1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 64 Providing Occupational Therapy for Older Adults with Changing Needs Bette R. Bonder

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After reading this chapter, you will be able to: 1.Discuss normal age-related changes that affect occupational performance. 2.Describe health conditions and trajectories in later life as these affect occupational performance. 3.Describe environmental factors that influence the experience of growing older. 4.Discuss unique considerations in evaluating and intervening to support successful aging and minimize dysfunction in later life.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (Continued) 5.Describe characteristics of health care systems that serve older adults. 6.Describe social factors that support or impede successful aging. 7.Discuss unique considerations in providing occupational therapy services to older adults throughout late life development. 8.Analyze common ethical issues in providing occupational therapy services for older adults.

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Older adults are the fastest growing segment of the population in the U.S. Persons age 65 and older constitute approximately 15% of the U.S. population –by 2050 this will increase to 20% A rapid increase in older adults has significant implications for work, education, economic development and health care

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Successful Aging Avoiding disease and disability Maintaining mental and physical function Maintaining active engagement with life Maintaining positive quality of life

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuum of Care Supporting Successful Aging Wellness and Prevention Evaluation & intervention for the promotion of health and prevention of disease Naturally occurring retirement communities Primary care Inpatient Care Evaluation Interventions to minimize dysfunction

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuum of Care Supporting Successful Aging (Continued) Skilled Nursing Facility Evaluation Intervention to regain independence Transition to home care Home Health Care Evaluation & safety assessment Intervention to promote aging in place Environmental modification

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Continuum of Care Supporting Successful Aging (Continued) Assisted Living Facilities Evaluation Intervention to: promote wellness; prevent disability; enhance function; and facilitate social and occupational participation

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reimbursement and Ethical Issues Reimbursement Issues Medicare has numerous and frequently changing limitations and regulations Medical services associated with preventive care are covered but preventive OT services are not covered

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reimbursement and Ethical Issues (Continued) Ethical Issues Given reimbursement limitations, how best to meet the needs of older adults Family members may have divergent views on the care of the older adult, but the OT needs to be responsive to the client’s needs and desires

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Summary OT Goals for Older Adults with changing needs: Prevent functional decline Maximize client’s performance in areas of occupation Decrease participation restriction and maintain quality of life