1. Deborah Davys and Ellen Tickle
Occupational Therapy and Older People: Assessment and Evaluation of Health and Well- being
Deborah Davys and Ellen Tickle
Getting older is one certainty and therefore should be of direct interest to us unless early death intervenes,
According to the World Health Organisation there will be 10 and a half million older people in the uk by 2050
3)This means in turn that there will be higher numbers of older people on OT caseloads

2. 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.

3. 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)
Ageing affect people – skins, hair, eyes, muscles, memory, responses, new learning etc,. But also socially retirement ages, social attitudes to older people, ageism, popular culture, language, expectations, sexuality- social construction of ageing and negative attitudes.
According to WHO 2006 population of older people due to increase
Policy
The National Service Framework for Older People (2001) is the first ever comprehensive strategy to ensure fair, high quality, integrated health and social care services for older people.
Statistical info (NSO
The UK has an ageing population,
numbers have more than doubled reaching 1.3 million in 2008.
By 2033 the number of people aged 85 and over is projected to more than double again to reach 3.2 million, and to account for 5 per cent of the total population

4. 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

5. 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
OT role and philosophy:
occupation and occupational balance is necessary for health and wellbeing
2)People want to engage in occupations that have value and meaning to them and fit in with their culture, roles, routines and habits
3) People want a sense of autonomy
4) Most people want to be valued and have valued social roles eg member of group or neighbourhood but commonly from relationships with other people e.g. partner, wife, friend, grandmother. Roles tell us about who we are, our place in the world and significantly affect how other people see us (Race 1999)

6. 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.
SYSTEMATIC REVIEW OF 17 STUDIES – 10 OF WHICH WERE RCT
Evidence judged as:
Strong – consistent, stat signif findings in outcomes measures in at least 2 x high quality RCT`s
Some evidence - stat signif findings in outcomes measures in at least 21x high quality RCT`s or 2 x high quality Controlled Clinical Trail or Other controlled Design
Insufficient evidence – Eligible studies that do not meet the criteria above

7. 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
Sample 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.
Adults aged 65 + in Netherlands

8. 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 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 problems- maintained at 28 months post intervention
OT`s led both the Activity based health promotion programme and the standard individual programme
The health promotion group took place 1 x 2hours per week and the programme consisted of self care, orientation, meals, communication, finance, problem solving, other professions such as lighting expert, optician,
The standard individual programme consisted of magnifiers, glasses, lighting info, optician, glasses and literature on the condition.

9. 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.
NB limited statistical power of results due to small sample size

10. 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)
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
These are a range of tools that have been used to assess health and well being for older people in research studies that relate to OT Not a comprehensive list from lit review but a sample of those commonly used
ET has an example of one assessment and a list of web addresses where they can be found and downloaded.

11. 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
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.

12. 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
World Health Organisation –

13. Assessment web addresses
Functional Status Questionnaire -
Mini Mental State Examination -
SPF-36v2 Health Survey -
Range of rating scale examples
Life satisfaction -