Occupational Therapy in Productive Aging: Top 10 Things

Occupational Therapy
in Productive Aging:
The Top 10 Things
Everyone Needs to Know
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,
Occupational Therapy in
Productive Aging: The Need
 “By 2030, the number of older Americans will have more
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).
Occupational Therapy in
Productive Aging
Occupational therapy is hands-on and practical
We focus on what occupation looks like in real life
We collaborate with clients and family to “create a workable plan for everyone involved”
(O’Sullivan, 2011 personal communication).
Occupational therapists are experts in activity analysis
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 person’s daily life” (Gitlin, 2011, personal communication).
Occupational Therapy
in Productive Aging:
Holistic and Client-Centered
“Occupational therapy practitioners are architects of life.”
(Clark, 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”
(O’Sullivan, 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
focused training on participation in everyday life” (Clark, 2011,
personal communication).
 Is the older adult’s routine productive and health promoting?
 What we do everyday is what we become.
 Healthy everyday activity is an insurance policy against decline.
 (Clark)
 “Occupational therapy practitioners help older adults maintain
independence by incorporating new health routines into old
routines” (O’Sullivan, 2011, personal communication).
OT in Action: Tina McNulty
I remember an experience working with a 61 y.o. who had difficulty
with not having enough energy to clean her house and
participate in scrapbooking, which was meaningful to her. I
performed a time use analysis (i.e. identified what activities she
performed at specific times during the day) which showed that
she didn’t eat until 4 pm. She had a cognitive impairment that
caused her to become distracted and forget to eat. From this
finding, we decided on a system of timers which helped her
with her eating routine. She still uses this routine which gives
her more awareness of time and ultimately more energy
because she eats sooner. With increased energy, she is able to
care for her daily needs, maintain participation in meaningful
activities, and maintain her overall health and well-being.
Participation in Occupation
Despite Limitations
“We don’t have to make the person better to make an impact.”
(Toto, 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
“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
The Top 10
Occupational Therapy Interventions
that are Cost-Effective and
Promote Wellness and Participation
1. Aging in Place and Home
“Occupational therapy practitioners help to transform a home from an enemy to a
friend full of security and comfort.”
(Smith, 2011, personal communication)
“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.
Aging in Place and Home
Modifications (cont.)
 “An occupational therapist evaluates balance, coordination, endurance,
safety awareness, strength, attention, problem solving, vision,
communication, and many other functions while the individual performs
daily tasks” (Fagan & Sabata, 2011, p. 1).
 Occupational therapy practitioners are essential team members to include
in collaboration with architects, builders, remodelers, national association
of home builders, AARP, Rebuilding Together, etc. (Morris, 2009).
 “There is no better place to treat or work with older adults than in their
own home where they need to be independent; we can make a better
impact, see solutions, and facilitate follow through” (Smith, 2011,
personal communication).
 Di Monaco et al (2008) found that increased adherence to home modification
recommendations led to decreased risk of falls.
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).
 “Fear of falling can be both a risk factor for falls and a consequence of
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).
 “A single home visit by an occupational therapist at a median of 20 days
after d/c significantly reduced the proportion of fallers from 26% to 8.8%”
(Di Monaco et al., 2008, p. 449).
 OT suggested targeted modifications of the home environment, behavioral
changes, and use of assistive devices.
Unique Occupational Therapy Intervention for
Falls Prevention: Stepping On
 Stepping On is a small group based educational program
facilitated by an occupational therapist
 Goals include: improve confidence in self to avoid falls and
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
 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
3. Low Vision and Safety
“Occupational therapy practitioners provide older adults with tools to remain safe and
independent at home (age in place) despite significant visual impairment.”
(Kaldenberg, 2011, personal communication)
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
OT in Action: Jen Kaldenberg
I worked with a 94 year old artist. She defined herself by
being an artist, however, she developed macular
degeneration which hindered her ability to participate in
this valued occupation. I provided her with environmental
adaptations such as increased lighting and low vision
devices such as a magnifying glass. As a result, she could
return to her art. This actually led to increased
participation in self-care as well as a more positive outlook
on her daily life.
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).
 Generalist occupational therapists routinely evaluate the sub-skills
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).
Unique Occupational Therapy Driving
Intervention: www.Car-Fit.org
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 driver’s 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).
OT in Action: Pam Toto
I had an experience with a woman with multiple sclerosis. She had a few
falls in her apartment. Because of the falls, she was afraid to ride the
bus and go in the community. She realized she couldn’t live
independently in her apartment if she couldn’t ride the bus. Her family
thought she needed to move to assisted living. As her occupational
therapist, I assisted her with community mobility and educated her
regarding self-management strategies for fatigue and anxiety,
advocating for herself by asking the bus driver to wait until she is
seated to begin driving, and pacing strategies for riding the bus such
as planning bus rides for the time of day when she has the most
energy. We rode the bus as part of our occupational therapy sessions,
and she was able to implement these strategies, remain independent
in her apartment, and decrease the potential for caregiver burden and
increased healthcare costs.
5. Social Participation and Social
 Decreased community mobility can lead to social isolation;
occupational therapy practitioners assist older adults with
accessing the community in order to promote increased social
 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
technology for social participation.
 Computer training and cell phone training can assist older adults
with continued social participation (Sanders et al., 2011).
6. Occupational Therapy and
 “In the community, practitioners can assist those with dementia to live in
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).
 “Although remediation of cognitive performance is not likely, the person
may demonstrate improved function through compensation or
adaptation” (Robnett, p. 1)
 “Enhancing function, promoting relationships and social participation,
and finding ways for those with dementia to enjoy life are the keys to
successful occupational therapy intervention” (Robnett, p. 2).
7. Working with Caregivers
“Occupational therapy practitioners can articulate the capacity of an older adult to help family with decisionmaking and daily care.”
(Gitlin, 2011, personal communication)
“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 individual’s 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” (O’Sullivan, 2011, personal communication).
Unique Occupational Therapy Caregiver
Interventions: TAP and COPE
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.
8. Wellness and Health Promotion
“Until we die, we have amazing capacity to change. It’s not about decline; aging
doesn’t necessarily mean you have to live through pain or discomfort.”
(Sabel, 2011, personal communication)
 “Occupational therapy has a preventive role – activity is viewed as a critical
element to promote longevity and healthy lifestyles” (Gitlin, 2011, personal
 The Well Elderly Study demonstrated that a “6-month preventive lifestyle-
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
Unique Occupational Therapy
Wellness Approach: Yoga and Tai Chi
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
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 purpose…regardless 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
OT in Action: JoAnne Wright
I worked with a woman with severe rheumatoid arthritis who
wanted to be able to continue to crochet, but had
significant ulnar drift. I created a splint that would assist
with ulnar drift and allow her to perform her activities of
daily living (dressing, bathing, etc.) as well as continue to
crochet. As a result, she re-engaged in her own self-care
and valued occupation of crocheting. This led to a more
positive outlook and decreased dependence on a paid
caregiver. With her increased participation, she also
improved in overall strength and mobility.
10. Chronic Disease Management
 “The Centers for Disease Control estimated that 25 million or 1
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
 Learning and incorporating health management tasks into existing
habits so they become part of one’s routine
AOTA and Aging:
Older Driver Resources:
Falls Prevention:
Stepping On:
AOTA Resources
CDC Compendium of Effective Community-based Interventions
Thank You!
Deborah Yarett Slater, MS, OT/L,
Laura Collins, AOTA Communications
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,
Anne Dickerson, PhD, OTR/L, FAOTA
Janie Scott, MA, OT/L, FAOTA
Jennifer Kaldenberg, MSA, OTR/L,
Ann O’Sullivan, OTR/L, LSW, FAOTA
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