What Alzheimer’s Taught Me as an Occupational Therapist
Five lessons from my work as an occupational therapist—and what they taught me about preserving dignity, independence, ability, and meaningful connection.
September is World Alzheimer’s Month, a time to increase awareness and understanding of Alzheimer’s disease and dementia. For me, it is also a time to reflect on what Alzheimer’s and occupational therapy have taught me about preserving ability, dignity, independence, and meaningful connection.
Many of those lessons came from the people I had the privilege of working with throughout my career.
Long before dementia became part of my personal life, I knew it professionally.
As an occupational therapist, I worked with people living with Alzheimer’s disease and other forms of dementia, including individuals living in dementia care communities.
My job wasn’t to change their diagnosis.
Instead, I was there to ask a different set of questions:
What can this person still do?
What is making this particular activity difficult?
What could we change about the task or environment to make it easier?
How can we help this person continue participating in the everyday activities that give life meaning?
At first, those questions may sound simple, but they can completely change how we approach dementia care.
More importantly, they are consistent with evidence-based occupational therapy practice. Current occupational therapy guidelines emphasize supporting functional performance and meaningful engagement for people living with Alzheimer’s disease and related neurocognitive disorders, while also educating and supporting their care partners.
Over the years, my patients taught me lessons that have stayed with me.
1. Look at What a Person Can Still Do
When someone is diagnosed with Alzheimer’s, it is very easy for everyone around them to begin focusing on what has been lost.
Memory.
Judgment.
Problem-solving.
Familiar routines.
Independence.
As an occupational therapist, I learned to look for something else, too:
What remains?
Consider something as ordinary as getting dressed.
A person with dementia may look at a closet filled with clothing and have no idea where to begin. They may put clothes on in the wrong order, become distracted halfway through, or simply walk away.
It can appear that they are no longer capable of dressing themselves.
The natural response is often to take over.
But what if we change the task instead?
We might lay out only the clothes needed that morning.
Put them in the order they’ll be worn.
Reduce unnecessary choices.
Give one short, clear direction at a time.
Then allow enough time for the person to respond.
As a result, someone who initially appeared unable to dress may actually be able to participate in much more of the activity than we realized.
Research supports this type of approach. A systematic review of activity modification in Alzheimer’s care found strong evidence supporting individualized activities based on retained skills and interests, short and clear cues, environmental modifications, and caregiver involvement.
Helping doesn’t always mean doing something for someone. Sometimes it means changing the situation so they can do more for themselves.
2. Behavior Is Often Communication
One of the most challenging aspects of dementia for families can be changes in behavior.
Someone may refuse a shower.
Become upset during dressing.
Repeatedly try to leave.
Ask the same question again and again.
Resist assistance.
It’s understandable for caregivers to become frustrated.
But working with people with dementia taught me to become curious before assuming someone was simply being difficult.
What might this behavior be telling us?
Maybe the bathroom is cold.
Maybe the water frightens them.
Maybe they’re in pain but can’t explain where it hurts.
Maybe they’re tired or overwhelmed.
Maybe they’re receiving too many instructions at once.
Or perhaps they don’t understand why someone they don’t recognize is asking them to remove their clothing.
When verbal communication becomes more difficult, behavior may communicate a need that the person can no longer easily express.
Current AOTA dementia practice guidelines include nonpharmacological behavioral approaches and care-partner education among evidence-supported interventions for people living with Alzheimer’s and related neurocognitive disorders.
Instead of asking only:
“How do we stop this behavior?”
Sometimes a better question is:
“What might this person be trying to tell us?”
3. The Environment Can Create Problems—or Help Solve Them
This is one of the things I have always loved about occupational therapy.
Sometimes we keep asking the person to change when changing the environment may be much more effective.
A home that worked perfectly for decades can gradually become confusing or unsafe as cognition and physical abilities change.
Too much clutter can make important objects difficult to find.
Poor lighting can make navigating a hallway harder.
A bathroom may no longer provide the visual or physical support someone needs.
Frequently used items may be stored in places that require too many steps to locate or safely retrieve.
Sometimes surprisingly small changes can make everyday activities easier.
We can simplify.
We can organize.
We can improve lighting.
We can provide visual cues.
We can reduce unnecessary choices.
We can put frequently used objects where they’re easier to see and reach.
Evidence supporting occupational therapy approaches includes individualized environmental modifications and compensatory strategies based on the person’s particular needs.
These changes aren’t necessarily about taking independence away.
They’re about creating an environment that supports the abilities a person still has.
For more practical ideas, read: Occupational Therapist-Recommended Products That Made Dementia Care Easier →
4. Independence Doesn’t Have to Mean Doing Everything Alone
Families sometimes feel that accepting help means their loved one has lost independence.
Occupational therapy taught me to look at independence differently.
Sometimes independence means being able to participate in your own life, even when assistance is needed.
Maybe someone can no longer safely prepare an entire meal but can still stir ingredients, set the table, fold napkins, or participate in making a favorite family recipe.
Maybe they can no longer complete their entire morning routine independently but can still wash their face, brush their hair, or choose between two shirts.
Those pieces matter.
They provide familiarity.
They provide purpose.
They offer opportunities for success.
Most importantly, they allow the person to continue being part of their own life rather than simply having everything done for them.
A systematic review of occupational therapy interventions found strong evidence supporting occupation-based interventions for adults with Alzheimer’s disease and related neurocognitive disorders and recommended integrating everyday occupations into daily routines to support occupational performance.
5. A Successful Day May Look Different Than It Used To
This can be one of the hardest adjustments for families.
We naturally compare today with yesterday.
She used to cook an entire Thanksgiving dinner.
He used to handle all the finances.
She used to get herself ready every morning.
Those memories matter.
But constantly measuring today’s abilities against yesterday’s can make it harder to recognize today’s successes.
Sometimes success becomes smaller.
She helped mix the cookie dough.
He chose the music.
She folded the towels.
He smiled when an old song came on.
She completed part of her morning routine with a little assistance.
These moments may seem insignificant compared with what someone once did.
They aren’t.
Meaningful activity doesn’t have to be complicated to have value.
Current occupational therapy guidance continues to emphasize meaningful occupation and participation as central goals when working with people living with Alzheimer’s disease and related neurocognitive disorders.
Alzheimer’s and Occupational Therapy: Looking Beyond Awareness
Awareness matters.
But this September, during World Alzheimer’s Month, I also hope we can change some of the ways we see the person behind the diagnosis.
Alzheimer’s disease can profoundly change cognition, function, relationships, routines, and family life.
But a diagnosis does not erase the person.
There can still be preferences.
There can still be routines.
There can still be humor.
There can still be connection.
There can still be abilities worth supporting.
And there can still be meaningful moments.
As occupational therapists, we look at the relationship between the person, the activity, and the environment.
When something stops working, eliminating the activity isn’t always the only answer.
Sometimes we can change how it’s done.
Simplify it.
Adapt it.
Provide a cue.
Change the environment.
Offer just enough assistance.
And then give the person an opportunity to succeed.
One Question I Hope Families Ask This September
If someone you love is living with Alzheimer’s disease or another form of dementia, I hope you’ll ask yourself:
“What can they still do—and how can I help make that easier?”
It’s a very different question from:
“What can’t they do anymore?”
That small shift in perspective can influence everything from dressing and bathing to meals, hobbies, home safety, and communication.
After years of working with people living with dementia, that is one of the lessons that has stayed with me most.
Look for the person. Look for the ability. Then build the support around them.
This World Alzheimer’s Month, I hope we don’t only raise awareness about what dementia can take away.
I hope we also talk about what remains—and how we can help preserve meaningful participation, dignity, and connection for as long as possible.
Evidence & Resources
For readers interested in learning more about the evidence behind the occupational therapy approaches discussed in this article:
Smallfield, S., et al. (2024). Occupational Therapy Practice Guidelines for Adults Living With Alzheimer’s Disease and Related Neurocognitive Disorders. American Journal of Occupational Therapy, 78(1). The guidelines synthesize evidence from systematic reviews and provide recommendations for occupational therapy interventions for people with Alzheimer’s disease and related neurocognitive disorders and their care partners. Read the AOTA Practice Guidelines →
Smallfield, S., & Heckenlaible, C. (2017). Effectiveness of Occupational Therapy Interventions to Enhance Occupational Performance for Adults With Alzheimer’s Disease and Related Major Neurocognitive Disorders: A Systematic Review. American Journal of Occupational Therapy, 71(5). The review found strong evidence supporting occupation-based interventions, physical exercise, and error-reduction learning. Read the research on PubMed →
Padilla, R. (2011). Effectiveness of interventions designed to modify the activity demands of the occupations of self-care and leisure for people with Alzheimer’s disease and related dementias. American Journal of Occupational Therapy, 65(5), 523–531. The review supports individualized activities, clear cues, environmental modifications, adaptive approaches, and caregiver involvement. Read the research on PubMed →
Green, M., et al. (2023). Interventions Within the Scope of Occupational Therapy to Improve Cognitive Performance for Individuals With Dementia and Mild Cognitive Impairment (2018–2022). American Journal of Occupational Therapy. This systematic review brief summarizes evidence regarding interventions addressing cognitive function for people living with Alzheimer’s disease, related dementias, and mild cognitive impairment. Read the research on PubMed →
About the Author
Kimberly Orlando, MOT, OTR/L, is an occupational therapist with nearly 25 years of experience including working with older adults and individuals living with dementia, as well as a former family caregiver to her mother, who lived with Lewy body dementia. She is the founder of Sunny by Kimberly, where she combines her professional experience and personal caregiving perspective to create practical resources that help caregivers support safety, independence, meaningful activity, and connection.
This article is for educational purposes and is not a substitute for individualized medical or occupational therapy advice.
