Running Head: OCCUPATIONAL PROFILE AND ANALYSIS: HOSPICE

Occupational Profile & Analysis: Hospice Care

Sydney Carnevale
Touro University Nevada

OCCUPATIONAL PROFILE AND ANALYSIS: HOSPICE

Occupational Profile
Client Information
Adler is a sixty-eight year old white male living in Las Vegas, Nevada. Adler was
diagnosed with Parkinsons disease six years ago and Parkinsons disease dementia (PDD) with
increasingly severe symptoms noted over the past few months. The client is currently
experiencing increased shortness of breath, decreased balance and strength, and impairments in
memory, attention and cognition. The client has been with Gerinet Hospice Care for slightly
more than six months with a hospice diagnosis of Parkinsons disease.
Adler lives in a one-story home in Las Vegas with his wife, who is his primary caregiver.
There are no other family members that live in the area. The bathroom is next to the bedroom
and has a tub/shower combo with grab bars but no chair. He is being seen by a certified nursing
assistant (CNA) from Gerinet three times a week. Until a year ago, Adler was independent in
activities of daily living (ADLs) and most instrumental activities of daily living (IADLs). Within
the last year, Adler has been experiencing significant memory loss that has affected his ability to
recall vital emergency, safety, and medication information.
Adler has been increasingly depressed and anxious over the last year. Adlers wife is
concerned that his antidepressants will make him disoriented and result in a fall. She works three
days a week during which Adler is left alone in the home. He is quite lonely when his wife is
gone and ends up sleeping most of the day. As a result, he often has a difficult time falling asleep
that same night and is very fatigued the next day. Adler has given up all leisure occupations
within the past three years and states he only watches television. He feels unmotivated and is
having significant difficulty remaining engaged in his daily routines.

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Reasons for Seeking Services

Hospice is an emerging practice area for occupational therapy, therefore Gerinet Hospice
Care does not offer occupational therapy as a service for their clientele. Based on observations of
Adlers performance, he would benefit from skilled occupational therapy services in order to
increase participation in daily occupations and meaningful activities through energy conservation
techniques, task and environmental modifications, and the establishment of routines and habits
that promote successful participation despite progressive cognitive and physical decline.
Adler is having difficulty remembering important information such as medication
dosages and frequency. Adler admitted that he was concerned about his ability to take the right
medications at the right time. His wife states that she has to set up his medications for him
because she is fearful he will overdose on medication by accident. He is using a transparent
plastic pill box that holds all of his medications although he often misplaces the pill box if he
does not put it back exactly in the same place on the sink.
Adler would also benefit from skilled interventions to address his declining balance,
functional gait changes, and the safe use of his front wheel walker (FWW). Neither Adler nor his
wife knows how to use the FWW safely and he finds that it will often slip away when he tries
to stand. He also is having more difficulty ambulating around his home due to an evolving
festinating gait. Further education regarding proper body mechanics and the safe use of durable
medical equipment (DME) could be beneficial for reducing the risk of falls and increasing his
ability to move around his home to complete his ADLs.
Adler would benefit from energy conservation techniques to increase participation in
ADLs. He has been experiencing weakness, fatigue and significant shortness of breath. Adler
stated that he is no longer able to cook a meal or complete a shower by himself because he runs

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out of steam. Specific breathing techniques and recommendations for adaptive equipment (AE)
could foster successful completion of meaningful occupations.
Supports and Barriers to Participation
When asked about what he did well or what he felt successful in, Adler often responded
negatively needed significant prompting to come up with examples. He finds solace in the
knowledge he can still toilet and perform grooming tasks by himself. He also mentioned that he
is happy that he is still able to effectively communicate with his wife. When asked to think of
more qualities he felt satisfied with, Adler became agitated and no further questions were asked.
Adler explained that the increasing physical weakness, shortness of breath, and memory
losses were significant barriers to his participation in meaningful occupations. He often would
forgo showering as to not bother his wife. Adler stated that he feels like a burden and that he
wants his wife to be his wife, not his caregiver. Adler said he feels paralyzed by his inability to
control his health and is fearful of the future. His anxiety has led to social isolation and he no
longer participates in activities in fear of feeling short of breath or becoming confused.
Environmental Supports and Barriers
The setup of the home is somewhat conducive to successful participation in occupations.
There are no stairs and the house has a very open floor plan. During the day, Adler spends most
of the time watching TV if his wife is not home. He can move about the home to go to the
restroom, the bedroom to rest, or go to the kitchen. He has a Life Alert system and wears it
around his neck in case of falls or emergencies. Adler also has access to other medical devices
such as his FWW and an oxygen machine in the bedroom to use as necessary.
A primary social support is the fact that Adler is being cared for his wife who is very
motivated to help Adler maintain his independence and quality of life for as long as possible. She

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is open to learning new techniques to care for her husband, whether it be through cognitive
strategies, transfer techniques, or environmental modification. Adler also expressed that the help
from hospice was an excellent support as he felt safe with his care, was not experiencing any
pain, and knew that if he needed anything he could always call.
Environmental barriers include dim lighting, long cords on the floor, and lack of public
transportation. Adler has had a fall as a result of the lighting and not being able to distinguish
between floor surfaces. The long cords on the floor have proved to be a safety concern especially
as Adler maneuvers his FWW through the home. Another barrier is the lack of his ability to sit
outside of his home because of stairs outside of the doors as well as lack of transportation.
Occupational History
Adler was born in Rhode Island in a small Jewish suburb of Providence. He was one of
two children living with their parents. Adler graduated from a local high school and never sought
out other educational opportunities. Adler lived in Rhode Island until the age of 20 when he left
to pursue a career at a manufacturing plant in New York City. It was there that he met his wife
and they were married three years later. The couple had three children all of whom have families
of their own. The children and grandchildren all currently live in Manhattan. Adler and his wife
continued to live and work in New York until they moved to Las Vegas twenty-one years ago.
Adler worked in Las Vegas at a local business and his wife worked in a small floral shop
during the week. Adler and his wife were very involved in the Jewish community and enjoyed
taking time to travel to New York. Adler began to notice that he was having more difficulty
maintaining his balance and felt increasingly weak at work. Over the years, Adler still tried to
remain engaged in the community and was able to move about the home with minimal difficulty.
Six years ago Adler was diagnosed with Parkinsons disease, however he had been experiencing

OCCUPATIONAL PROFILE AND ANALYSIS: HOSPICE

symptoms long before then. Adler was given a FWW one year ago after he had a fall. Adler
began to experience declines in cognitive function approximately six months ago, especially
memory. Adler has become more dependent on his wife to complete his ADLs and IADLs.
Showering is very difficult for him to complete due to fatigue, short of breath, and confusion.
Adler no longer cooks but he can prepare simple cold meals without help. Adlers wife fills up
his pill box every Sunday, however Adler has been requiring more prompting to take his
medication at the right time.
Values and Interests
Adler truly values his relationship with his wife and it causes him great stress that his wife
has now had to become his caregiver. He is unhappy with the changes that are occurring and
feels guilty that his wife has to help him complete even the most mundane tasks. Alder also
values his independence. As his symptoms progress, he is finding it difficult to maintain his
independence. Adler wishes to remain independent, especially in more personal self-care
activities such as toileting and bathing, for as long as possible. Until recently, Adler has always
loved to cook. He was the primary meal preparer of his home for many years and he found the
activity cathartic. He wants to re-engage in cooking as it will provide him with some activity to
immerse himself in while his wife is at work. Adler also explains that he has started making art
and wishes to continue now that he is mostly homebound.
Daily Roles
Adler stated that his roles included patient and husband, however the role of husband was
slowly slipping away as his wife became more like his caregiver. Adler engages in few non selfcare occupations and has continued to delegate tasks to his wife. Adler loves his wife and will try
to make her cards when she is out of the house. He finds that completing a card or a small picture

OCCUPATIONAL PROFILE AND ANALYSIS: HOSPICE

makes him feel like he is giving back to their relationship. He is angry about the stress he feels
he has placed on his wife but is not sure how to re-engage in meaningful roles such as preparing
meals for the home or maintaining the home.
Patterns of Engagement
Adler has not been able to drive for over five years now. He gave up driving because he
no longer felt he had the physical or cognitive capacity to drive safely. He no longer participates
in other IADLs such as meal preparation or medication management. His wife has taken many
roles in response to Adlers declines. Before his diagnosis he was always out of the house and in
the community, but now he feels as though he is a prisoner in his own home
Adler has become more dependent on his wife to complete his self-care and basic ADLs.
This change has increased his depression and he stated he feels helpless. Adler can complete
basic grooming ADLs while seated in the bathroom in front of the sink but he can no longer
shower by himself. He is concerned he is losing the ability to toilet by himself and is very
concerned that this potential decline will seal his wifes role as his caregiver.
Priorities and Desired Targeted Outcomes
Adlers chief priority is to maintain independent in his ADLs for as long as possible. He
is willing to implement new strategies to maintain his independence and increase his overall
quality of life. He would like to focus on effectively using his FWW to complete activities such
as toileting and bathing independently. Adler wishes to be more independent in his ability to
manage his medication. He wishes to focus on preventing possible overdosing or medication
mix-ups. He believes that if he is more independent in his daily routine he will feel less
depressed and be more motivated to participate in activities. Adler is also open to trying new
techniques to manage his fatigue and shortness of breath. Role competence will be addressed as

OCCUPATIONAL PROFILE AND ANALYSIS: HOSPICE

Adler wants to be able to cook a meal and create art without feeling short of breath. He wants to
become more involved in the relationship with his wife but not as her patient.
Occupational Analysis
Context/Setting
The observation of Adlers performance was conducted in the master bedroom in his
home. Adler is currently receiving hospice services at his home.
Observations of Dressing and Analysis
I was able to observe Adler perform upper and lower body dressing while seated edge of
bed. Adler experienced significant shortness of breath throughout the activity but did not utilize
many rest breaks. He exhibited good static sitting balance and fair dynamic sitting balance as he
gathered his clothes for upper body dressing. He was able to complete this portion of the activity
with extra time and limited frustration. Lower body dressing proved more difficult and
he exhibited poor activity tolerance, unsafe use of DME, and confusion regarding the location of
items. He did not utilize any adaptive equipment during the task. Adler was incredibly frustrated
throughout the lower body dressing activity that led to erratic breathing patterns. He was able to
locate his pants and put them on with the use of his FWW for balance, however the FWW was
facing the wrong direction. No sequencing deficits were noted throughout the task.
Adlers wife made him take a break, and she brought him his oxygen via nasal cannula.
He sat for approximately three minutes to catch his breath. Once in control of his breathing, he
went to put his socks and slippers on, however, he could only find one of the socks and became
angry that someone had moved it. With some cueing, Adler was able to look under the sheets to
see his sock had been next to him. He felt embarrassed by his oversight and finished putting on
his socks and slippers. Overall, he had some difficulty maintaining his balance sitting on the edge

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of the bed while lifting his feet up to put on the socks but he was able to complete the task
without physical assistance.
OTPF Domains
Many occupational domains are affected by Adlers diagnosis including: ADLs, IADLs,
rest and sleep, leisure, and social participation. Based on the clients desired outcomes and goals
it will be important to address those domains that are directly linked to his safety, such as
learning how to safely utilize the FWW to complete self-care ADLs. Addressing rest and sleep,
leisure, and social participation can help tackle psychosocial factors that are impacting Adlers
ability to successfully participate in meaningful occupations.
Problem List
Prioritized Problem Statements and Justification
1. Client requires multiple VCs re medication management routine 2 memory deficits.
A significant portion of the clients anxiety and depression seems to stem from the
recognition of his changing functional abilities. Both the client and his wife are concerned
about his ability to manage his medication and take the prescribed amount. By addressing
cognitive deficits through compensatory techniques, the client may feel more in control of his
life and have greater success in the completion of ADLs and IADLs. Focusing on cognition
should be a primary focus of the intervention as cognitive processes are central to all aspects
of participation, especially safety awareness and judgement.
2. Client requires Mod (A) to complete showering 2 activity tolerance.
Adler relies on help from his wife to complete his bathing routine and this situation
has been increasingly frustrating for him. He is highly motivated to complete showering and
self-care ADLs with greater independence and success. Adler would benefit from skilled

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instruction regarding the safe use of DME and AE in the shower in order to prevent future
injury and increase his current level of occupational performance.
3. Client requires Min (A) for functional transfers c FWW 2 safety awareness.
Neither Adler nor his wife feel as though they received enough education to safely
use the FWW during activities. Adler utilizes the FWW for transfers and functional
ambulation however he rarely positions the equipment in a safe way to complete the task. If
he continues to use the walker without proper safety precautions there is an increased chance
of future falls as his physical and mental faculties continue to decline.
4. Client requires Min (A) to complete meal preparation activity 2 memory deficits.
Adler has had more difficulty completing meal preparation activities due to
decreasing memory which poses safety concerns, such as leaving the stove on. Addressing
meal preparation through environmental modifications and adaptive cognitive strategies will
improve self-efficacy and role competence. As his cognition continues to decline, it will be
important to continually adapt the environment and the task demands in order to reflect
Adlers abilities.
5. Client requires (S) to complete LB dressing 2 dynamic sitting balance.
Due to the progressive nature of the clients diagnosis, implementing adaptive
dressing strategies are important while the client is still able to comprehend and teach back
the techniques to the therapist. Safety concerns were observed during the lower body
dressing activity, such as the unsafe use of the FWW for balance. Although safe use of DME
will be addressed during all activities and skill generalization will be encouraged,
establishing safe DME use for dressing will improve functional outcomes.
Long Term and Short Term Goals

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LTG: Client will complete morning & night time medication routines c Mod (I) c use of
timer pill box & reference sheet within two weeks.
o STG: Client will sort one weeks worth of morning medication into pill box c (S)
& set timer on pill box within one week.
o STG: Client will create a written medication sheet for the month c (S) c important
medication information to hang above the pill box within one week.

LTG: Client will complete bathing routine c (S) for setup using a TTB & long handled
AE tools within three weeks.
o STG: Client will safely perform shower t/f c (S) for cueing c FWW & TTB within
one week.
o STG: Client will learn at least two dyspnea control techniques c (S) & teach wife
techniques within one week.

Intervention, Approach and Outcome

Short Term Goal One Intervention. Although Adlers cognitive status will continue to
decline, it is important to him that he can still manage his medication at this time. This
intervention can focus on reviewing the current medication list with him as prescribed by hospice
care. It is important to review the current medication list as the names and dosages of
medications frequently change depending on his current health needs. Adler will be encouraged
to review the types of medication he has to take as well as consider the precautions of the
medication (such as taking the pills with food). Adler can then sort the pills into the pill boxes
with assistance as necessary. The use of a pill box with a timer can provide Adler with a visual
and auditory cue of when to take his medication in case his wife is not home. The pill box should
have large letters on the front corresponding to the days as Adler has mild vision loss.

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Throughout the intervention, it will be imperative that his wife is present so that she can learn
cueing strategies and ways to develop routines to assist her husband in the future.
Cognitive strategies should be developed for those with cognitive decline to maintain
independence and improve safety outcomes at home. This is especially true regarding medication
regimens for older adults, especially those with chronic conditions, as they are often complex
and are given with minimal instruction (Kaasalainen et al., 2011). Environmental supports, such
as the use of a timed or color coordinated pill box, can assist in independent medication
management. Interventions should focus not only on learning a new cognitive strategy, but
medication compliance especially as cognitive symptoms become more severe. The use of
adaptive equipment and new cognitive strategies supports a modify approach (American
Occupational Therapy Association [AOTA], 2014). The goal of this intervention is to prevent
possible drug overdose or other medication-related complications by providing Adler with the
tools he needs to navigate his many medications.
Short Term Goal Two Intervention. A cooking activity that involves writing out a
recipe list can address similar performance skills and client factors needed to create a medication
reference sheet while also addressing Adlers desire to become more independent in the kitchen.
Adler will be encouraged to complete a meal activity that has at least five steps, such as making
spaghetti with sauce. He will be asked to write down the steps to the recipe including pertinent
safety information (ex. turning off the stove at the completion of the task). He will have to
identify possibly safety hazards as well as describe ways to remedy the situation. These
reminders will be written on the recipe guide and highlighted. The activity will take place in the
kitchen, and Adler can utilize his FWW to move about the space. He will be encouraged to use
energy conservation techniques such as sitting down at the stove, using a smaller pot for water,

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and taking rest breaks while the water is boiling. He and his wife will receive instruction on how
to make the kitchen a more workable environment by modifying the space, such as bringing
commonly used items to accessible shelves. One of the benefits of this intervention is that it
involves occupation as a means to address pertinent client factors and performance skills that can
help Adler reach his goal in writing out a medication list with the necessary dosage and
precaution information.
Effective cognitive strategies must be enveloped within purposeful and meaningful
occupations for the client to truly benefit. Familiar activities can help showcase efficient
occupational performance, boost autonomy, and encourage role competence. The client must be
motivated to become immersed in the intervention for the effects to be long-lasting and
generalizable (Phinney, Chaudhury, & OConnor, 2007). This intervention is focusing on
preventing possible complications from taking the wrong medication as well as preventing future
occupational performance problems. Although Adlers cognitive and physical status will
continue to change, the goal of the intervention is to increase Adlers ability to participate in his
daily routine through compensatory strategies.
Short Term Goal Three Intervention. Adler will be taught proper methods to transfer
from standing to the TBB with the FWW. He is currently able to get into the tub/shower with
minimal difficulty however he finds it very challenging to get out of the shower due to fatigue.
His wife often has to help him in the shower because Adler becomes much too tired while
standing to complete the activity safely. The use of a TTB will not only provide him a safer way
to get in and out of the shower but allow him to utilize energy conservation and dyspnea
techniques to increase his activity tolerance. Adler will be given instruction regarding the safe
use of his FWW, specifically how to make sure it is positioned in a way that promotes safe

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transferring. All shower mats will be removed to eliminate the risk of the FWW getting stuck or
caught. His wife will also be taught how to assist Adler during the transfer and how to provide
effective cues if necessary. Not only does focusing on the shower transfer increase his safety and
independence, but other occupations can also be addressed throughout such as getting dressed,
undressed, and self-care ADLs that can be done sitting down in the shower.
Home hazards are an undeniable truth and are often the cause of life changing falls for
older adults. For those with declining balance, home hazards may pose an enormous threat to
safety and health. The reduction of home hazards through environmental modifications and
training can significant decrease the risk of future falls (Lord, Menz, & Sherrington, 2006). It
will be important to focus on teaching both Adler and his wife how to use the FWW to transfer to
the TTB to ensure compliance with safe transfer techniques. This intervention will focus on
performance modification through the implementation of DME and new transfer techniques
(AOTA, 2014). The goal of the intervention is to prevent future fall or injury and provide an
energy conservation control method through practice and skilled instruction.
Short Term Goal Four Intervention. Adler enjoys creating art and feels as though it is a
small way to give back to his wife. An art activity not only addresses leisure deficits but can
include the use of cognitive, dyspnea, and energy conservation techniques that can be
generalized to other daily activities. Adler can complete a table top art project that addresses
performance factors such as locating items, safely navigating to the table with his FWW,
initiating the activity, and completing the activity. Adler can be encouraged to utilize safe transfer
techniques with DME and dyspnea techniques if he feels out of breath. As Adler gathers and
organizes the supplies, the therapist can prompt him to use diaphragmatic breathing or pursed-lip

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if he feels out of breath. Energy conservation techniques such as completing the activity during
the time of day he feels most energized can also be encouraged.
Progressive cognitive diseases, such as Parkinsons disease dementia, significantly affect
creativity as there is damage to parts of the brain responsible for interpreting and retrieving
images from memory (Cummings, Miller, Christensen, & Cherry, 2008). The use of art can
enable clients to use colors or lines to represent how they feel if they are no longer able to
communicate effectively their emotional state. Adlers participation in an art activity will
promote feelings of control and address important psychosocial issues are being addressed such
as declining communication, stress, and guilt. Dyspnea control techniques interwoven within a
meaningful activity have a greater chance of being generalized and adopted as a habit.
The approach method of this intervention is to modify the task environment and
performance techniques to promote success. The use of dyspnea control and energy conservation
techniques is a new concept for Adler and will have to be taught across various activities to
promote independence use. The desired outcome is to increase Adlers feelings of well-being,
which includes positive changes in self-esteem, increased role competence and meaning, and
successful participation in self-determining activities (AOTA, 2014).
Precautions and/or Contraindications
During the interventions, it will be important to take into consideration some precautions
in order to uphold the safety of the client and caregiver. Monitoring Adlers vital signs, especially
his oxygen saturation, will be crucial during all tasks and activities. Decreased oxygen saturation
can put the client at greater risk for confusion or a fall. Another precaution to consider is Adlers
balance and how the disease progression will continue to negatively impact his ability to safely
ambulate with and without DME to complete his daily routine. Extreme fatigue and poor activity

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tolerance is also something to take into account as it could lead to falls, exacerbate symptoms of
fatigue, and can lead to feelings of frustration or depression.
Frequency and Duration
In order to address Adlers functional concerns, it would be appropriate if he received
skilled occupational therapy services for approximately sixty minutes per day, two to three times
per week depending on health status. It should be noted that due to the progressive nature of his
diagnosis compounded with the mission of hospice, aggressive treatment options are not
appropriate and the focus should be on the maintenance of client factors and performance skills.
Activity Grading
During the cooking activity, there will be many opportunities to grade various tasks to
develop the just right challenge. One way to grade down the activity is to have Adler write down
the steps of the recipe as he completes each one, rather than writing them all at the end. By
adapting this portion of the activity, Adler can focus on recalling information and identifying
safety hazards with greater success and independence. One way to grade up the activity is to
have Adler complete a more complicated meal that requires more than five steps or that requires
greater insight into possible safety hazards, such as using sharp utensils. It should be noted that
the grading of this activity should focus on adjusting the cognitive components, rather than the
physical components, to progress towards the intended goal.
Framework
The compensatory frame of reference would be the most appropriate choice to guide
Adlers treatment as it is used when a disability is considered chronic or permanent.
Interventions that are based on the compensatory frame of reference focus on teaching clients
new ways of completing meaningful activities through modifications in method, the

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environment, materials, and techniques. Task performance can be strengthened by reducing the
number of steps, introducing adaptive tools and implementing energy conservation strategies.
Adlers current functional deficits call for the use of the compensatory frame of reference
to increase successful participation in meaningful occupations. For example, the use of a tub
transfer bench or long handled bathing tools could increase successful participation. Energy
conservation techniques will improve Adlers overall safety and independence in the home. The
establishment of new habits and routines can help sustain independence and improve
occupational performance. The basic tenets of this framework emphasize encouraging the clients
to take an active role in problem resolution and goal determination.
Caregiver Education
Caregiver education is incredibly important especially within the scope of hospice care
and as Adlers disease progresses. The therapist should focus on utilizing an explanatory model
of illness for both the client and caregiver to have a firm understanding of disease mechanisms as
they relate to functional outcomes. His wife should be given information and resources regarding
the progression of Parkinsons and PDD and how occupational performance will calibrate to
reflect the practical reality of future functional decline.
Another primary focus of caregiver education will be to help redefine successful occupational
performance. Although Adler may not maintain high levels of independence, he may still be able
to participate in a significant way. Redefinition of success will decrease caregiver burnout and
address her emotional health. Strategies should be taught that focus on behavior management,
especially as Adler's dementia symptoms, become more severe. Through communication
techniques and sensory strategies, Adlers wife can help to decrease behavioral outbursts and
confusion as the disease progresses.

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Further education regarding transfer techniques and bed mobility will be significant for
both Adler and his wife, especially as the disease progresses. Adler will remain at home until he
passes away, as per the philosophy of hospice care, so it would be beneficial for Adlers wife to
learn proper body mechanics for transfers in order to reduce risk of injury. Adlers wife would
also benefit from education regarding cognitive strategies that she can utilize to keep Adler safe
while he is at home. Techniques such as labeling drawings, removing sharp items, and labeling
hot versus cold faucets can prevent injury and further debility. Establishing and maintaining
simple routines for her husband will promote higher greater functional participation in ADLs
over time. Instruction should also be given on how to cue properly Adler to perform tasks,
whether it be through verbal, tactile, or proprioceptive means.
Adlers wife should be given guidance as her roles continue to change in the relationship.
She should feel as though she can find the necessary resources, such as support groups and home
modification companies. For many caregivers, feelings of occupational imbalance and
deprivation are common and must be a consideration of treatment. As Adler approaches the end
stages of life, his wife will begin role disengagement. Her role as a caregiver has become an
integral part of her identity and, therefore, she will go through a significant transitional period.
She should be given instruction on how to assist with final stages of personal development and
be encouraged to recollect on important memories with her husband to promote a healthy and
gentle transition. The implementation and practice of positive coping strategies could increase
feelings of role competence, self-efficacy, and increased quality of life.
Outcome Measures
The Mini Mental State Examination (MMSE) is a reliable measure of cognitive impairment
among individuals with dementia. The assessment is highly sensitive to cognitive change over

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time that can help project functional outcomes and needs. The MMSE is a quick examination of
registration, attention and calculation, recall, language, ability to follow simple commands, and
orientation (Alzheimers Society, 2015). These cognitive factors need to be measured and tracked
to maintain safety and quality of life in the home. The results can be used to create specific
cognitive strategies to increase Adlers occupational performance as well as help guide the
caregivers educational process.
The Functional Independence Measure (FIM) would be an appropriate measure to track
Adlers abilities to perform ADLs and the resulting caregiver burden (Keith, Granger, Hamilton,
& Sherwin, 1987). Many healthcare professionals are trained in the use of the FIM, therefore, it
will be helpful to use in a hospice setting as many different professionals will see Adler
throughout the week. As Adler becomes more dependent, the interdisciplinary team will need to
evaluate what physical and cognitive strategies are most appropriate to meet the clients goals
and the needs of the caregiver all while upholding the mission of hospice care.
The Burden Interview would help determine specific factors that are the primary cause of
caregiver burden. The assessment has been designed to expose the stresses felt by caregivers of
dementia patients (University of Iowa Health Care, n.d.). Although Adler is the primary client,
the nature of hospice care calls for interventions to include the caregiver and other family
members. Tracking levels of caregiver burden will provide the occupational therapist with an
understanding of the impact of the clients disability on the caregivers quality of life and
emotional state.

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References
Alzheimers Society. (2015). The mini mental state examination (MMSE). Retrieved from
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=121
American Occupational Therapy Association. (2014). Occupational therapy practice framework:
domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1),
S1-S48.
Cummings, J. L., Miller, B. L., Christensen, D. D., & Cherry, D. (2008). Creativity and
dementia: emerging diagnostic and treatment methods for Alzheimer's disease. CNS
Spectrum, 13(2 Suppl. 2), 1-20.
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