Most health professionals working in residential aged care facilities (RACFs) will agree that physiotherapy and exercise for individuals living with dementia is a neglected area, even though there is evidence that demonstrates numerous benefits.
A systematic review found studies demonstrated significant improvements in cognition, agitation, mood, mobility and functional ability for individuals living with dementia in RACFs when they participated in exercise.
Recent Australian studies have also demonstrated the feasibility of physiotherapy and exercise for individuals living with dementia in RACFs, as well as improvements in functional ability and behavioural and psychological symptoms of dementia.
Best practice dementia care guidelines recommend nonpharmacological interventions, such as physiotherapy and exercise, be the first approach utilised by healthcare practitioners when helping individuals living with dementia manage their symptoms.
The Accreditation Standards for Australian RACFs promote independence and exercise, in line with current evidence. In contrast, the Aged Care Funding Instrument (ACF) focuses on dependency levels of individuals living in RACFs
Although it might be an unintentional outcome, RACFs become financially dependent on assessing the dependency of individuals in their care rather than promoting independence. None of the ACFI domains include funding for exercise interventions (Australian Physiotherapy Association 2016). Physiotherapy is only considered in a restricted role as part of pain management.
The rigid ACFI guidelines impede physiotherapists using their clinical reasoning skills to provide interventions, such as exercise as part of chronic pain management.
Instead, ACFI guidelines prescribe the type and frequency of pain management treatment, unsupported by current evidence (Australian Physiotherapy Association 2012). A recent review of ACFI found it was no longer fit for purpose because it does not reflect a contemporary understanding of the aged care sector, or the characteristics of individuals living in RACFs.
Evidence supports the use of exercise to maintain function, independence and reduce pain for individuals living with dementia in RACFs. In contrast, ACFl appears focused on assessing dependency levels, rather than assessing care needs which would prevent, maintain or promote the capacity and function of individuals living with dementia in RACFs.
More needs to be done to enable RACFs to adopt a reablement model of care which would, inevitably, include a focus on promoting exercise and physiotherapy among individuals living with To facilitate changes, issues with policies and practices, such as ACFI need to be addressed, or perhaps a new evidence-based funding tool needs to be developed.
This content was originally published in ANMF’s Australian Nursing & Midwifery Journal, Volume 25, No.7, February 2018
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