The Memory Unit OT

It’s no secret that individuals on the Memory Unit often like to roam the halls. Sometimes they get into other resident’s rooms. Sometimes they get behind the nurses’ station. Sometimes they walk so much they put themselves at risk of falling because they never give their muscles a chance to rest.

We’ve already talked at length about why this happens, and a bit about what we can do to redirect to something more structured and meaningful.

But let’s remember that increased walking isn’t always a bad thing. Sometimes it’s the preferred activity. Sometimes it has the most meaning for a resident in that given moment. Which means that our role isn’t to stop the behavior from happening, but to make sure the behavior is as safe and meaningful as possible.

There are Three Basic Things I like to Consider when Assessing Safe Mobility.

1. The current abilities of my resident.

What is her current balance grade? Have I tested that? How far can she walk before she shows signs of fatigue? Does she use an assistive device when walking, and can she remember to use it? Does she have any supplemental things that would need to move with her (i.e. oxygen, splints or braces, etc.)? Does she have appropriate footwear, and can she tolerate it? Has she sustained any falls while living on this unit? Where and when have those falls occurred? Is there a potential to upgrade her status in any of these areas with continued therapy?

In addition to these more objective questions, I’m also going to consider the intrinsic/extrinsic questions about her behavior to determine the ‘why’ behind her constant moving and walking.

2. The Current Setup of the Environment.

Is the unit one long hallway or a continuous loop? Are there a lot of items in the hallway (i.e. walkers, wheelchairs, med carts, mechanical lifts, linen shelves, trash bins, etc.)? Do they all need to be there? Are there lots of narrow corners or small spaces to navigate? Is the floor carpeted? How many windows are there? Is the lighting appropriate? Are there areas to sit down if/when needed? How many other residents are up and moving around during the day? How many staff are present on this unit at any given time (generally)? When are the busiest times of the day?

Figure out what’s working and what isn’t. Talk with the other staff. Spend a portion of your session just observing your resident’s behavior. Try to see her at different times of the day, if able. Investigate the current routine, environment, and behaviors.

3. The current risks if nothing changes (if any).

If I do absolutely nothing about any of the things I’ve noticed so far, what will happen? Is this resident at risk for falling? Does she need an assistive device? Can her balance improve? Could this environment better support her (and likely the other residents)?

Once You’ve Investigated the Current Situation, You Can Start Implementing that OT Magic.

Does your Resident have Potential to Improve Her Mobility? Start working on endurance and activity tolerance. Use some of your sessions to address balance and transfers.

Does she Ultimately Benefit from an Assistive Device when Walking? Incorporate lots of repetitions of walking with an assistive device to improve carryover. Make sure the walker is clearly labeled. Decorate it together with things that are meaningful to her, or use a personalized name plate (these walker banners are so fun and are customizable too!)

Does the Environment Need a little Modification? Remove excess clutter from the halls. Talk with the nursing and maintenance staff about better storage strategies for equipment. Have chairs available throughout the unit for rest breaks as needed. Open the curtains to allow for natural lighting. Secure shoe mats at doorways.

Does the Routine Need a little Modification? Determine staff who could walk with the resident during the times of the day when she is the most active. Reach out to her family to encourage them to visit during these times of the day as well. Implement a routine bathroom schedule. Ensure that snacks and drinks are frequently available to her. Incorporate her ‘why’ for walking into your sessions and into her functional routine.

As with all dementia care strategies, there is no one-size-fits-all solution. We have to assess and determine the specific needs of each resident. We maximize her abilities as much as possible, improving her environment to support her in the areas where her body can’t.