Stephanie Stephenson, MOT, OTR/L AOTA Emerging Leaders Development Program 2011
Definition of Occupation
Ordinary and extraordinary things people do in their day-to-
day lives that occupy time, modify the environment, ensure survival, maintain well-being, nurture others, contribute to society, and pass on cultural meanings and through which people develop skills, knowledge, and capacity for doing and fulfilling their potential (Crepeau et al., 2009, p. 1162).
Activity that is personally meaningful and contextually
anchored within older peoples everyday lives has the greatest ability to enhance health-related outcomes (Hay et al., 2002, p.1386).
than doubled to 70 million, or one in every five Americans (Ad Hoc Group on Aging, 2007, p. 1).
Occupational therapists facilitate optimal occupational
performance and community participation across the full spectrum of ability, from healthy adults actively engaged in their communities to those who are coping with serious physical and mental health conditions in more supported environments like assisted living facilities and nursing homes (Ad Hoc Group on Aging, 2007, p. 1).
We focus on what occupation looks like in real life We collaborate with clients and family to create a workable plan for everyone involved (OSullivan, 2011 personal communication).
Emphasis on the therapeutic relationship leads to client-centered goal-setting as individuals feel able to share what is meaningful to them
What are the demands of the activity? What are the barriers to performing the activity? What skills are required to complete the activity? How does the environment affect participation in the activity? What is the cultural meaning ascribed to the activity?
Occupational therapists can implement and execute broad theoretical ideas; they flesh out what it looks like in a persons daily life (Gitlin, 2011, personal communication).
Occupational therapy goes so far beyond activities of daily living and addresses overall life management, including health promotion and balance within all contexts (Clark). Occupational therapy practitioners utilize their understanding of the aging process to enable older adults to participate in meaningful activities in their desired environment given their individual abilities and personal attributes. Occupational therapy practitioners analyze situations from a variety of life points of view (OSullivan, 2011, personal communication). Older adults have unique perspectives on what is considered independent vs what kinds of activities or changes in routine are considered dependent. Occupational therapy practitioners consider each adult individually to understand their perspective on aging and what is meaningful in relation to maintaining independence (Yuen et al., 2007).
Impact of Routine
Occupational therapy is the only profession with explicitly
independence by incorporating new health routines into old routines (OSullivan, 2011, personal communication).
Occupational therapy practitioners help people function with various limitations such as cognitive or physical (Gitlin, 2011, personal communication).
Occupational therapy practitioners focus on what someone CAN do (Smith, 2011, personal communication).
Occupational therapy practitioners help people figure out how to bring older adults home even with physical barriers (Clark, 2011, personal communication).
Our emphasis on [participating in daily activity] translates into living life meaningfully whether well elderly, chronically ill, or recovering from injury (Scott, 2011, personal communication).
The Top 10
Occupational Therapy Interventions that are Cost-Effective and Promote Wellness and Participation
Aging in place does not just happen. Aging in place is a process and an outcome (Siebert, 2007, p. 2). Aging in place is not simply maintaining residence in a dwelling. It is the acquisition of services, supports, and resources that sustain engagement in valued activities, routines, roles, and relationships within the home and community. So, aging in place also means sustaining participation without having to move (Siebert, 2007, p. 2).
Occupational therapy provides clients with the tools to optimize their home environments relative to individual abilities and promote full participation in daily life activities.
safety awareness, strength, attention, problem solving, vision, communication, and many other functions while the individual performs daily tasks (Fagan & Sabata, 2011, p. 1).
in collaboration with architects, builders, remodelers, national association of home builders, AARP, Rebuilding Together, etc. (Morris, 2009).
own home where they need to be independent; we can make a better impact, see solutions, and facilitate follow through (Smith, 2011, personal communication).
recommendations led to decreased risk of falls.
There is no better place to treat or work with older adults than in their
2. Falls Prevention
In 2000, the total direct medical costs of all fall injuries for people 65 and
older exceeded $19 billion. By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion (CDC, 2011). falling. Occupational therapists assist older adults to recognize and overcome their fears and problem-solve about how to keep from falling while staying active. Fear of falling can lead to self-limitation in performing activities and tasks that people need to do to remain as independent as possible (Scheinholtz et al., 2006, p. 2).
Fear of falling can be both a risk factor for falls and a consequence of
after d/c significantly reduced the proportion of fallers from 26% to 8.8% (Di Monaco et al., 2008, p. 449).
changes, and use of assistive devices.
encourage behavioral change to meet the goal of reducing falls Intervention approaches: lower limb balance and strength exercises, coping with visual loss, medication management, environmental and behavioral home safety, and community safety strategies
Clemson et al. (2004) demonstrated reduced falls in the
intervention group by 31% as a result of the Stepping On program. In addition, the intervention group displayed increased confidence and used more protective behavioral practices.
Tools may include: low vision devices, home modification/adaptation, lighting options, medication management strategies, reading adaptations, etc.
Low vision has a psychosocial impact on the older adult, including but not limited to being able to recognize faces or accurately dial the phone number of a friend.
Occupational therapy practitioners can assist the older adult to remain in social circles and be active and engaged socially.
In addition to low vision adaptation, occupational therapy practitioners can increase older adult safety by providing recommendations about the home environment, including reducing clutter, refining organizational skills, and strategies to safely live at home following cognitive decline (Scott, 2011, personal communication).
For example, occupational therapy practitioners can ensure that older adults can dial 911 in an emergency.
4. Driving/Community Mobility
Comprehensive driving evaluations mean more than
continuation/discontinuation of driving, or pass/fail; occupational therapy helps older adults transition from driver to rider with the emphasis on the mobility the driving provided, preserving social engagement and an active lifestyle (Schold Davis, 2012, personal communication; Scott, 2011, personal communication).
Occupational therapy evaluation and intervention helps older adults
retain driving when possible through strategies, adaptive devices, or vehicle modification (Schold Davis).
indicative of driving risk: vision, cognition, and physical function.The generalist role is important in determining readiness for and success with the most complex of IADLs during on the road driving tests (Dickerson, 2011, personal communication; Schold Davis).
CarFit is an educational program that offers older adults the opportunity to understand the design of safety features in their vehicle and the steps required to make adjustments to attain optimal person-to-vehicle fit.
The CarFit program is a positive and non-judgmental educational opportunity for drivers seated in their vehicle. Each program is encouraged to offer a Goody Bag of local educational information including where to find off the shelf adaptive devices as well as driving rehabilitation services (what they are and how to find them). All resources support a drivers choice to drive as long as safely possible. CarFit contributes to driver safety. It is the hope that enhanced awareness and the attainment of optimal person vehicle fit can lead to decreased accidents, injuries, and death. The longer a driver remains accident/injury free the longer he or she drives, reducing the demand for communities or providers such as Medicaid/Medicare to financially support transportation for the older adult (Costa, 2011, personal communication; Schold Davis, personal communication, 2012).
occupational therapy practitioners assist older adults with accessing the community in order to promote increased social participation.
For example, assisting the older adult to arrange transportation to
an activity at the senior center or promoting intergenerational socialization by assisting the adult to volunteer at a local school.
Occupational therapy practitioners address access to
their own homes safely for as long as possible through environmental evaluation and adaptation. Practitioners may also provide wellness programs, such as falls prevention and caregiver educational sessions. They help those with dementia in long-term-care and adult day health settings to retain existing function for as long as possible. Throughout the continuum of care, occupational therapy practitioners intervene both as direct care providers and as consultants (Robnett, 2012, p. 1). may demonstrate improved function through compensation or adaptation (Robnett, p. 1)
and finding ways for those with dementia to enjoy life are the keys to successful occupational therapy intervention (Robnett, p. 2).
If families were supported in how they can help older people age in place or live with children, there would be less people in residential community situations (Clark, 2011, personal communication). Occupational therapy is important in helping family and caregivers understand the importance of meaningful occupations (Toto, 2011, personal communication).
For example, meal preparation may be an important role for an older family member, but the family may feel they are keeping a family member safe by removing the individuals need to participate in meal preparation. The family may not consider the consequence of eliminating this role or understand how to support the older adult in maintaining their contribution to the family.
Occupational therapy practitioners assist caregivers with maintaining a connection to their own life and valued activities separate from care giving (OSullivan, 2011, personal communication).
Tailored Activity Program 8 session, 4 month structured occupational therapy intervention that provides dementia clients with activities tailored to their capabilities and trains family caregivers in their use (Gitlin, Hodgson, Jutkowitz, & Pizzi, 2010).
It has been shown to reduce the frequency of behavioral occurrences, particularly shadowing and repetitive questioning, and reduce caregiver time providing instrumental care and daily oversight.
Care of persons with dementia in their environments (COPE) nonpharmacologic, biobehavioral approach to support physical function and quality of life for clients with dementia and the well-being of their caregivers (Gitlin, Winter, Dennis, Hodgson, & Hauck, 2010).
It targets modifiable environmental stressors. The intervention seeks to re-engage clients in daily activities and increase functionality, thereby alleviating caregiver burden. Improved client functioning especially in instrumental activities of daily living (i.e. meal preparation, shopping, managing finances, etc.), client participation, and caregiver wellbeing and confidence using activities.
element to promote longevity and healthy lifestyles (Gitlin, 2011, personal communication).
oriented intervention had a positive effect on vitality, social function, mental health, life satisfaction, depressive symptomatology, and bodily pain (Clark et al., 2011, p. 4).
The Well Elderly Study was based on the hypothesis that participation in occupational can positively impact health and prevent decline. Participants were divided in a treatment group involved in occupation-based treatment and a control group that did no not receive occupational therapy, but participated in social activity groups.
Occupational therapy practitioners can use yoga or tai chi as part of a holistic approach to treatment in preparation for or as an adjunct to occupation-based intervention
Occupational therapy practitioners need additional training and must demonstrate competency with these interventions in order to incorporate them into a comprehensive occupational therapy program Just as physical agent modalities are used as preparatory or adjunctive to therapy, yoga and tai chi can be used as preparation to enable a client to participate in a valued activity.
Yoga aids in breathing deeper and easier, decreased pain, stress reduction, autonomic responses such as metabolizing sugar better, increased memory, increased attention (Sabel, 2011, personal communication). Tai Chi improves body awareness so the principles can be applied to everyday occupations such as sitting at a desk, bending down, reaching up, lifting heavy objects, etc.
9. Mental Health
Occupational therapy arose as a profession closely linked to psychotherapy in the early 20th century as health professionals recognized the impact of participation in meaningful daily activity on mental and physical health (Crepeau et al., 2009).
Seven million people older than age 65 in the United States live with a diagnosable psychiatric illness. That number is expected to double. Older adults with psychiatric illness have lower quality of medical care, have higher mortality rates than those without psychiatric illness, and are more likely to be placed into nursing homes despite their ability to complete all self-care activities (Scott & Mahaffey, 2010, p. 98). Occupational therapists play a key role in understanding behavior and finding ways to intervene that help their clients maintain dignity, participation, and a sense of purposeregardless of mental status (Scott & Mahaffey, p. 110).
Modification of environment to promote relaxation or reduce stress and agitation Alleviation of depression through participation in meaningful activities
in 10 Americans experience limitations in daily living activities and participation in the community due to a chronic disease (Bondoc & Siebert, 2012).
Occupational therapy interventions assist in: Addressing problems or symptoms associated with specific chronic conditions to sustain current abilities Developing strategies to incorporate energy conservation and activity modification techniques into daily activities to cope with physical demands and reduce fatigue associated with many chronic conditions Learning and incorporating health management tasks into existing habits so they become part of ones routine
Resources
http://www.aota.org/Consumers/consumers/Adults.aspx
http://www.aota.org/older-driver www.carfit.org
Caregivers:
http://www.aota.org/Practitioners/Resources/Collections/Resources/Aging.aspx
Falls Prevention:
Stepping On:
http://sydney.edu.au/health_sciences/staff/lindy_clemson
http://www.dhs.wisconsin.gov/aging/CDSMP/SteppingOn/index.htm#How%20was%20the%20Program%20Develo ped?
http://www.cdc.gov/HomeandRecreationalSafety/images/CDCCompendium_030508-a.pdf
Thank You!
Deborah Yarett Slater, MS, OT/L, FAOTA Laura Collins, AOTA Communications Director JoAnne Wright, PhD, OTR/L, CVLT Donna Costa, DHS, OTR/L, FAOTA Tina McNulty, PhD, OTR/L Richard Sabel, MA, OTR, MPH, GCFP Laura Gitlin, PhD Elin Schold Davis, OTR/L, CDRS Karen Smith, OT, CAPS Florence Clark, PhD, OTR/L, FAOTA Pamela Toto, PhD, OTR/L, BCG, FAOTA Anne Dickerson, PhD, OTR/L, FAOTA Janie Scott, MA, OT/L, FAOTA Jennifer Kaldenberg, MSA, OTR/L, SCLV, FAOTA Ann OSullivan, OTR/L, LSW, FAOTA
References
AOTA Ad Hoc Group on Aging. (2007). The AOTA report to the executive board. Bondoc, S., & Siebert, C. (2012). The role of occupational therapy in chronic disease management: Chronic disease fact sheet. Retrieved May 23, 2012 from http://www.aota.org/Consumers/Professionals/WhatIsOT/PA/Facts/Chronic-DiseaseManagement.aspx?FT=.pdf CarFit. (2011). Program goals and outcomes. Retrieved December 10, 2011, from http://www.car-fit.org/ Centers for Disease Control and Prevention. (2011). Costs of falls among older adults. Retrieved December 10, 2011, from http://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html Clark, F., Jackson, J., Carlson, M., Chou, C., Cherry, B., Jordan-Marsh, M., et al. (2011). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 randomised controlled trial. Journal of Epidemiology and Community Health. Retrieved on December 10, 2011, from http://jech.bmj.com/content/early/2011/06/01/jech.2009.099754.short Clemson, L. Cumming, R. G., Kendig, H., Swann, M., Heard, R., & Taylor, K. (2004). The effectiveness of a community-based program for reducing the incidence of falls in the elderly: A randomized trial. Journal of the American Geriatrics Society, 52(9), 1487-1494. Crepeau, E., Cohn, E., & Schell, B. (Eds.). (2009).Willard and Spackmans occupational therapy. Philadelphia: Lippincott Williams & Wilkins.
References
Di Monaco, M., Vallero, F., De Toma, E., De Lauso, L., Tappero, R., & Cavanna, A. (2008). A single home visit by an occupational therapist reduces the risk of falling after hip fracture in elderly women: A quasi-randomized controlled trial. Journal of Rehabilitation Medicine, 40, 446-450.
Eklund, K., Sjostrand, J., & Dahlin-Ivanoff, S. (2008). A randomized controlled trial of a health-promotion programme and its effect on ADL dependence and self-reported health problems for the elderly visually impaired. Scandinavian Journal of Occupational Therapy, 15, 68-74. Fagan, L. A., & Sabata, D. (2011). AOTA fact sheet: Home modifications and occupational therapy.
Gitlin, L. N., Hodgson, N., Jutkowitz, E., & Pizzi, L. (2010). The cost-effectiveness of a nonpharmacologic intervention for individuals with dementia and family caregivers: The tailored activity program. American Journal of Geriatric Psychiatry, 18(6), 510-519.
Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W. (2010). A biobehavioral home-based intervention and the wellbeing of patients with dementia and their caregivers: The COPE randomized trial. Journal of the American Medical Association, 304(9), 983-991. Hay, J., LaBree, L., Luo, R., Clark, F., Carlson, M., Mandel, D., et al. (2002). Cost-effectiveness of preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society, 50, 1381-1388. Morris, A. L. (2009, April 6). Collaboration for accessibility and aging in place. OT Practice, 14-17.
References
Robnett, R. (2012). AOTA fact sheet: Dementia and the role of occupational therapy. Sanders, M., Alvanas, K., Doherty, K., Kurczy, K., & Wetmore, C. (2011). Community-based programs to promote successful aging in older adults. AOTA Annual Conference Poster Presentation. Scott, J. B., & Mahaffey, L. (2010). Occupational engagement of older adults with mental illness. In M. K. Scheinholtz (Ed.) Occupational therapy in mental health: Considerations for advanced practice (pp. 97-113). Bethesda, MD: AOTA. Scheinholtz, M. K., Burkhardt, A., & Miller, P. A. (2006). AOTA fact sheet: Occupational therapy and prevention of falls. Siebert, C. (2007, December). Aging in place and occupational therapy. Gerontology Special Interest Section Quarterly, 30(4), 2-4. Yuen, H. K., Gibson, R. W., Yau, M. K., & Mitcham, M. D. (2007). Actions and personal attributes of community-dwelling older adults to maintain independence. Physical and Occupational Therapy in Geriatrics, 25(3), 35-53.