Occupational Performance and Mild Cognitive Impairment in a Primary Care Memory Clinic

Abstract

As Ontario faces a major shift in demographics, it is anticipated that the number of community-dwelling people living with cognitive impairment will increase significantly. Occupational therapists (OTs) may play a key role in ensuring timely diagnosis and/or informing a comprehensive plan of care for this population by assessing and reporting on functional abilities. The purpose of this study was to explore the impact of an OT home assessment on diagnosis and plan of care for persons with Mild Cognitive Impairment (MCI) in a primary care Memory Clinic setting using a before and after design. A toolkit of clinical measures was developed to assess self-perception of occupational performance, instrumental activities of daily living (IADLs), falls risk and home safety. Thirty-one participants who had been assessed by a Memory Clinic team completed a one-hour OT home assessment focused on these attributes. A change in the plan of care was proposed for 24 of 31 participants (i.e., 77%) after the assessment findings were reviewed by the lead physicians of three Memory Clinic teams. Clinical information from an OT home assessment was used by the Memory Clinic teams to change follow-up visit times, plan diagnosis and/or medication review and initiate additional community supports for persons with MCI. Women in this sample were more likely than men to experience changes to their plan of care and were also at a higher falls risk as indicated by scores on a screening tool of this attribute. Several time sensitive issues were identified during the OT home assessment including falls risk, home safety issues and participant concern with driving ability. The addition of an OT home visit to an existing Memory Clinic Model has the potential to change the overall plan of care and to identify issues that may impact overall health and wellness, and the ability to live well at home. While the context for this study was an existing Memory Clinic Model in primary care, the findings have implications for older adults in any health setting who are experiencing cognitive changes.