Occupational Therapy and Older
People: Assessment and Evaluation of
Health and Well- being
Deborah Davys and Ellen Tickle
Session learning outcomes:
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Consider the role and background of
occupational therapy regarding health and
wellbeing in older people.
Consider the evidence base for occupational
therapy interventions with older people.
Present a range of relevant assessment and
evaluation tools.
Older People: definitions, issues and
context
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Issues – physical, psychological, social
Statistical info
UK government perspective –notable policies
directly aimed at older people; NSF for Older
People (2001) and Employment Equality
(Age) Regulations (2006), Equality Act (2010)
Definitions of health and well being
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According to WHO (2006) , healthy ageing is
concerned with living a longer yet healthier life and
relates to physical, social and mental health along
with reduced levels of disability
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WHO (2001) suggests a major determinant of
healthy ageing is living an independent life for as
long as possible
OT role re older people
Core OT philosophy is related to :
 Occupation is fundamental to health and wellbeing
 People want to engage in occupations that are
meaningful and purposeful to themselves as an
individual
 People want to take control of and manage their
own lives
People want to be valued
Evidence of efficacy of community OT with older
people
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Steultjens et al (2004) carried out a systematic review related to the
effectiveness of OT in in maintaining independent community living for
older people aged 60 and above.
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Strong evidence for the efficacy of OT advising on equipment to
improve functional ability.
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Some evidence for the effectiveness of OT in skills training alongside
home safety assessment to reduce the incidence of falls in older
people.
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Some evidence for the effectiveness of OT in improving functional
ability, social participation and quality of life for older people.
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Insufficient evidence for OT interventions that involve counselling
primary caregiver of dementia patients about maintaining patients
functional abilities.
Evidence for OT within mental health, well being
and older people
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Graff et al 2007 Effects of Community OT on Quality of Life, Mood and
Health Status of Dementia Patients and Their Caregivers: A
Randomised Control Trial. Journal of Gerontology. Vol.62A, No 9
1002-1009.
Sample - 135 community dwelling older people with mild to moderate
dementia and their informal caregivers
Intervention - 2 groups ; OT intervention group ( environmental
modification, cognitive behavioural strategies, problem solving) and
no OT intervention for 10 weeks.
Outcome measures - Dementia Quality of Life Instrument, the
Cornell Scale for Depression, Centre for Epidemiologic Studies
Depression Scale, General Health Questionnaire 12 and Mastery
Scale used with patients and their carers.
Results - Overall Dementia Quality of Life was significantly better in
the intervention group compared to the control group and significant
12 weeks post intervention.
Evidence for OT in health promotion training for
older people with visual difficulties
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Eklund et al (2008) A randomized control 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. Vol.15, pp68-74.
Sample - 229 older people (65 years +) who have macular
degeneration
Intervention -Activity based health promotion programme compared to
an individual programme- both led by OT`s
Outcome measures – Functional tasks e.g. stairs, bath, dressing etc.,
SF-36 and self-rating scales for health issues such as coronary,
vascular, musculoskeletal, psychological and fatigue issues.
Results - The health promotion maintained their ADL independence
level despite lowered visual acuity whilst individual intervention group
increased dependence in ADL. Both groups lowered general health
levels but the health promotion groups reported fewer health problemsmaintained at 28 months post intervention
Evidence for OT regarding well being and life
engagement for older people
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Horowitz and Chang (2004) Promoting well-being and engagement in life
through occupational therapy lifestyle redesign. Topics in Geriatric
Rehabilitation. Vol.20, No.1, pp46-58.
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Sample - 28 older people with a range of chronic conditions (depression,
COPD, diabetes and spinal stenosis)
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Intervention - 16 week experimental group for lifestyle redesign( focused on
daily routines, physical and mental activity, nutrition, medication, home and
community safety and assistive technology) controlled with usual adult day
programme.
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Outcome measures -Mini-Mental Status Exam, Functional Status
Questionnaire, SF-36(V2), Centre for Epidemiological Studies Depression
Scale, Life Satisfaction Index-Z Scale, and the Master Scale.
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Results -a favourable outcome for the experimental groups in relation to Role
Functioning, Bodily Pain, General Health Survey SF-36,Social Activity on the
Functional Status Questionnaire and Centre for Epidemiological Studies
Depression Scale.
Examples of tools used within
research to assess and evaluate
health and well being for older
people (Graff et al 2007
Horowitz and Chang 2004,
Clark et al 2001)
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Mini-Mental Status Exam, Functional Status Questionnaire,
SF-36(V2), Centre for Epidemiological Studies Depression
Scale, Life Satisfaction Index-Z Scale, Master Scale
Dementia Quality of Life Instrument, Cornell Scale for
Depression, General Health Questionnaire 12
References
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Clarke,F., Azen,S., Carlson,M. et al.(2001) Embedding health-promoting
changes into the daily lives of independent-living older adults: long-term
follow-up of occupational therapy intervention. The Journals of
Gerontology Series B: Psychological Sciences and Social Sciences 56B
(1):pp60-63.
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Eklund et al (2008) A randomized control 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. Vol.15, pp68-74.
Graff et al 2007 Effects of Community OT on Quality of Life, Mood and
Health Status of Dementia Patients and Their Caregivers: A
Randomised Control Trial. Journal of Gerontology. Vol.62A, No 9 10021009.
Horowitz and Chang (2004) Promoting well-being and engagement in
life through occupational therapy lifestyle redesign. Topics in Geriatric
Rehabilitation. Vol.20, No.1, pp46-58.
References continued:
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Steultjens , E.M.J., Dekker,J., Bouter,L.M., Jellema,S. et al (2004) Occupational
therapy for community dwelling elderly people: a systematic review. Age and
Ageing.Vol.33 No.5 pp 453-460.
World Health Organisation – www.who.org
Assessment web addresses
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Functional Status Questionnaire http://rangevoting.org/fun_status_question.pdf
Mini Mental State Examination www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.p
df
SPF-36v2 Health Survey http://www.dfwback.com/pdfs/SF36HealthSurvey.pdf
Range of rating scale examples
http://counsellingresource.com
Life satisfaction - http://www.gesher.org/MyersBriggs/life_satis_index.html