Dementia ranks as a leading cause of disability for elderly patients. Even worse, researchers expect the prevalence to quadruple over the next thirty years.¹ The disability caused by dementia takes a toll on both the person with dementia and the rest of the family. Yet there may be a solution that goes under-recognized and underused. People rightly devote a lot of attention to the cognitive decline caused by dementia, but dementia often causes rapid physical decline as well. Simply addressing that physical decline can go a long way toward restoring some independence for patients with dementia and supporting family caregivers.

The Toll of Dementia

It’s easy to imagine how dementia can reduce quality of life for those affected by it, and research confirms this is typically the case.¹ Perhaps less well appreciated is the physical toll that caregiving takes on the caregiver. Did you know that retirees who care for a disabled spouse have a 63% higher mortality risk? What’s more, the disability caused by dementia increases healthcare spending and costs to society.

Also less well known is the fact that dementia causes rapid physical decline. This includes problems with coordination, balance, posture, and gait.² These physical challenges add to the disability caused by mental decline and exacerbate the problems with quality of life, caregiver wellbeing, and healthcare costs.³ 

Exercise Therapy for Dementia

Normally, when people face disability caused by disease or injury, the logical treatment is physical therapy. Doctors and families may think of dementia differently. Since the physical effects of dementia are different than those from many other sources of disability, perhaps the role of exercise therapy would be different as well. While exercise therapy in dementia is not the same, research gives us good news. A body of dementia research now shows that physical therapy can slow functional decline, improve balance, and reduce fall risk.^4-7

Nevertheless, people with dementia typically receive fewer rehabilitation services, not more. This may stem in part from focusing on mental decline to the expense of attention to the physical effects of dementia. The problem certainly stems from travel difficulties inherent with disability from dementia.⁸ 

Home Health and Dementia  

When problems leaving the home result in difficulty accessing rehabilitation, Medicare-certified home health is one possible solution. In these situations, Medicare will usually pay 100% of costs. Recently, Dr. Cheri LeDoux, from the University of Colorado, analyzed Medicare records to verify the effectiveness of home health for reducing disability related to dementia. Their results are published in the Journal of the American Geriatrics Society.⁸ They verified that indeed home health improves disability related to dementia. They also showed that the more physical therapy a person with dementia gets at home, the better. 

Dementia and Activities of Daily Living

For each patient, Medicare tracks independence with the following activities of daily living. Therefore, these are the elements of ability/disability tracked in LeDoux’s research.

• Grooming
• Upper-body dressing
• Lower-body dressing
• Bathing
• Getting on and off the toilet
• Toileting hygiene
• Getting up and down from chairs or the bed
• Walking or other locomotion
• Feeding
• Meal preparation
• Telephone use

How Much Physical Therapy Does a Person with Dementia Need?

LeDoux and colleagues found that the more physical therapy a patient receives at home, the higher the likelihood of improvement with activities of daily living.

Number of Physical Therapy Visits – Probability of Improvement

• 0 PT Visits (just nursing) – 60%
• 1-5 PT visits – 69%
• 6-13 PT visits – 81%
• 14 or more PT visits – 89%

Related Article

• Long-term Care Improves Cognitive Function in Elderly

References

1. Arrighi HM, McLaughlin T, Leibman C. Prevalence and impact of dementia-related functional limitations in the United States, 2001 to 2005. Alzheimer Disease & Associated Disorders. 2010 Jan 1;24(1):72-8.
2. Pressley JC, Trott C, Tang M, Durkin M, Stern Y. Dementia in community-dwelling elderly patients: A comparison of survey data, Medicare claims, cognitive screening, reported symptoms, and activity limitations. Journal of Clinical Epidemiology. 2003 Sep 1;56(9):896-905.
3. Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, Zuidema S, McGilton KS. A comprehensive approach to reablement in dementia. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2017 Sep 1;3(3):450-8.
4. Weber SR, Pirraglia PA, Kunik ME. Use of services by community-dwelling patients with dementia: a systematic review. American Journal of Alzheimer’s Disease & Other Dementias®. 2011 May;26(3):195-204.
5. Telenius EW, Engedal K, Bergland A. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial. BMC Geriatrics. 2015 Dec 1;15(1):158.
6. Jensen CS, Hasselbalch SG, Waldemar G, Simonsen AH. Biochemical markers of physical exercise on mild cognitive impairment and dementia: systematic review and perspectives. Frontiers in Neurology. 2015 Aug 26;6:187.
7. Lam FM, Huang MZ, Liao LR, Chung RC, Kwok TC, Pang MY. Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy. 2018 Jan 1;64(1):4-15.
8. LeDoux CV, Lindrooth RC, Seidler KJ, Falvey JR, Stevens‐Lapsley JE. The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia. Journal of the American Geriatrics Society. 2020 Apr;68(4):867-71.