Role of OT in Aging-in-Place Initiatives

PURPOSE: The aim of this study was to determine the efficacy of programs and interventions within the scope of occupational therapy practice which address or modify the risk factors that impact older adults (age 60+) and their independence. As the aging population expands, there is a growing need for support to these individuals. Occupational therapists approach the lifespan through a holistic and client-centered perspective which places them in a key spot to address these issues.

DESIGN: The research team conducted a systematic review of 42 peer reviewed articles. Inclusion criteria consisted of peer reviewed articles published in the last 30 years that explored interventions within the scope of OT, in which participants aged 60+ were community dwelling or living independently. We excluded articles if participants resided in assisted living or received care in long term care facilities, or had one of the following diagnoses: dementia, neurological disorder impacting mobility, or severe cognitive decline. Additionally, articles that focused on the efficacy of an assessment tool or were limited to qualitative exploration of fear of falling were excluded.

METHOD: An extensive search and analysis of literature published from 1991 to 2020 from five electronic databases (CINAHL, ProQuest Central, Academic Search Premier, Cochrane Library, and OTSeeker) was conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Two reviewers completed an independent title and abstract screening, with disagreements resolved by consensus and input from two other reviewers. Included articles were peer-reviewed, involved community-dwelling participants age 60+ receiving interventions within the scope of occupational therapy.

RESULTS: Findings support the effectiveness of OT-led interventions on preventing falls. OT was directly involved in the intervention in 23 of the 42 articles reviewed; this included seventeen Level 1, two Level 2, and four Level 3 studies. While effective interventions fell along a continuum that included population, small groups and/or an individual, statistically significant improved outcomes in falls reduction were found in studies that paired community-based programs with tailored home visits. Programs that included discussion of a range of topics around productive aging and preventing falls proved far more effective than generalized education. Lastly, the findings support programs that integrate a multidisciplinary approach to treatment, as well as those that utilize community volunteers.

CONCLUSION: The evidence supports OT in addressing risk factors that threaten independence and promoting successful aging for older adults. Strong evidence for OT was found for the following: group and individual multifactorial programs, home-based, and exercise interventions. The skill of an OT practitioner in understanding the roles, habits, routines, and environment of the individual allows for pragmatic recommendations that foster higher rates of adherence than generalized education and/or recommendations. Considering the scope of training and the holistic approach to treatment, OT is a sensible point profession to use to assess and coordinate care for community-dwelling older adults.

IMPACT STATEMENT: This research supports the valuable role of OT in the area of aging in place and provides evidence for the profession to be prioritized as an effective member to be included in community agencies. These findings can inform the effective delivery and integration of OT to support older adults age in place at the population-, group-, and individual-level.

References

Alexander, J., Sartor-Glittenberg, C., Bordenave, E., & Bordenave, L. (2015). Effect of the matter of balance program on balance confidence in older adults. GeroPsych, 28(4), 183-189. https://doi.org/10.1024/1662-9647/a000121

Clemson L., Fiatarone Singh M. A., Bundy A., Cumming R. G., Manollaras K., O’Loughlin P., & Black, D. (2012). Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): Randomised parallel trial. BMJ: British Medical Journal, 345(7870), e45-47. https://doi.org/10.1136/bmj.e4547

Guse C. E., Peterson, D. J., Christiansen, A. L., Mahoney, J., Laud, P., & Layde, P. M. (2015). Translating a fall prevention intervention into practice: A randomized community trial. American Journal of Public Health, 105(7), 1475-1481. https://doi.org/10.2105/AJPH.2014.302315

Szanton, S., Leff, B., Wolff, J. L., Roberts, L., & Gitlin, L. N. (2016). Home-based care program reduces disability and promotes aging in place. Health Affairs, 35(9), 1558-1563. https://doi.org/10.1377/hlthaff.2016.0140