CHAPTER I PROBLEM AND ITS BACKGROUND Introduction Occupational therapy is a treatment that incorporates meaningful activity to promote participation

in everyday life. Occupational therapists work with seniors in different settings including assisted living facilities, nursing homes, adult day care centers and community senior centers. A therapist always begins with an evaluation to determine what difficulties a person might be having that interfere with independence. Occupational therapy is very beneficial to the elderly population. Therapists help the elderly lead more productive, active, and independent lives through a variety of methods, including the use of adaptive equipment. Occupational therapists work with the elderly in many varied environments, such as in their homes in the community, in hospital, and in residential care facilities to name a few. In the home environment, occupational therapists may work with the client to assess for hazards and to identify environmental factors that contribute to falls. Occupational therapists are often instrumental in assessing for appropriate wheelchairs for the elderly. In addition, therapists with specialized training in driver rehabilitation assess an individuals ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommendations for adaptive equipment, training to prolong driving independence, and alternative transportation options. Senior centers are an

important community resource or older adults. Recognized as a designated local point by the Older Americans Act, senior centers help older adults to access programs and services that promote health and independence. Today, senior centers serve a multitude o purposes, including meal and nutrition sites, screening clinics, recreational and fitness centers, social service agency branch offices, mental health counseling clinics, older worker employment agencies, volunteer coordinating centers, and community meeting facilities. With each generation, senior centers continue to grow and evolve in order to help older adults age in place and age successfully. Occupational therapists and occupational therapy assistants bring an understanding or the importance of participation and occupation or overall well-being to senior centers. Occupational therapy practitioners can fill a unique role by enhancing clientcentered programming in senior center communities. Geriatric occupational therapy focuses on helping elderly people do all of the activities of daily living (ADL) that have become difficult or impossible for them to do because of aging, diseases, disorders, or disabilities. Occupational therapy may also help seniors improve their ability to work, enjoy leisure time, and participate in social activities, depending on their interests and capabilities. The goal of geriatric occupational therapy is to assist elderly people to fulfill their roles (occupations) in their home and community and to help them improve the way they function. Improved functioning will enhance their dignity and the quality of their lives.

Occupational therapy focuses on ADLs and aims to help elderly people regain enough function to continue living at home or independently as much as possible.

Theoretical/Conceptual Framework When you start having concerns about your elder and their ability to care for themselves, it's important that you take the time to do an assessment of the situation. This can be as simple as making general observations about how they are getting along at home, or as involved as hiring an outside professional to conduct a geriatric assessment. Some occupational therapists work with elderly patients. These therapists help the elderly lead more productive, active, and independent lives through a variety of methods. Therapists with specialized training in driver rehabilitation assess an individual's ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommendations for adaptive equipment, training to prolong driving independence, and alternative transportation options. Occupational therapists also work with clients to assess their homes for hazards and to identify environmental factors that contribute to falls.

Statement of the Problem This study sought to know the role of occupational therapy to shelter homes for elders . Specifically, the researcher sought to seek the answer to the

following questions. 1. What is the meaning of occupational therapy? 2. How is it differ from physical therapy? 3. What are the duties of an occupational therapist? 4. What are the duties of occupational therapist to elder people sating at shelter homes?

Objectives of the Study The aim of the researcher for this study is to know duties and responsibilities of an occupational therapist to senior patients living at Golden Acres in Quezon City. Aside from that, this study also tackles the importance of their job to help the senior to have a comfortable life during their stay at the shelter homes.

Significance of the Study Respondents. This study is significant to them because they are the beneficiary of this paper. Student. This study will help the students who are studying and wanting to be an occupational therapist someday to know the importance of their job to elder people. Professor. This study is beneficial to them as their professor because they can get some that they can impart to her future students. Future Researcher. This study will serve as a future reference for them if they planned to conduct a study that is related to this topic.

Definition of Terms For clarification and appreciation of the study, the following terms are defined: Alzheimer's care- may refer to senior care services that specialize in individuals with Alzheimers Disease- common form of dementia of unknown cause, usually beginning in late middle age, characterized by memory lapses, confusion, emotional instability, and progressive loss of mental ability. Dementia- severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neurons in the brain. Elder People-this refers to the person who are past their adolescent and over the age of 65 years old.

Geriatric Care- specialized area of medicine that deals with the health of senior citizens. Geriatric care focuses on the prevention and treatment of disabilities and diseases that commonly affect individuals that are over 65 years old. Occupational Therapy- The use of productive or creative activity in the treatment or rehabilitation of physically or emotionally disabled people. Physical Therapy- the treatment of physical dysfunction or injury by the use of therapeutic exercise and the application of modalities, intended to restore or facilitate normal function or development. Shelter Homes-it is a place which is like a home for elder people who have been place into for proper care given by caregivers and nurses because their families cannot give it to them for various reasons. Therapy- the treatment of disease or disorders, as by some remedial, rehabilitating, or curative process.

Chapter II Review of Related Literature

Occupational therapists are trained to assist people to overcome various problems in order to live more independent lives. People may need assistance due to injury or illness, mental health problems, developmental delay or the effects of ageing. Occupational therapists work in many different environments, including schools, nursing homes, hospitals and workplaces. They take a holistic approach to healthcare and treatment, and their goal is to improve skills for living so that people can accomplish more, and improve wellbeing and quality of life. They work with the person, their family, and other healthcare professionals where necessary. Many people do not understand how occupational therapy differs from physical therapy. The primary difference is that the occupational therapist assesses the patients ability to perform his daily occupations or activities and the physical therapist focuses on improving mobility. When a physical therapist treats a person with a hip fracture his goal may be for the patient to walk and use the stairs. An occupational therapist, on the other hand, may recommend bathtub grab bars and a raised toilet seat to increase safety and independence during self-care occupations. Perhaps no other disease afflicting the elderly is as devastating as a dementia that impacts memory and abilities to communicate, solve problems and ultimately perform self-care tasks such as eating and toileting.

Occupational therapists are trained to assess the patients cognitive status and use behavioral interventions to address the changes in personality that may be upsetting to caregivers. The Department of Health (DH) asked the National Institute for Health and Clinical Excellence (NICE) to produce public health guidance for primary care and residential care on interventions that promote the mental wellbeing of older people. This guidance focuses on the role of occupational therapy interventions and physical activity interventions in the promotion of mental wellbeing for older people. It is anticipated that this is the first of a range of NICE public health guidance on the health and wellbeing of older people. The guidance is for NHS primary care and other professionals who have a direct or indirect role in, and responsibility for, promoting older peoples mental wellbeing. This includes those working in local authorities and the wider public, private, voluntary and community sectors. It will also be relevant for carers and family members who support older people and may be of interest to older people themselves. The guidance complements and supports, but does not replace, NICE guidance on supporting people with dementia and their carers in health and social care, managing depression in primary and secondary care, assessing and preventing falls in older people, obesity, commonly used methods to increase physical activity, physical activity and the environment, behavior change and community engagement .

The types of activities the physical and occupational therapists complete with an elderly loved one may seem similar, but their professional focuses are very different, yet complementary. The scope of practice for each therapist will depend on their elder-care specialty area (stroke rehabilitation, orthopedic rehab) and the environment where they work (nursing home, home health care, outpatient therapy). The following description is basic and provides a general outline of distinction between the two professionals and is not exclusive to elder care. Let's first cover ground of commonality between the two types of therapists. Those wanting to be occupational and physical therapists are required to enter into a Bachelor's or Master's level therapy program to initially begin practice. The mandatory college entry requirements are changing for therapists but this description does apply for most therapists who graduated before 2001. Entry into a therapy program is very competitive. After successfully completing the therapy training program, therapists are required to complete several supervised clinical internships. These clinical internships span a range of settings including elder care, senior centers: nursing homes and rehabilitation centers. After the internships, a graduate is required to successfully pass a national board examination and secure a professional license to practice.

A physical therapist generally focuses on balance, walking, and general movement. For example, a physical therapist will teach an elderly stroke victim in a nursing home how to walk again or sit without leaning to one side. The general and informal dividing line is, physical therapists work with the body from the waist down, and occupational therapists work with the body from the waist up. This is not a cut and dry distinction but in terms of physical rehabilitation of movement it is fairly consistent. Occupational therapists work with a elder to maintain independence in their basic self care needs and performance of activities of daily living (self care tasks). Ensuring independence with self care includes recommending appropriate devices and gadgets to increase safety and functional ability. For example, an occupational therapist may recommend modifications to a home to help a senior age in place, rearrangement of furniture and home layout, equipment to prevent hand tremors during eating, and teaching a elderly stroke victim how to get dressed with one hand. Most often, physical and occupational therapists work together to provide rehabilitation therapy. This collaborative effort ensures a patient can move well and remain as independent as possible with caring for him or herself. When an adult or elderly person is affected by an illness, accident or workplace injury, an occupational therapist can help them on the road to recovery. They may assist with the return to home and work life through the

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development of new skills for daily living, such as household tasks and personal care, return-to-work or leisure programs. They may also make or facilitate changes to the work or home environment to make life easier and safer. Occupational therapy is treatment that focuses on helping a person achieve independence in his or her day-to-day life. Within the geriatric population, occupational therapists typically focus on a person's bathing, dressing, and grooming abilities. Occupational therapists are trained to identify problems in these areas and make recommendations for

improvement. At times, equipment recommendations are made including rolling walkers, tub benches, commodes and adaptive eating utensils. Nursing homes, whose halls are filled with nurses and aides bustling from room to room, are a main workplace for another type of healthcare worker. Occupational therapists (OTs) play a role at nearly every nursing home in the nation, providing elderly residents with adaptations and training that will help them thrive independently for as long as possible. They are found in many types of institutions, from hospitals and schools to rehabilitation centers and long-term care facilities, helping individuals along all points of the human lifespan. Occupational therapy is a health profession providing service to people whose lives have been disrupted by physical injury or illness, developmental problems, the aging process, or social and psychological difficulties. The goal

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of occupational therapy is to assist each individual in achieving an independent, producing, and satisfying life. Most elderly persons receiving occupational therapy in the contemporary period receive such services in nursing homes or in other skilled nursing facilities. Health care economics in the United States is in a state of turmoil as a result of dynamic changes occurring in the health services environment. The contemporary health services sector is comprised of a wide variety of types of health care providers. Health maintenance organizations, behavioral medicine clinics, nursing homes, and general acute care hospitals are among the major components of the health services sector. A major and growing source of change for health care economics is the presence of corporate health care providers as major players in the health services sector. Occupational therapy is provided through each of these venues for elderly patients.

Nursing Homes In nursing homes, retirement centers or senior homes, Occupational Therapists provide information about client handling techniques. The Occupational Therapist educates staff members on how to safely transfer residents in and out of bed or in and out of wheelchairs, for example. This is crucial for the safety of the residents and helps to reduce the incidences of work place injuries. This education keeps both the staff and the residents safe, and ensures the comfort of all involved. Occupational Therapists also

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understand the proper use of body bio-mechanics. This forms the basis of client handling education, and training is required to properly utilize these principals by staff members. Occupational Therapists are able to effectively train staff members in this area and others, such as fall prevention. To help staff members with this, the Occupational Therapist will outline physical risks for individual residents, environmental risks, and risky behaviors of the elderly who are mobile and who have a diagnosis of arthritis, hip arthritis, or osteoarthritis. Understanding risky behaviors is particularly important as it is a significant factor in maintaining the independence of elderly residents while simultaneously ensuring their safety. Occupational Therapists working in long term care also educate staff and family members on ways to keep residents safe with the use of mobility aids such as walkers or wheelchairs, tilt-in-space wheelchairs, or canes. In order to keep residents at nursing homes, senior centers or retirement homes safe, this type of training must take place. Occupational Therapists also help staff members learn the proper use of sit to stand lifts and ceiling lifts in order to prevent workplace injuries. Occupational Therapists do more than perform wheelchair assessments or help rehabilitate people. Their role is multi-faceted and, as we can see from the above examples, often includes education and training, something many people dont think of when they think about Occupational Therapy. In order for a nursing home, senior center or retirement home to have a rounded team of healthcare specialists, an

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Occupational Therapist must be involved because of the wide range of roles he or she plays in the long term care field. Nursing homes typically hire OTs for full-time work, but some work on a contractual basis, filling in for those on vacation or providing temporary assistance while a nursing home looks for a long term employee. Irene Tipton has been working as a contract occupational therapist for nearly 30 years, filling her weeks with rewarding assignments and experiencing the full range of occupational therapy, from surgical suites and psych wards to schools and nursing homes. Throughout her three decades of service, Irene estimates that she has worked at about 40 different nursing homes or assisted living facilities throughout the greater Seattle area, spending up to about 6 months at each facility. Her wide range of experience makes her a fabulous candidate for providing unbiased information about residents' experiences of

occupational therapists in nursing homes. Occupational Therapy in Nursing Homes While only about 10 percent of residents in long-term care facilities utilize occupational have regular appointments with them. And with one OT seeing about eight patients per day, you can imagine how many are employed by larger nursing homes and rehabilitation facilities! When Nursing Home Residents Need OT Irene spends much of her time in long-term care facilities such as nursing homes, helping residents through a number of physical changes as

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they age. Large physical disruptions caused by strokes, diabetes or high blood pressure call for OT treatment. She typically meets with a nursing home resident three to six times per week for two to four weeks after an injury, assessing his needs, prescribing special adaptive equipment, and training him on how to use it. Residents in nursing homes who don't experience injuries or falls will often see OTs when new ambulatory needs are suspected. To that end, Irene commonly recommends new types of walkers or wheelchairs, and trains nursing aides how to best help with activities of daily living. She also recommends smaller equipment such as "reaches," "sock aids," long shoe horns, "dressing sticks," raised toilet seats and bathtub benches that help elderly people with unsteady limbs or chronic pain function more independently. The Benefits of OT in Nursing Homes Irene says that the main benefit to nursing home residents who receive occupational therapy is a more independent life. Though residents in nursing homes may need significant help with activities of daily living, OTs provide them with the tools they need to maintain as much autonomy as possible. This happy balance of skilled nursing care and self care helps residents feel vigorous and capable even as their needs increase.

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Related Studies With the myriad challenges in long term careincluding the increased complexity of resident care, adherence to compliance standards and the heightened expectations from family and residentsoccupational therapists (OTs) are an underutilized professional resource. This is unfortunate, given the role of the OT in enabling individuals to achieve and/or maintain an independent, functional and meaningful life through therapeutic interventions. It is possible and desirable to maintain or even improve the independence of individuals who make the transition to long term care. Having access to a team of health care professionals that includes an OT can afford residents the opportunity to enhance their functional independence. Furthermore, with the implementation of the minimum data set and the increased need to record all restorative and rehabilitation activities, the expertise offered by the OT strengthens the long term care home's documentation process. OTs are university-trained registered health care practitioners who work under practice standards established by the Ontario College of Occupational Therapists. OTs work in a wide range of locations, including long term care homes. The age of OT clients also varies, from infants to the elderly, although seniors are the OT's second largest client group, second only to the general adult population. Occupational therapy can help senior citizens stay healthy and live independently, with lasting results even six months after seniors initially work

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with a therapist, according to a study from the University of Southern California. Study results, published in the January 2001 issue of the Journal of Gerontology: Psychological Sciences, show that such therapy could help keep seniors in good health and reduce health care and nursing home costs as the nations population ages. The results build on the USC Well Elderly Study, a widely cited, three-year research project published in 1997 that documented the impact of occupational therapy on independent-living senior citizens. The study spotlighted the key role of occupational lifestyle redesign, in which a therapist helps a client develop and adopt a routine of beneficial daily activities based on the clients individual needs. In the original Well Elderly Study, Clark and a multidisciplinary team of researchers worked extensively with 361 senior citizens in the Los Angeles area. One third of that culturally diverse group received individualized occupational therapy while the remaining two thirds either participated in a variety of activities led by non-therapists (such as dancing, knitting and the like) or had no treatment at all. The one third of seniors who had occupational therapy showed remarkable improvement in quality of life and health measures compared to the remaining two thirds. Now, the follow-up study shows that most of these gains (90 percent) were sustained six months later. The seniors benefited particularly in the areas of physical functioning, vitality, social functioning, and general mental health and similar measures.

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Occupational therapy was not explicitly referenced in the report, which likely speaks to the fact that the role of the OT in long term care is in its infancy. As well, there is no specific funding for this professional service, unlike physiotherapy, which can be accessed through OHIP funding. (There are some long term care homes that can access OT through a rehabilitation company in conjunction with OHIP-funded physiotherapy services.) Instead, residents must attempt to secure OT through their local community care access centre or purchase the service privately. Mobility and positioning Mobility and positioning is the most recognizable role for OTs in long term care. Many OTs are assistive devices program authorizers. As such, they complete assessments for mobility and seating equipment (e.g., walkers, wheelchairs, cushions and scooters) and submit the application for funding on behalf of the resident to the MOHLTC's Assistive Devices Program Branch. Ensuring residents have the appropriate mobility devices is a crucial factor in maximizing safety, mobility and comfort and is a key role of the OT. Restraints Most long term care homes have adopted a policy of least restraints.' OTs support the home by offering recommendations for alternative positioning devices that reduce and/or eliminate the need for restraints. The OT works closely with the staff, residents, family members and equipment vendors to determine the best alternatives given the client's specific

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circumstances. Furthermore, the OT's documentation may help to support adherence to MOHLTC standards. Falls Prevention Reducing the risk of falls requires an interdisciplinary, multi-faceted team approach. OTs collaborate with the health care team to evaluate the resident's status, assess behavioral challenges, provide interventions and make recommendations regarding improvements to the living environment (e.g., rearranging furniture in the bedroom) and to incorporate the use of assistive devices (e.g., grab bars, transfer poles) into daily care. Activities of Daily Living The tasks involved in self-care although automatic during our adult lives can become increasingly difficult as we age. This does not mean that residents who struggle with their own care must become fully dependent on others. OTs are expert at finding solutions that enable residents to maintain or even regain some of their independence and dignity in carrying out their activities of daily living. Treatment can include retraining the resident, the prescription of adaptive equipment (such as Velcro instead of buttons and zippers as fasteners) and the education of front-line staff in ways they can help residents remain or become independent. Meals and the entire dining experience are increasingly important in long term care. For residents who cannot feed themselves or require assistance with eating, the challenge is allocating adequate staff resources.

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OTs work on retraining residents who have lost their ability to feed themselves due to stroke or injury. The OT can also offer recommendations for adapting the physical environment, mealtime positioning and eating utensils that maximize a resident's independence. For residents with dysphagia, the OT can assist to ensure proper positioning and make recommendations to increase swallowing safety and reduce the risk of aspiration. Dementia Care Behavioral problems associated with the progression of dementia are difficult for long term care homes both in terms of limited resources and risk of injury to staff and residents. OTs can plan specialized activity programs that focus on supporting remaining abilities. Coordinating group activities for residents that provide meaningful and purposeful engagement in a structured setting help to maintain cognitive function and reduce disruptive behavior. Restorative Care The restorative care approach and the programs that result from this philosophy are an integral component of resident care. The OT can develop and supervise restorative care programs that centre on feeding and dressing. The OT also assists in ensuring the programs are goal-oriented, residentcentered and outcomes-based.

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Splinting Whether the result of an injury or a chronic disability, affected limbs can be splinted by the OT to maximize function and prevent further deterioration. Preventative splinting of joints can also help to reduce further loss of range of motion. For example, splinting of the hand post-stroke often reduces the risk of contractures developing and minimizes pain in the hand and wrist. This inevitably makes it easier for front-line staff to keep the area clean and well cared for. Staff in-Service Training OTs should be considered an essential part of any educational program for the health care team in long term care. Instruction on safe transfer techniques, adaptive equipment training and communication strategies for residents with cognitive or sensory impairment are examples of the range of issues to which OTs can contribute solutions in long term care. Occupational therapy can improve daily functioning, social

participation, and wellbeing in people with dementia living in the community and improve the sense of competence and wellbeing of their primary care givers. It might reduce healthcare costs because of improved independence in patients and improved sense of competence in care givers, which might result in lower costs of informal care, delayed admission to nursing homes, and lower costs of other healthcare and social servicesfor example, costs for day care, home care, or meals on wheels. Occupational therapy is not

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usually recommended for patients with dementia in primary health care. Recent research has looked at the efficacy and effectiveness of community occupational therapy in patients with dementia and their primary care givers. In one study of an efficient preventive nine month occupational therapy programme there was a trend towards lower medical costs and more independent living. In a cost effectiveness study of cognitive stimulation therapy in patients with dementia, Knapp and colleagues concluded that it was cost effective because it has benefits on cognition and quality of life and has no adjuvant costs compared with usual care. Melis et al reported effectiveness of a multidisciplinary home based intervention for frail older people on prevention of functional decline and improved wellbeing for reasonable costs. Brodaty and Peters found that an intensive 10 day training programme for care givers was cost effective as it saved $5975 per patient in 39 months and was associated with patients being able to live at home for longer and decreased psychological morbidity in care givers. According to an article in "Age and Ageing" from 2004 in volume 33, pages 453-460, "occupational therapy interventions for elderly people in the community results in positive outcomes." Nearly one-third of occupational therapists (OTR) and certified occupational therapy assistants (COTA) work with the geriatric population. They do a lot of types of treatments and activities, using many strategies. The main goal of helping those in the geriatric population is for them to regain or maintain the highest level of

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independence possible. It is the hope of most elderly people to stay in their homes as long as possible. Occupational therapy commits to improving and maintaining the highest level of function possible of its clients so that people can have healthier, more productive and satisfying lives. Occupational therapy dedicates itself to quality health care which includes disease prevention, staying well and rehabilitation services for individuals across the lifespan. As people age, they use more occupational therapy services as a rule. Effectiveness Occupational therapy has been proven effective for the geriatric population, with a number of medical conditions and surgical recoveries. Besides working with individual people to increase their strength and regain important life skills, occupational therapists work with a geriatric community to counsel families, local governments and community groups to make sure that each group is doing its part to help older adults maintain their independence. Conditions The most common diseases, conditions and surgical recoveries that OTRs and COTAs are involved in for the elderly include: arthritis, chronic obstructive pulmonary disease (COPD), stroke, broken shoulder, wrist, hip and knee replacement as well as repair or replacement of these body parts, depression, diabetes, sensory impairments and dementia. The key in geriatric care is to avoid these injuries and illnesses to begin with. To do this, OTRs

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and COTAs focus on adapting and modifying the performance of activities of daily living that have become difficult or impossible to do because of agerelated changes, disorders or disabilities. Occupational therapy provides help with other activities that relate to geriatric clients that still work. They also find ways for elderly patients to be involved in leisure and social activities that are dependent upon the patient's capabilities and interests. Settings It is the aim of occupational therapy to improve the ability of elderly people so they can stay in their home. If institutionalized care is required, occupational therapy can enhance their lives there by helping them to maintain their highest level of function there, even if full recovery from a health issue is not possible. Activities Of Daily Living Occupational therapy focuses on ADLs because they are necessary for independent living. The basic ADLs include: going to the bathroom, bathing, grooming, dressing, eating and moving from one surface to another, such as moving from a chair to a bed or bathtub. Instrumental ADLs require more complex thinking. These tasks include things like preparing meals, using the telephone, operating a computer, managing finances and medications as well as cleaning; doing laundry, going shopping, and other errands, traveling from one place to another, which includes driving. Driving is quite complicated because it includes integration of visual, physical and mental tasks and being

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able to coordinate these tasks, which may be mild to moderately impaired as you age. Occupational therapy may help geriatric clients with other activities to help reduce the risks of social isolation and its detrimental consequences. They do this by assisting geriatric patients to maintain social activities they know and encouraging involvement in new ones as well as providing ways to promote continued learning and other mind-stimulating activities, which help promote feelings of self-worth and may help prevent dementia. Occupational therapy can help older adults who are having difficulty performing everyday tasks due to the effects of aging. Dressing, bathing and shopping for food can all present challenges for older adults as they age. The goal of occupational therapy in the geriatric population is to promote independence in performing everyday living tasks. Basic Activities of Daily Living Activities of Daily Living, or ADLs, are usually the cornerstone of an occupational therapy program for geriatric patients. Basic ADLs include dressing, bathing, eating and moving from one place to another, such as from a bed to a chair or walking to the shower or bathtub. These basic ADLs are often practiced with the help of an occupational therapist or home nursing assistant. Therapeutic activities often include actual performance of these daily living tasks with the help of a therapist or assistant. Upon assessment, a therapist may provide adaptive equipment or suggest ways to engage in activities differently to promote independence and safety.

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Complex Activities of Daily Living Complex activities of daily living include cooking, doing laundry, operating a computer or telephone, managing medications or cleaning. As adults age, these tasks may become more difficult due to age-related changes, illness or disability. With complex ADLs, it is often the work of a therapist to determine which assistive devices or techniques will help the client perform the tasks as independently as possible. This can mean written instructions for each complex ADL, as well as the use of assistive devices for getting around safely. Occupational therapists will assess and change the OT program for clients as they age or need further assistance. Social or Emotional Activities Occupational therapists are often asked to assess and address the social and emotional well-being of their geriatric clients. Aging, illness and certain disorders associated with aging can sometimes have a detrimental effect on the emotional well-being of older adults. Occupational therapists will assess a client's interests and attempt to provide access to social activities for them to participate in. This can include providing safe transportation to a senior center or adult day care facility or promote continued learning, which may prevent dementia. Location The main goal of occupational therapy for older adults is to empower them to be able to stay in their own home as long as possible. However,

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many geriatric occupational therapy patients reside in assisted living facilities, nursing homes and rehabilitation centers. If institutional care is necessary, the focus of therapy shifts to being able to provide the skills and care necessary to maintain the highest level of function possible to preserve their quality of life. The increasing elderly population is one of the health care concerns in western societies. The ageing process is associated with decreasing functional abilities, lower quality of life and increasing health care costs for the community. Governmental policies aim at enhancing or maintaining independent living by providing services and care for community dwelling elderly people. Occupational therapy (OT) might be able to play an important role in reaching this aim. Community dwelling elderly people are defined by their age (60 years of age) and by living independently. This group can suffer from a large variety of health care problems; from just getting older (not diseases specific) to suffering from multiple pathologies. Also, people with specific medical diagnoses that occur more frequently in an older population, such as stroke, osteoarthritis or dementia, is part of this population. OT treatment focuses on increasing or maintaining functional independence, social participation and quality of life, both from a preventive perspective and a treatment perspective. A survey in the Netherlands showed that the majority of patients referred to OT in the general health care system were of older age (mean age 61 years) and suffered from a chronic condition [1]. Improving

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personal care, domestic and locomotors abilities and enhancing physical independence and mobility were the most frequently chosen treatment goals for this population [1]. OTs efficacy for older people has been reviewed before but none of these reviews addressed the community dwelling elderly people separately. Carlson et al. [2] incorporated studies concerning OT for institutionalized elderly people. Patterson et al. reviewed the evidence for the efficacy of pre-discharge home visits conducted by the occupational

therapist. Therefore, the objective of this systematic review is to determine whether OT improves or maintains outcomes for community dwelling elderly people.

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Chapter III Research Methodology Locale and Population The location of this study chosen by the researcher is the Golden Acres located at Quezon City. Research Instruments As implied the researcher conducted a non random sampling technique and employed 30 respondents, Each of the subjects was oriented about the nature and purpose of the study. A set of questionnaire was provided to each subject. The data gathered from the subjects served as the primary data where conclusion and recommendation of the study are derived. The data collected were then collated and tabulated. The questionnaire contained two parts. The first part deals with age and gender information of the subjects. encountered by the subjects. Part II inquires about the problems

Data Gathering Procedure The questionnaire was given to every chosen respondent identified in the sampling. The questionnaire collected information on household residents, age, and educational attainment as well as the characteristics of the

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employed respondent. The questionnaire was employed to identify eligible individuals for the interview. Statistical Treatment of Data Simple percentage and frequency was used as measures of central tendencies employing this formula: P= f/n Where P = Percentage f = Frequency n = total number of respondents. Weighted mean was also be used to determine the final response category of the data using the following formula: AWS = TWS/ N Where: AWS = Average weighted score TWS = Total weighted score N = total number of cases

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Chapter 4 Presentation, Analyses and Interpretation of Data

The results of the study conducted among thirty (30) residents are shown, analyzed and interpreted in this chapter. The Respondents Profile The data in Table 1 show the profile of the subjects by age and gender.

TABLE 1
Socio-demographic description of participants

Age

Gender Female Male 14 5

Educational Length of stay level Six Months More Than Less Than 7, 6 years* (3,5)

Cognitive status MMT/30

Parental link

Residents (n=19) Families 3 daughters (n=8) 2 spouses

82,5* (8,5)

(n=11) (n=8)

25,0* (4,9)

66 **

11 years**

(n=6) (n=2)

1 friend 1 sister 1 brother

Diagnoses of main residents: Dementia : 5, Frailty : 4,Multiple sclerosis: 3, Stroke : 3,Macular degeneration : 3, Blindness : 2, Femoral amputation: 1, Paget's Disease: 1, Obesity : 1, Parkinson's Disease : 1 *: mean and standard deviation ** : median

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: Mini Mental State Examination (Folstein & Folstein, 1975).

The interviewees included 19 residents and 8 family caregivers. The mean age of the residents was 82.5 and most of the participants were women. Eleven residents had a length of stay greater than 6 months and 5 of the residents suffered from dementia (see Table 1). TABLE 2:
Residents' and family caregivers' opinions on human environment Opinion of/about Peers Family caregivers Health professionals Care managers and Caregivers

Residents Taking care of others, feelings Being supported physically Feeling love and care, Of being part of a group counselors. Family Caregivers Needs the presence Needs to decrease emotional of intact residence stress Feeling of availability Of continuity by their parental

Presence, transparency from Presence, open mildness

and emotionally, keeping a sense respect and compassion. affective security

Table 2 presents the residents' and the families' opinions on the human environment. Individuals provided their opinions on the people who were part of their daily lives such as their peers, families, caregivers, care managers and other health professionals. They were asked questions such as What are the qualities of the best caregiver?" The resident expressed many concerns about their peers while the families expressed concerns about the caregivers. According to the residents, the human environment should give them an opportunity to share enjoyable moments, take care of others, feel like part of a group, feel respect within a relationship, admire others, and even to gossip.

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Families stressed the availability of the caregivers, good will, helpfulness, loving care, sympathetic involvement, reciprocity in relationships,

competence, and respect. In one example taken from the verbatim transcript, it is clear that some residents would like to see a nurturing role enacted toward or around them. The following quotation was provided by a resident with moderate dementia: "Giving care to someone, it's a kind of love, and we received as much as we give. I know that, because that's what I did all my life" (Resident No. 10). Families also emphasized the need to feel that caregivers are available: "A good caregiver is the one who pays attention to the resident's needs, listens, gives exclusive time to the resident and leaves personal problems at home" (Family No. 1).

TABLE 3 Residents' and family caregivers' opinions on human environment

Opinion of/about
Organizational structures Material and human and external link resources Residents Needs of feeling emotional Security by seeing the care of Family Caregivers no concern Need to never feel Need to never feel but the availability Programs and activities Having occasions of Architectural environment

Having access to adaptive ADL facilities

financial restrictions self actualization activities.

Having access to welcoming Having access to extra Rooms and place.

Residents and families identified other characteristics concerning the physical and institutional environment including the organizational structure, material and human- resources, programs and activities, physical layout and external

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links (see Table 3). Residents spent most of the time talking about the resources; families spoke about the physical layout of the nursing home. For example, residents said that the new financial restrictions should not be visible: "In the last few years, the needs have increased and the financial resources have decreased. The nursing home is no longer adapted to the elderly who were either very ill or impaired. It is difficult for the staff and for us too, you know" (Resident No. 13). Family caregivers said large extra spaces, private rooms and programs are important: "It is important for my mother to know that she has access to a lot of activities, including the chapel. Usually, she goes every Sunday morning, it's important for her" (Family No. 7).

TABLE 4: Hierarchy of the main characteristics of the best substitute home as perceived by residents and family caregivers
Interpersonal characteristics characteristics Environmental

1.Feeling respect of the residents needs

2. 3. 4. 5. 6. 7. By the caregivers Feeling of complicity in a relationships Appreciating the caregivers compassions Having easy access to private rooms

Feeling compassion and support. Maintaining a role in community. Sharing good times, laughing teasing with Peers. 8. Preserving the sense of control. 9. 10.

No feeling of financial restrictions. Staff ability

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Finally, Table 4 presents the interpersonal and environmental characteristics on a scale from most to least important, combining the opinions of residents and family caregivers. The relative importance of the characteristics was determined in two ways: by counting verbatim comments related to each characteristic and by the ranking given to each characteristic by the participant. Interpersonal characteristics are the most detailed and included: feelings of respect, involvement, reciprocity in relationships, and competency through technical (nursing) acts and attitudes. The objectives of the study also included comparing the residents' and family caregivers' opinions mainly by identifying differences. Families prioritized the non-human environment while residents spoke more frequently about relationships. "If there is not enough space in her room, she cannot move easily with her wheelchair. The private room is very important, she spends her entire day in the room" (Family No. 3). "What I like the most is when she (another resident) comes to visit me. She asks me questions about my health and my problems" (Resident No. 17).

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Chapter5 Summary of the Findings, Conclusions and Recommendations Summary of the Findings: Occupational therapists are aware of the importance of quality of life indicators. This qualitative study identified the relationships and physical environment characteristics that are most important to residents and family caregivers respectively. It highlights the fact that elderly people like everyone else, need to feel they are still alive, growing and part of community life. The 11 characteristics for the best substitute living environment as identified by the 27 participants could be considered the most useful quality of life indicators for outcome measures. Although families do not live in nursing homes, they talked about what they observed during their visits. They are concerned about relationships, but the environment seems more important to them than to the residents. New residents continue to attempt to adapt to community life in care facilities and need to feel a sense of continuity. Once they are admitted to a nursing home, any change may cause a weakening of

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their identity. Residents of long term care facilities need to feel that they still have the same identity which will facilitate their growth. These results are very similar to those obtained in previous studies, but they provide more tangible details about the indicators frequently used for the quality of life concept in long term care. For one, according to Frijters et al. (2001), the more the residents are committed to the community, the better their quality of life is. Green and Cooper (2000) indicated that residents' quality of life is greatly influenced by the role each one plays in non-traditional activities. The results have a strong internal validity because of the control of the scientific criteria of credibility, transferability, dependability and conformability. The information collected is exhaustive, because data saturation was obtained with the five nursing homes, validation was done with additional participants, and useful notes were taken after each interview. The study was guided by a reference model for the data collection and analyses. Finally, until now, no study has considered the opinion of the residents with dementia as valid information. Mozley et al. (1999) also confirmed that a high proportion of elderly people can answer questions about their quality of life, even in the presence of significant cognitive deficits. However, another type of validation could have been performed by using a validation method based on two extreme cases: one case with a very well-adapted resident and another one with a resident with adaptation difficulties. Not only would this type of validation have enhanced the quality of the research, but it would also have made it possible

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to further explore the process of adapting to a substitute environment. The concept of quality of life has been studied by Voyer and Boyer (2001). They compared different types of quality of life assessments in order to clarify the concept. This included the type of measure, type of evaluation and time actor. According to these authors, quality of life is defined by the general feeling of well-being, the satisfaction of needs, a favorable objective evaluation on the life conditions from another person, and no mental disease symptoms. With respect to this definition, our results focused only on the subjective and affective evaluation of quality of life. For this reason, our

consideration of the quality of life concept may represent a limitation of the study. However, these authors confirm the influence of time on the perception of the concept, since evaluation criteria for quality of life appear to change once a resident has begun adapting to his or her environment.

Conclusion: As a student who is aspiring to be an occupational therapy, I realize that my job is very important especially to those elders who are staying in a shelter homes such as Golden Acres. During my study, I notice that many of them were sad and hoping that their families will visit them or fetch them. Even though they try to keep their pain and sadness by trying to smile back at you, you can see the pain in their voices when they answer the questions. Showing them that there are people who still cares for them and showing

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them love is already a big thing to them, rehabilitation program being done by a physical therapy plays an important role in order for them to stay happy and feel that life is still great.

Recommendation Through this study about the role of occupational therapy in caring for the elders, there are people who will be enlighten that occupational therapy is very important for elders especially to those who are suffering from various illness due to their old age such as dementia and Alzheimers disease. Through this therapy, they can still be comfortable and happy with their lives living with the people whom they do not know but are experiencing the same life that they had.

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 What We Heard: Long-Term Care Quality Consultation 2008: A Common Vision of Quality in Ontario Long-Term Care Homes. Toronto : Ministry of Health and Long-Term Care, Seniors Health Research Transfer Network, 2008.

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