Portrayal of Cognitive Changes in the Media: Connections to Occupational Therapy

Madeleine Wirth, OTD, OTR/L, University of Pittsburgh

During the pandemic, like most other responsible occupational therapy students, I committed my time to the occupational balance of two things: academics and binge watching any and every TV show I could find. As our occupations and routines changed drastically, I reflected on the changes not only in my daily life, but also in the daily life of the clients and caregivers who I stopped seeing abruptly. During my OTD capstone experiential preceptorship, I was privileged to work with clients in a variety of stages of dementia, ranging from mild cognitive impairment to end-stage Alzheimer's disease, as well as their caregivers.

One night, I noticed a trend in the portrayal of cognitive impairment in the media through two popular ABC shows: This Is Us and Grey's Anatomy. For readers who are unfamiliar with the story lines, here is the gist. In This is Us, Rebecca, a middle-aged mother of three, begins to exhibit changes in behavior. Although one of her sons notices these changes, Rebecca continues to deny any difficulty until Thanksgiving Day, when she loses her sense of direction, cell phone, and train of thought, leading her to wander throughout the greater Philadelphia area. In Grey's Anatomy, Dr. Richard Weber, a witty, genius general surgeon who has taught all the medical residents and attending physicians, has an immediate onset of impulsivity, social withdrawal, confusion, disorientation, and hallucinations during a medical conference. In both scenarios, I noticed the TV programs not only portraying the symptoms of cognitive changes, but also the experiences of family and friends, including their reactions and actions toward their loved one.

Shock, sadness, disbelief, support, and anger were all emotions displayed on the faces of family members immediately after realizing their loved one had changed. Then, there was a period of blaming themselves, “How could I have not realized these changes sooner?” This is the truth. Many clients and caregivers I have served have explained this to me. It is gradual, over a few episodes, until there is an event that pushes family members to realize what has been happening and causes them to seek help. Receiving the diagnosis through a series of tests and screens is the first step, followed by a period of establishing a new routine. In the past, the media had a habit of portraying dementia in a negative tone. During the later stages of dementia, institutionalization may be necessary, but in the early and middle stages many individuals with dementia thrive in the community that is familiar to them. It is refreshing to see modern media reflect the realistic tones of homes and lives that real-life clients, family members, and friends experience. Along with the refreshing positive change, these shows accurately demonstrate that not only does the individual with dementia need to process the diagnosis and adjust to a new routine, but their surrounding family and friends also experience a transition.

So, you may be thinking: Where is the referral to occupational therapy? While I would hope that it is happening off screen, this shift in thinking highlights an opportunity to advocate for our services. As part of our scope of practice, occupational therapy practitioners can work with individuals with cognitive changes and their caregivers to support them in establishing new routines. Environmental modification and activity analysis are the strong skillsets that we bring to addressing any stage of dementia. Incorporating loved ones and educating them on changes their loved one will experience is part of the therapeutic relationship. In addition, addressing the lifestyle changes that occur, especially as dementia progresses, can facilitate aging in place and fulfilling end-of-life wishes. Fortunately, the reality is that most individuals with dementia are staying at home longer due to the support of family and friends.

As I enter the field with this refreshing perspective, I’ve made a commitment that whenever I see future TV show episodes come out portraying the world of dementia care, I will talk more about occupational therapy. I will talk about the support occupational therapy can provide to individuals experiencing cognitive changes and their caregivers. I will talk about the team of health care professionals who can help them adjust to new routines. I will be part of the positive approach we all can have to supporting those affected by dementia.

I invite you to binge watch the shows and continue spreading the positivity that occupational therapy can bring to this population.

Madeleine Wirth, OTD, OTR/L, is a recent graduate from the Doctor of Occupational Therapy program at the University of Pittsburgh, where she also received a Graduate Certificate in Gerontology. As a young occupational therapist, she is interested in working with older adults and their caregivers to assist older adults to successfully age in place with the highest quality of life.