Annotated Bibliography: Integrating Occupational Therapy into Elderly Care

Annotated Bibliography

Dickson, K. L., & Toto, P. E. (2018). Feasibility of integrating occupational therapy into a care coordination program for aging in place. American Journal of Occupational Therapy, 72(4), 1-7. doi: 10.5014/ajot.2018.031419.

Long-term services and supports are available to older adults who wish to age in place even though they may experience age-related impairments and chronic health conditions. Aging in place is defined as “the ability to live in one’s own home and community safely, independently, and comfortably” (Dickson & Toto, 2018). Approximately 87% of American older adults desire to age in place, however, the supply of long-term services and supports is insufficient to serve this growing population (Dickson & Toto, 2018). This article examines the solution of occupational therapy for lessening this need. “Occupational therapy that centers on environmental modifications, education, and skills training to activate older adults to “do for themselves” has been identified as an effective, critical intervention for promoting independence, safety, and quality of life” (Dickson & Toto, 2018). This article presented a study of the benefits of integrating an occupational therapy program into a long-term service and support plan. It examined patients over 16 weeks and implement individualized plans and goals for each person in the study. “Of the program’s feasibility benchmarks, 87% were met” (Dickson & Toto, 2018). The results of this study proved occupational therapy to be an effective approach for helping older adults age in place, and present valuable information for the future of long-term care plans. Most of the services provided through long-term care plans are focused on external needs such as personal care or transportation. Although there are many chronic diseases that will not allow for a person to be fully independent, occupational therapy can help maintain and enhance the abilities that are remaining. Many patients are able to do more for themselves than they may realize. New technologies are emerging every day that allow older adults to have more independence with ADLs, IADLS, and other activities of choice. They just need the resources to receive these technologies, and occupational therapy would provide the training for how to properly use them. It would teach clients to maximize their independence, instead of learning helplessness. The goal of occupational therapy is for people to have the maximum amount of independence possible, and if it were incorporated into more long-term care plans, the amount of long-term care required could drastically be reduced. I have seen first-hard how an occupational therapist worked with a stroke victim and taught him the skills to be able to perform his ADLs again. For older adults, or people of any age, independence is a valuable asset to one’s self-esteem.

Horowitz, B. P., Tagliarino, J., & Look, K. (2014) Occupational therapy education, attitudes on aging, and occupational therapy students and therapist interest in gerontology practice. Physical & Occupational Therapy in Geriatrics, 32(2), 136-151. doi: 10.3109/02703181.2014.905898

The demand for geriatric occupational therapist is increasing, and only a small percentage of occupational therapist specialize or work in geriatrics. “Demographic demands and evidence supporting the benefits of OT rehabilitation and preventive interventions for older adults are likely to increase demand for rehabilitation and preventive services to facilitate discharge to home post hospitalization, improve older adults’ functional abilities, address long-term care needs, and promote community living and quality of life” (Horowitz, Tagliarino, & Look, 2014). Occupational therapy services will greatly impact the institutionalization of older adults and allow more older adults the opportunity to live in their own homes. Advancements in technology allow older adults to have the resources to remain in their home, but it is the responsibility of the occupational therapist to raise awareness of these resources and promote the maximization of the abilities that older adults possess. However, ageist attitudes within society influence the amount of therapist that desire to work with the elderly. The study in this article explored occupational therapy student’s attitudes regarding older adults, and the conditions which influence their attitudes such as positive contact and experience with older adults. This study is of great importance to me regarding my future career. Gerontology education showed a significant result on participants’ willingness to work with older adults, and it also found a weak significant result between willingness to work and positive attitudes towards older adults. These findings indicate that there is a need for gerontology education amongst occupational therapy students. I hope that it brings awareness between the lack of geriatric occupational therapist and the need for them.  If more occupational therapy students had exposure and education regarding the abilities of older adults, they would be more willing to work with them, and they would also have a lower level of anxiety when working with them. Education and attitudes are key factors in how successfully a therapy is executed. It is vital that professionals in the health care field have adequate knowledge of the needs of older adults, their families, and the aging community. “Recent passage of the Affordable Care Act is anticipated to increase already high demand for OTs, including demand in gerontology practice across practice settings” (Horowitz, Tagliarino, & Look, 2014). Negative attitudes about older adults is not only a health care issue, but it is also a societal issue which affects the desire of older adults to age in place within their community. Many people share negative views regarding working with older adults, but the adequate education, their views can be changed. Throughout my gerontology education, my views have been changed dramatically. Occupational therapist educators need to implement geriatric programs within the curriculum to expose students to more older adults, so students will be more willing to address the workforce and societal need.

Mahoney, W. J., Ceballos, J., & Amir, N. (2019). Occupational therapy practitioners’ perceptions about older adults with developmental disabilities in traditional health care settings. American Journal of Occupational Therapy, 73(3), 1-6. doi: 10.5014/ajot.2019.029835

The purpose of this study was to assess occupational therapy practitioners’ perceptions about working with older adults with developmental disabilities (Mahoney, Ceballos, & Amir, 2019). A random survey was mailed to occupational therapist regarding questions of perceptions of comfort, knowledge, challenge, and supports and barriers that may be present when working with older adults with DD (Mahoney, Ceballos, & Amir, 2019). There is a relatively low percentage of older adults with DD who require occupational therapy, but this percentage represents a growing population of those in need including those who suffer from dementia, stroke, mental illness, and orthopedic injuries. As the population ages, the needs of the population change. Dealing with an older adult with a DD can be difficult, but with the right strategies, it is possible. Mandy adults with DD are living longer, and thus, practitioners need to be trained to address their needs and deal with the challenges that encompass the wide variety of developmental disorders. Despite a person’s disorder, their quality of life can be improved through various therapeutic techniques. The factor that contributed to occupational therapists feeling most comfortable and knowledgeable working with older adults with DD was experience with people with DD, even if it was not necessarily in an occupational therapy setting. This study shows the need to advanced research to develop these techniques to ensure this population is receiving optimal resources for their specific condition.  Although most occupational therapy practitioners reported feeling comfortable and knowledgeable enough to work with these individuals, almost one-third indicated feeling somewhat or not at all knowledgeable, demonstrating a need for additional training and resources (Mahoney, Ceballos, & Amir, 2019). There are several implications that resulted from this study including practitioners need to seek resources and training to be able to properly address the needs of this population and education programs that should include learning opportunities with this population within the occupational therapy curriculum. I have had many experiences working with elders with dementia, and many of the occupational therapist that I have talked to do not feel apt to work with these patients. Why has this population been left out of occupational therapy research? Many of them would be able to improve their activities of daily living with minor adjustments from occupational therapist who asses and work with them and their caregivers. It would not only improve the quality of life of the patients, but it would also improve the quality of care that their caregivers can provide as well.

Pillatt, A. P., Nielsson J., Schneider R. H. (2019) Effects of physical exercise in frail older adults: A systematic review. Fisioterapia e Pesquisa, 26(2), 225-232. doi: 10.1590/1809-2950/18004826022019

This article examined a study over the effects of exercising on frail older adults. Frail is used to define “older adults with clinical characteristics attributed to aging, associated with the existence of comorbidities, such as unintentional weight loss, exhaustion, decreased muscle strength, gait and balance disorders, and sedentary lifestyle” (Pillatt, Nielsson, & Schneider, 2019). Being frail negatively impacts multiple areas of a person’s life. Not only does it illicit limitations on a person’s ADLs and IADLs, it influences a person’s social life and their ability to engage in their community. There is already evidence that exercise brings many health benefits, but this study specifically analyzed older adults who are already frailty and the effects that exercise had on their condition. It used a variety of different exercises of various intensities depending on the person’s ability. The results indicated that exercise is beneficial to frail older adults, “with improvements in the functional aspects, such as increase in palmar grip strength, lower limb strength, mobility, physical performance, muscle mass, balance, gait and stride length” (Pillatt, Nielson, & Schneider, 2019). It also showed improvement in the quality of the person’s life and cognitive functioning. The study concluded that exercise was sufficient to reduce frailty and to be overall more beneficial than other methods in improving a person’s life. If something as simple as exercise can improve physical and cognitive functioning, then strategies to increase the level of activity of older adults should be implemented within communities. Many older adults become sedimentary because they no longer have a reason to get out of bed. Exercise has a vast number of benefits, and it can be in the form of a fun and engaging activity. More senior centers should be aware of this and encourage more active activities, instead of sedimentary games such as Bingo. I believe if older adults had more options for enjoyable exercise, such as a yoga or hiking class specifically for older adults, they would be more apt to participating in and enjoying physical activity.

Sung, H., Chang, S., Chin, M., & Lee, W. (2015). Robot-assisted therapy for improving social interactions and activity participation among institutionalized older adults: A pilot study. Asia-Pacific Psychiatry, 7(1), 1-6. doi: 10.1111/appy.12131

Animal-assisted therapy is a growing phenomenon, but it is limited due to a variety of concerns. An alternative to real animals is the use of robot animals in therapy. This study assessed individuals’ communication and interaction skills before and after therapy with a pet robot for four weeks. “Previous work has shown that animal-assisted therapy can, to some degree, reverse loneliness and further prevent depression of older adults residing in long-term care facilities” (Sung, Chang, Chin, & Lee, 2015). There have also been studies done examining robotic pets in place of real animals that showed similar results. This study used a robotic pet named Paro. The individuals in the study were encouraged to interact with Paro by talking and touching. “Wilcoxon signed rank test showed that the activity participation of the participants was significantly improved (z=-2.66, P=0.008), indicating that the four-week group robot-assisted therapy significantly improved the activity participation of the older adults” (Sung, Chang, Chin, & Lee, 2015). They also reported the results of their study was similar to that of another study done by Wada and Shibata. In that study the residents of the nursing home thoroughly enjoyed their time with Paro, and they even asked about future meeting times and were more willing to leave their rooms. Animal-assisted therapy can be a positive attribute to any older adult home. It provides interaction and can evoke social interactions among the residents about the animal or robot. In this four-week study, the interaction and participation skills of older adults were significantly improved. If this were applied regularly in nursing facilities, the result could be even better than predicted. The robotic pet could give some sense of responsibility and meaning to a person with cognitive disabilities that is not able to care for a real animal. Even for older adults without cognitive disabilities, the benefits will be numerous. If the robot-pet simply gets a resident to venture out of their room for joyous social interactions, it can have lasting positive impacts.