Occupational Therapy and Older People

Anita Atwal, Ann McIntyre

• Publisher: Wiley-Blackwell
• Year: 2013
• Print ISBN: 9781444333336
• eBook ISBN: 9781118556146
• Edition: 2
• Topic: Medicine
• Subtopic: Occupational Therapy

This book locates older people as major clients of occupational therapy services. It provides a comprehensive resource for students and a basic working reference for clinicians. The book encompasses current theories, debates and challenges which occupational therapists need to engage in if they are to provide pro-active and promotional approaches to ageing. Detailed coverage of bodily structures, functions and pathologies leads onto chapters dedicated to activity, occupation and participation.

The ethos of the book is to inspire innovation in the practice of occupational therapy with older people, promoting successful ageing that entails control and empowerment.

This new edition has been fully revised and updated. In addition brand new material has been included on occupational transitions (retirement, frailty and end of life); user perspectives; public health including advocacy, enablement and empowerment; people entering old age with disability and mental health conditions; visual impairment; assistive technology driving and ageism.

Chapter 1
Introduction

Anne McIntyre and Anita Atwal (with contributions from Jennifer Wenborn)

This introductory chapter provides a justification for why occupational therapists should be interested in working with older people and explains the structure of the book. The demands of occupational therapy practice with older people are considered, and a brief explanation is given for how the World Health Organization’s [WHO] International Classification of Functioning, Disability and Health [ICF] (WHO 2001) can be used in occupational therapy practice. We also present our own reflections and that of an occupational therapy expert, Jennifer Wenborn, interspersed in boxes within the chapter, on why we work with older adults. We are not proud of our initial attitudes, but we hope that we do convey our enthusiasm for occupational therapy with older people.

Ageing is a process which occupational therapists cannot ignore, for globally there will be 1.2 billion people over the age of 60 by the year 2025 and by 2050 these figures will have doubled, with 80% of older people living in developing countries (WHO 2002). It is also worth considering why there is a global increase in the ageing population. There are three main factors – a decline in mortality, an increase in longevity and also a decline in fertility (Beard et al. 2012). It is also important to realise that the numbers of the oldest-old (or those people aged over 85 years) has doubled in the last 25 years and is predicted to more than double in the next 20 years (Wise 2010). Instead of regarding the growth in the ageing population and also the increasing life expectancy as success stories, these are often viewed with doom and gloom. This doom and gloom is often associated with the belief that old age equals indignity and dependency, as well as economic concerns of the need for more money to pay for additional health and social care. Yet healthy older people can be considered a precious resource, making important contributions to their families, communities and the economy at large, by either paid or voluntary employment (WHO 2002).

The type of service provided by occupational therapists for older people varies ­internationally, and it has to be acknowledged that the authors of this book speak from their own perspective. The services that occupational therapists provide to older people are not only determined by the needs of a growing older population, but also by government policy – either at a local or national level. As occupational therapists that work in England, we have seen many changes in the way that services are delivered to older people, in both the public and private sectors. Health and social care services for older people are not only provided by public services in the acute or rehabilitation in-patient settings for older people with physical or mental health care needs, but also by community health or social care services. Occupational therapists also provide services to older people in residential and nursing home care. Increasingly, older people are receiving services ­provided by the commercial and also the voluntary sectors. These are exciting and ­challenging times for occupational therapists working with older people.

Using this book

As in the first edition of this book, we discuss the biological, psychological and social elements of health and wellbeing for older people rather than having a bio-medical focus on health conditions. There are several reasons for this; many older people are referred to occupational therapy services with multiple difficulties in occupational ­performance and not all of these are caused by a health condition – some may be the result of the normal ageing process, or by environmental and contextual factors. There is also an increasing emphasis within health and social care on health promotion, and occupational therapists are becoming increasingly aware of their role with the ‘well’ older age group.

Once again, we have used the World Health Organization’s [WHO] bio-psycho-social model of health, the International Classification of Functioning, Disability and Health [ICF] to provide a framework for the book, and the domains of the ICF have provided definitions for the content of each chapter (WHO 2001).

The motivation for writing a second edition of our book is our desire and wish for occupational therapists to continue to move towards an ‘active ageing’ approach (WHO 2002). Active ageing (Box 1.1) signifies an important paradigm shift: away from a ‘needs based’ approach to a ‘right based’ approach which support the rights and ­continued participation of older people both in the community and the political process (WHO 2002).

This chapter provides an introduction to the core issues that influence our practice as occupational therapists, including some personal reasons. Chapter 2 considers common concepts and theories of ageing, contextualising them within an occupational ­science perspective. Chapters 3, 4 and 9 consider other contextual factors such as social, cultural, environmental and economic factors. Chapter 5 does consider some of the more common health conditions that affect people in old age, but also directs the reader towards the evidence base for occupational therapy intervention as well as highlighting some ­commonly- used outcome measures. Chapters 6 and 7 consider the ageing body in terms of body functions and structures. Chapter 8 presents how activity and participation changes in older age.

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Box 1.1 What is active ageing?

It is the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age. (WHO 2002: 12)

‘Active’ refers to continued participation in society and to realise their potential for physical, social, and mental wellbeing whilst ensuring adequate protection, security and care when assistance is needed. This includes continued participation in social, economic, cultural and spiritual, and civic affairs.

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It is hoped that this book encourages the reader to view the strengths of older people during the ageing process, to consider old age as a time of celebration and to promote occupational justice for their older clients whilst still meeting all the demands of present-day practice.

The demands of occupational therapy practice

Although policies, demands and service provision vary from country to country, there is an increasing need for occupational therapists to clearly articulate the importance of their role and the evidence base of occupational therapy interventions to other professionals who might hold the power to commission services on behalf of older people, or to older people themselves and their families. Within the UK, public health and social care service provision is being increasingly determined by guidance provided by the National Institute for Health and Clinical Excellence [NICE] and the Social Care Institute for Excellence [SCIE]. What is encouraging is the inclusion of occupational therapy research within the UK NICE guidelines (NICE 2008). This guidance refers to occupational therapy and physical activity to promote the mental wellbeing of older people. These guidelines are extremely important for supporting and developing interventions within UK clinical practice.

Interestingly, where occupational therapy is well established, there is often little or no evidence for the service provided. Indeed, a systematic review of occupational therapy practice for older adults with lower limb amputations found that research evidence with this population is limited and scarce, and yet occupational therapists are key members of the multidisciplinary team for these older adults (Spiliotopoulou and Atwal 2011). However, complacency is dangerous, as one reason for occupational therapy posts being axed or services being contracted is a lack of evidence to support interventions or to ­provide evidence of its cost-effectiveness.

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Box 1.2 Why work with older adults? – Jennifer Wenborn.

“I left occupational therapy college in 1979 very undecided about which speciality I wanted to work in – except I was clear I was NOT going to work in ‘geriatrics’ (as older people were then known). This was due to a very unsatisfactory first clinical placement at a (well-known) geriatric hospital, following which I seriously considered leaving the course as I didn’t think OT was the right job for me. I started a rotational post in a central London hospital but almost immediately the unit was shut to save money and I was transferred to ‘slow stream geriatric rehabilitation’. Not the most auspicious start to my brand-new career! However, I soon found that I enjoyed building relationships over time with the patients and working as part of a multidisciplinary team. Senior and Head OT posts followed, and I enjoyed and developed a broad range of experience, predominantly working with older people. After 15 years in the NHS I opted for redundancy when yet another reorganisation came along.
Eighteen months at the College of Occupational Therapists establishing their consultancy service followed before becoming self-employed. Over the next ten years I provided a wide range of services: individual assessments and interventions; setting up new services – ­occupational therapy within a private hospital; fast-track technician to facilitate NHS discharge; long-term care insurance assessment service for a reinsurance company; Commission for Health Improvement (CHI) reviews; Department of Health and Health Advisory Service project work; NHS management and supervision; education and training. I increasingly worked in care homes – with older people and adults with severe disability – learning more about people with dementia and acquiring specialist skills such as seating provision and multisensory stimulation.
I was then asked to provide some input to a new NHS Nursing Home until appointed to the 50:50 clinical/academic post. Having caught the research bug when I completed my Masters in Occupational Therapy ten years earlier I couldn’t resist applying. I went on to complete my PhD, based on a randomised controlled trial of occupational therapy intervention for people with dementia in care homes. I now work full-time for University College London, using my OT skills to evaluate non-pharmacological interventions for people with dementia and their family caregivers. My next goal is to do more occupatio...

Table of contents

• Cover
• Table of Contents
• Acknowledgements
• Title
• Copyright
• List of Contributors
• Chapter 1: Introduction
• Chapter 2: Perspectives of ageing
• Chapter 3: The social context of older people
• Chapter 4: Policy development and implications for occupational therapy practice
• Chapter 5: Health conditions and active ageing
• Chapter 6: The ageing body – body functions and structures: Part 1
• Chapter 7: The ageing body – body functions and structures: Part 2
• Chapter 8: Occupation and successful ageing – activity and participation
• Chapter 9: Environmental impacts, products and technology
• Index
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• End User License Agreement