Occupational Therapy with Aging Adults

Promoting Quality of Life through Collaborative Practice

Karen Barney, Margaret Perkinson

• Publisher: Mosby
• Year: 2015
• ISBN:
  9780323290838
• Topic: Medicine
• Subtopic: Occupational Therapy

Look no further for the book that provides the information essential for successful practice in the rapidly growing field of gerontological occupational therapy! Occupational Therapy with Aging Adults is a new, comprehensive text edited by OT and gerontological experts Karen Frank Barney and Margaret Perkinson that takes a unique interdisciplinary and collaborative approach in covering every major aspects of geriatric gerontological occupational therapy practice. With 30 chapters written by 70 eminent leaders in gerontology and OT, this book covers the entire continuum of care for the aging population along with special considerations for this rapidly growing demographic. This innovative text also covers topical issues spanning the areas of ethical approaches to treatment; nutrition and oral health concerns; pharmacological issues; low vision interventions; assistive technology supports; and more to ensure readers are well versed in every aspect of this key practice area.

• UNIQUE! Intraprofessional and interprofessional approach to intervention emphasizes working holistically and collaboratively in serving older adults.
• Case examples help you learn to apply new information to actual patient situations.
• Questions at the end of each chapter can be used for discussion or other learning applications.
• Chapter on evidence-based practice discusses how to incorporate evidence into the clinical setting.
• Chapter on ethics provides a deeper understanding of how to address challenging ethical dilemmas.
• UNIQUE! Chapter on the wide range of physiological changes among the aging patient population highlights related occupational performance issues.
• UNIQUE! Chapter on oral health explores the challenges faced by older adults.

Section I

Conceptual Foundations of Gerontological Occupational Therapy

Outline

1. Gerontological occupational therapy: Conceptual frameworks, historical contexts, and practice principles

2. Ethical and legal aspects of occupational therapy practice with older adults

3. Looming disease burden associated with the aging process: Implications for occupational therapy

4. Theoretical models relevant to gerontological occupational therapy practice

5. Foundations of evidence-based gerontological occupational therapy practice

6. Approaches to screening and assessment in gerontological occupational therapy

7. Occupational therapy intervention process with aging adults

TitleChap

Chapter 1

Gerontological occupational therapy: Conceptual frameworks, historical contexts, and practice principles

Margaret A. Perkinson, PhD, FGSA, FAGHE, FSfAA, Karen Frank Barney, PhD, OTR/L, FAOTA

Chapter outline

Basic Concepts and Theories of Old Age

Evolution of Gerontological Concepts and Theory Regarding Late-Life Activity/Occupation

Current Concepts and Theory in Occupational Therapy Relevant to the Understanding and Facilitation of Late-Life Activity/Occupation

Conceptual Framework of the Book: Late-Life Experience from an Occupational Perspective

The Study of Aging in Historical Context

The Demographic Transition

Resulting Social Changes and Their Implications for Later-Life Occupations

Implications of Current Gerontological Debates for the Practice of Occupational Therapy

The Evolution of Gerontological Occupational Therapy

Characteristics of Occupational Therapy Practice with Aging Adults

Person-Related Questions

Context-/Environment-Related Questions

Occupational Options Related Questions

Occupational Performance/Participation Related Questions

Outcomes-/Participation-Related Questions

Fundamental Intervention and Outcome Considerations with Older Clients

Challenges in Gerontological Practice and Research

Gaps in OT Curricula

Image Issues

Reimbursement Structures, Standardization of Care, and Implications for Professional Development and Professional Identity

Objectives

• Review basic gerontological concepts and theories

• Discuss theoretical frameworks of gerontology within occupational science and occupational therapy theoretical perspectives

• Provide historical and global contexts that underscore the significance of the field of gerontology in general and gerontological occupational therapy in particular

• Provide an overview of the history of and the challenges and opportunities inherent in gerontological occupational therapy

• Discuss the contributions and application of gerontological concepts to occupational therapy interventions

• Provide conceptual guidelines for facilitating occupation-based interventions with older adults

In spite of illness, in spite even of the archenemy sorrow, one can remain alive long past the usual date of disintegration if one is unafraid of change, insatiable in intellectual curiosity, interested in big things, and happy in small ways.

Edith Wharton

I grow more intense as I age.

Florida Scott-Maxwell

As we grow old . . . the beauty steals inward.

Ralph Waldo Emerson

These are exciting times to be a gerontologist, both for researchers and practitioners. Long-held negative notions of old age are giving way to more complex, nuanced understandings of late-life experiences and processes. These newly refined understandings, based on a growing body of gerontological research, should inform and guide those in positions to assist older adults in the search for an enriched later-life stage suffused, as the earlier quotes suggest, with an alive, intense state of inward beauty. Given the purview of occupational therapy, that is, “achieving health, well-being, and participation in life through engagement in occupation,”⁷ as well as its holistic approach and emphasis on client-centered care and quality of life, occupational therapists are especially well suited to benefit from and contribute to contemporary gerontological theory and practice. This chapter introduces the basic concepts, theoretical and disciplinary orientations, and goals that underlie this book. It also provides historical and global contexts that explain why the current epoch may well be considered revolutionary in respect to old age, and why this aging-related revolution is especially relevant to the field of occupational therapy. After an overview of the history of and challenges inherent in gerontological occupational therapy (OT), we underscore the significance of current gerontological debates to the development and implementation of gerontological OT interventions.

Basic concepts and theories of old age

Evolution of gerontological concepts and theory regarding late-life activity/occupation

Early gerontologists framed aging largely in negative and universal terms. Old age was equated with physical decline, cognitive dysfunction, social disengagement, and marginalization. Disengagement theory predominated, claiming universal processes of decline and mutual withdrawal of the aged from society and society from the aged. This presumably played out when older adults voluntarily relinquished former roles and activities to embrace peace and quiet. At the same time, representatives of the immediate social group or larger society presumably perceived older members as unable to fulfill the requirements of former work and social roles and reallocated those roles (and the attached resources) to the up-and-coming younger generation. The period of late life was both problematized and medicalized as entailing inevitable, “incurable” biological and psychological declines that warranted little more than custodial care or occasional efforts at rehab for those who showed less decrement or possessed more resources.

Subsequent theorists disengaged from disengagement theory, replacing it with its polar opposite, activity theory. Life satisfaction ebbed and flowed, depending on the levels of activity in which an older adult engaged. Whereas disengagement theory posited a direct positive relationship between life satisfaction and decreased activity in later life, activity theory claimed a similar relationship between life satisfaction and increased activity in old age. The relationship between activity and aging has remained a central focus of gerontological theory, a focus that parallels the central domains of occupational science and occupational therapy, that is, fostering quality of life through participation in requisite, life-sustaining, and meaningful activities or occupations.

The new “positive gerontology” extends this line of thought, replacing earlier assumptions of inevitable decline with concepts such as successful aging, productive aging, and civic engagement as appropriate and attainable goals in later life.^{37, 51, 59} (See Chapter 4 and Chapter 18 for more extensive discussions of the evolution of gerontological theory as it pertains to occupational therapy.) Although it contributed to the advancement of the field in terms of theory, scholarship, and policy, positive gerontology is not without its critics.^{49, 50, 61} Deeply rooted in individualistic, contemporary U.S. values of independence, autonomy, activity, and progress, the precepts of positive gerontology may not hold in alternate cultural contexts,^{43, 62, 63, 64} for example, in societies that value interdependence over self-sufficiency. In addition, by continuing to equate “success” in aging with the maintenance of good physical and mental health, substantial sectors of older adults with functional limitations (or lacking financial resources to access the means to optimal health) would be doomed, by definition, to the status of “failure.”

Critical social gerontologists have contributed to the discussion by examining the influence of cultural, historical, and political factors on the construction, experience, and valuation of aging. Neither equating aging with deficits nor denying the reality of age-related losses, critical social gerontologists stress the potential to achieve personal mastery and a sense of meaning and continued growth—what some may call resilience—in the face of loss of whatever nature.

Current concepts and theory in occupational therapy relevant to the understanding and facilitation of late-life activity/occupation

The Person-Environment-Occupational-Performance (PEOP) model¹⁴ provides an ecological transactional systems framework central to the organization of this book (Figure 1-1). It represents the most recent refinement of a model that has been widely used in the fields of occupational science and occupational therapy and that underlies the predominant intervention guidebook, Occupational Therapy Practice Framework: Domain and Process (3rd ed.).⁷

FIGURE 1-1Occupational performance (doing) enables participation (engagement) in e...