Study: Preventive OT benefits healthy seniors
Elderly patients remained independent, healthier
Preventive occupational therapy (OT) can make a significant difference in helping senior citizens remain independent and lead healthier, more satisfying lives, a study at the University of Southern California in Los Angeles has shown.
The study results should send a message to policy-makers and managed care organizations that they can reduce costs by using occupational therapy as a preventive tool, says Florence Clark, PhD, OTR, chairwoman of the USC Department of Occupational Science and Occupational Therapy, which conducted the Well-Elderly Study. Medicare spends $45 billion a year, or 60% of its budget, on nursing home care, she says. "We hope that our results are so impressive that policy-makers will see the benefit of offering preventive OT in health care packages. If they can prevent disability and help people stay independent, they can avoid the high cost of medical care," Clark says.
"With the burgeoning baby boomer popu-lation, we’re going to need to do everything we can to help people stay independent," she adds.
Researchers studied 361 senior citizens, ages 60 to 89, who lived in federally subsidized apartment buildings for low-income seniors in Los Angeles. The subjects came from a broad mix of backgrounds and included African Americans, Hispanics, Asians, and whites.
A third of the participants received two hours of group OT a week and a one-hour individual OT session each month. One control group had no interventions. The other group participated in two hours a week of organized social activities led by nonprofessional. There were nine participants in each OT and social activity control group. Senior citizens in the OT groups showed a nearly 14% advantage over their peers in the two control groups, according to results published in the Oct. 22, 1997, issue of the Journal of the American Medical Association.1
The researchers used a range of tools to measure physical health, mental and social functioning, and satisfaction with life at the beginning and the end of the study. At the end of nine months, the subjects who received OT interventions showed more gains and fewer declines than those in the two control groups.
On the SF 36 Health Status Survey, for example, members of the OT groups showed improvement in five of eight subscales. They showed fewer declines on the other three subscales than subjects in either control group. In the control groups, the subjects declined substantially on every measure over the nine month period, Clark says. "In the OT group, we were able to slow down decline on three measures and show improvement on five," she adds.
Therapist’s guidance helps
The senior citizens who were involved regularly in activities fared no better or worse than those who received no treatment at all. This suggests that the involvement of a trained therapist was an essential ingredient in producing the beneficial effects, Clark says. The occupational therapists taught their groups how to overcome barriers to daily living, such as using adaptive equipment, and energy conservation techniques.
The program was designed to help participants alter their approach to everyday activities such as shopping, exercising, and grooming to maximize functionality and productivity, she says. The occupational therapists also spent an hour a month on individual sessions in the participants’ homes and developed a comprehensive individual plan for each participant, she explains.
After a fall, one elderly woman became afraid to go outside, for instance, so she spent most of her time confined to her apartment and suffered from depression. She particularly feared getting on the bus, her most readily available and affordable means of transportation. The occupational therapist simulated a step that approximated the step she would have to take to get on the bus. After practicing in the safe environment of her home, the woman felt confident enough to join the group on a bus excursion and since has done more traveling on her own, Clark says.
For group activities, the occupational therapists concentrated on activities that required little money, since participants were on fixed incomes. One popular group excursion was taking the city’s new Metro public transportation system to Long Beach. Many of the senior citizens were unaware the Metro was operating and would never have ventured to use it themselves.
The social control group went on outings, worked on craft projects, played games, and attended dances. The activity leader made suggestions and let the group choose the activities, Clark says.
The study was sponsored by the National Institute on Aging, The National Center for Medical Rehabilitation Research, and the American Occupational Therapy Foundation.
Clark says she hopes the publicity the study has generated will help the public and policy-makers better understand occupational therapy and how important it is to help people redesign their lifestyle after an illness or injury. She cites data that show nearly 10 million people watched television coverage of the study after her presentation at the American Medical Association’s 16th Annual Science Reporters Conference.
"It’s been very hard to get insurance coverage for occupational therapy because, in general, the public hasn’t understood what OT does, and it has been confused with other therapy. All of a sudden, word is getting out about what OT is and what it can do in the area of prevention," she says.
Reference
1. Clark F, et al. Occupational therapy for independent-living older adults: A randomized controlled trial. JAMA 1997; 278:1,321-1,326.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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