By Janet Engel. OT/L, CAPS
As our life expectancy continues to increase, so does our likelihood of developing dementia. We may be asking ourselves this question: Is mom or dad safe at home alone? Dementia is a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain. Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia, are just a few diseases that fall under this large umbrella. Dementia affects our ability to carry out activities of daily living (ADL’s). Once a diagnosis of dementia has been determined, does this mean that the individual is no longer able to live alone, safely? The answer is complicated.
Cognitive Screening Tool
Using a standardized screening tool like the Allen Cognitive Levels, also known as the ACL, is a great place to start. The ACL was created by Claudia K Allen, MA, OTR. FAOTA, an occupational therapist and educator, and her colleagues. It is an assessment used to help providers spot cognitive conditions like dementia. It is also used to determine how much help a person may need with ADL’s and their ability to safely live alone.
The ACL is different from other cognitive tests. It does not test memory or verbal answers to questions. Instead, it uses fine motor skills, ability to follow directions, and learning. The person is asked to use a needle and a leather string to perform 3 different types of stitches. One stitch builds on the other to create a more complex stitch. The person is rated on the number of mistakes they make as well as their ability to recognize and fix a mistake and their ability to learn the stitch from the occupational therapist administering the test and replicate it correctly. The ACL is also an effective measure of an individuals’ functional abilities. Their score is directly related to their ability to prepare a meal safely, bathe, get dressed, perform personal hygiene tasks, and ultimately live safely by themselves.
The ACL has 6 levels. Level 0 is a comatose state, meaning the person is unaware of themselves or their environment. Level 1 – the person can move around a little but requires total assistance from a caregiver for all ADL’s, Level 2 – the person may be able to perform large body movements however continues to need 24 hour assistance to complete a daily routine. Level 3 – A person operating at a level 3 is recommended to have help and supervision and some level of assistance with all ADL’s such as dressing, bathing, toileting, and personal hygiene. Level 4 – this is a gray area. At a lower level 4, a person may have difficulty with problem solving and may need a strict routine and frequent checks to live alone safely. If a person is at the higher level 4 they may get by with weekly check-ins safely. Level 5 – Is characterized by mild cognitive impairment. The person is still able to perform a daily routine safely and learn new things. Believe it or not…teenagers operate at a level 5. If you have been the parent of a teenager this explains a lot…I know from personal experience. Level 6 – the highest level with no cognitive impairment. Our ability to perform executive functions is intact.
If you have a loved one that has been diagnosed with dementia or you are personally suffering from this disease, seek the help of an OT or another professional that is trained in using the ACL, to accurately determine your ability to live alone safely. A significant amount of money can be saved and quality of life preserved in preventing prematurely moving into assisted living or memory care. Equally, it is just as tragic to allow a loved one to live alone without the proper support in place to ensure their safety. In order to schedule a cognitive evaluation with an OT, contact your primary care physician, neurologist, or psychologist for a referral. Services provided by an OT are covered under private and Medicare and Medicaid insurance.