Presented by Sunday Care Therapy

Occupational Therapy (OT) plays a pivotal role in the lives of those living with dementia. This guide explores the transformative power of OT, moving beyond basic care to meaningful intervention. We delve into the current landscape of dementia in the UK, the stages of progression, and four critical domains of practice: Eating, Social Interaction, Exercise, and Sleep.

Part 1: The Landscape of Dementia (2025 Statistics)

Understanding the scale of dementia is crucial for contextualizing care. As of 2025, the statistics in the UK paint a stark picture of the growing need for specialized support:

• Prevalence: Approximately 982,000 to 1 million people in the UK are currently living with dementia. This figure is projected to rise to 1.4 million by 2040.
• Leading Cause of Death: Dementia remains the leading cause of death in the UK. It disproportionately affects women, with nearly 48,500 female deaths compared to just under 27,000 male deaths in the previous year.
• Diagnosis Gap: Despite the high prevalence, there is a significant diagnosis gap. On January 31, 2025, there were 495,904 recorded diagnoses, meaning roughly one-third of people with dementia have not received a formal diagnosis.
• Young Onset: Dementia is not exclusively a condition of old age. Around 1 in 20 people with dementia are younger than 65, totaling over 70,800 people in the UK.
• Economic Impact: The cost of dementia to the UK economy is estimated at £42 billion per year, with projections suggesting this could rise to £90 billion.

Part 2: Understanding the Stages of Dementia

At Sunday Care Therapy, we utilize the Global Deterioration Scale (GDS) developed by Dr. Barry Reisberg. This staging system allows therapists and families to understand the progression of the disease and tailor interventions accordingly.

The 7 Stages of Dementia

Focus on Later Stages (5-7)

Occupational Therapy interventions often focus intensely on the later stages where quality of life can be significantly improved through adaptation.

• Stage 5 Interventions: Focus on preserving identity. Introduce repetition for priming and procedural memory. Grade activities to ensure success and reduce anxiety.
• Stage 6 Interventions: Create a positive sensory environment. Manage stress and monitor for “sundowning” (increased agitation in late afternoon/evening). Be vigilant about diet, swallowing difficulties, and wandering.
• Stage 7 Interventions: The priority is comfort. Tactile stimulation and pain management are essential. Continuous monitoring of skin integrity and sensory input is required.

Part 3: The 4 Domains of Occupational Therapy Practice

Based on thousands of hours of care delivery, Sunday Care Therapy has identified four key domains where therapeutic intervention yields the highest impact.

Domain 1: Eating and Drinking

Diet plays a massive role in brain health. Diets high in processed foods and sugar cause inflammation, which can accelerate the deterioration of connective tissue and the development of Amyloid/Tau plaques in the brain.

Nutritional Guidelines:

• “Eat the Rainbow”: Aim for 10 portions of different fruits and vegetables daily.
• Reduce: Processed meats, dairy (especially butter/margarine), excess alcohol, and refined white carbohydrates.
• Include: Herbs, spices, dark chocolate, herbal tea, and healthy fats (avocado, extra virgin olive oil).

Sensory & Environmental Interventions:

• Contrast is Key: “No white on white.” Mashed potatoes on a white plate can be invisible to someone with dementia. Use plates that contrast strongly with the food.
• Lighting: Turn up the lumens! Ensure lighting is functional and focused on the food.
• Positioning: Never feed a client while they are flat on their back. Ensure they are in a functional, upright position (even for breakfast in bed).

Domain 2: Social Interaction

Social isolation is a major risk factor for mortality and rapid cognitive decline. Interaction stimulates the Amygdala (emotions) and Prefrontal Cortex (personality), keeping these brain regions active.

The SCT 6 Steps to Effective Social Integration:

1. Start Small: If the person is out of practice, do not overwhelm them with large groups.
2. Start on Their Terms: Use a familiar environment and have a trusted support person present.
3. Make it Routine: Incorporate socializing into the daily schedule to utilize priming memory.
4. Positive Framing: Use inviting language. “Aren’t we lucky we get to play cards with John today?”
5. Reminders: Explicitly cue recognition. “John is your good friend from bingo.”
6. Model Emotion: “Fake it till you make it.” Model the joy and calmness you want them to mirror.

Domain 3: Exercise

Exercise is fundamentally about blood flow. It enhances brain connectivity, reduces inflammation, and promotes neurogenesis (the growth of new brain cells).

The Goal:

• Aim for 150 minutes per week (or 30 minutes daily) of moderate-intensity activity.

Functional Exercise for Later Stages: For clients who are bed-bound or have limited mobility, exercise doesn’t mean the gym—it means “Anything Functional.”

• Folding clothes
• Drying dishes
• Balloon boxing
• Assisted personal hygiene routines

Domain 4: Sleep

Sleep is the brain’s maintenance window. During deep sleep, the glymphatic system flushes out metabolic waste, including beta-amyloid and tau proteins. Sleep is also vital for converting short-term memories into long-term ones.

Strategies for Better Sleep:

• Routine: Maintain a strict cycle for waking up, meals, and bedtime.
• Daytime Activity: Inactivity during the day is a primary cause of wakefulness at night.
• Lighting: Exposure to bright morning light sets the body clock. Avoid screens and bright lights 1-2 hours before bed.
• Environment: The bedroom should be calm, quiet, de-cluttered, and have a comfortable temperature.
• Nap Management: Limit naps to 20-30 minutes and avoid sleeping after 3:00 PM.

Sunday Care Therapy – Occupational Therapy-led Home Care Provider