Introduction

Geriatric Essentials

• Occupational therapy (OT) focuses on helping elderly people do all the activities of daily living that have become difficult or impossible to do because of age-related changes, disorders, or disability. When indicated, new, creative strategies and appropriate assistive devices are suggested, and exercises to enhance participation are taught. These strategies help elderly people adjust the way they function as required by age-related changes, disorders, or disability.
• OT provides help with other activities (eg, work, leisure, social), depending on the patient's capabilities and interests.

Occupational therapy (OT) aims to improve the ability of elderly people to do activities of daily living (ADLs); to fulfill their roles (occupations) in their home and community; to adjust the way they function as required by age-related changes, disorders, or disability; and thus to enhance their dignity (see Table 30-1). When possible, OT enables patients to regain enough function to continue living at home. If institutionalization is necessary, OT can enhance function there. Thus, the goals of OT for some elderly people do not include recovery of full premorbid function, which is a goal for most younger people.

OT can benefit elderly people with physical or social dysfunction or at high risk of developing such dysfunction. Dysfunction may result from such conditions as hip replacement, disabling COPD or arthritis, stroke, emotional disturbances (eg, depression), or sensory impairments.

OT focuses on ADLs because they are essential to independent living. Basic ADLs (BADLs) include eating, dressing, bathing, grooming, toileting, and transferring (eg, moving between surfaces such as the bed, chair, and bathtub or shower). Instrumental ADLs (IADLs) require more complex cognitive functioning than BADLs. IADLs include preparing meals; communicating by telephone, writing, or computer; managing finances and daily drug regimens; cleaning; doing laundry, food shopping, and other errands; managing finances; traveling as a pedestrian or by public transportation; and driving. Driving is particularly complex, requiring integration of visual, physical, and cognitive tasks; the ability to do and coordinate these tasks may be mildly to moderately impaired with aging.

OT may also help patients with other activities, depending on their capabilities and interests. OT may provide strategies to enhance a patient's ability to work (paid or volunteer). Patients may be taught compensatory strategies that enable them to continue their leisure activities. To reduce the risk of social isolation and its detrimental consequences, OT helps elderly patients maintain familiar social activities and encourages new ones. OT also provides strategies to promote continued learning and to keep the mind active; such strategies help promote feelings of self-worth and may help prevent premature dementia.

Registered occupational therapists have at least a bachelor's degree; a master's degree will soon be required. Certified OT assistants (COTAs) have an associate degree. Occupational therapists evaluate patients initially and plan the appropriate interventions; COTAs, supervised by an occupational therapist, then implement the interventions.

This topic was last updated April 2006.