Professional Documents
Culture Documents
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
“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:
Foundations
Holistic and Client-Centered
“Occupational therapy practitioners are architects of life.”
“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 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
1. Aging in Place and Home
Modifications
“Occupational therapy practitioners help to transform a home from an enemy to a
friend full of security and comfort.”
“Aging in place does not just ‘happen.’ Aging in place is a process and an outcome”
(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).
“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).
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.
OT in Action: Jen Kaldenberg
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
Networking
Decreased community mobility can lead to social isolation;
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.
“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
“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.”
“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).
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-Disease-
Management.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 Spackman’s 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 well-
being 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.