Occupational Therapy and Older

People: Assessment and Evaluation of

Health and Well- being
Deborah Davys and Ellen Tickle

Session learning outcomes:

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

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

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

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

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.

Strong evidence for the efficacy of OT advising on equipment to

improve functional ability.

Some evidence for the effectiveness of OT in skills training alongside

home safety assessment to reduce the incidence of falls in older people.

Some evidence for the effectiveness of OT in improving functional

ability, social participation and quality of life for older people.

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

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
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

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.

Sample - 28 older people with a range of chronic conditions (depression, COPD,

diabetes and spinal stenosis)

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.

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.

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
Mini-Mental Status Exam, Functional Status Questionnaire,
2004, Clark et al 2001)
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

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.

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:

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

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/Myers-Briggs/life_satis_index.ht
ml