geriatr Soc. 1994;42(6):614-9.
5. Groot C, Hooghiemstra A, Raijmakers P, van Berckel B, Scheltens P, Scherder E, et al. The effect of physical activity on cognitive function in patients with dementia: a metaanalysis of randomized control trials. Ageing Res Rev. 2016;25:13-23.
6. Law C-K, Lam FM, Chung RC, Pang MY. Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review. J Physiother. 2019;66(1):9-18. 7. Hughes J, Bagley H, Reilly S, Burns A, Challis D. Care staff working with people with dementia: training, knowledge and confidence. Dementia. 2008;7(2):227-38.
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