Home-based occupational therapy for community-dwelling older adults: A study of effect and participants' perspectives

Research output: Book/Report/PhD thesisPhD thesisResearchpeer-review

Abstract

Older adults with multiple chronic health issues can be referred to occupational therapy in Denmark if they experience problems performing their daily occupations in their homes. The aims of the PhD study were to examine whether home-based, client-centred, and occupation-based occupational therapy may help older adults to improve and maintain their occupational performance, and to understand how older adults experience and deal with their occupational performance after they have received occupational therapy.
A sequential mixed methods design was adopted, encompassing three studies. In Study I, an assessor-blinded randomised controlled trial with 119 older adults tested the effectiveness of 11 weeks of intensive client-centred and occupation-based occupational therapy delivered in the older adults’ homes. The control group received the usual practice of the municipality. In Study II, a systematic literature review of experimental research examined the effectiveness of home-based and occupation-based occupational therapy. Eight articles reporting six RCTs were included. In Study III, individual qualitative interviews were performed with 11 older adults who had received home-based, client-centred, and occupation-based occupational therapy. Their experiences and expectations concerning their occupational performance were analysed using inductive qualitative content analysis.
In Studies I and II it was found that home-based, client-centred, and occupation-based occupational therapy can effectively improve older adults’ occupational performance in the short term. Study III supplemented this result with older adults’ own views on home-based occupational therapy; they generally valued the intervention and the higher independence they had achieved.
An evidence- and theory-based strategy chart was developed, building on findings from all three studies concerning strategies to deal with performance problems and on the Person-Environment-Occupation (PEO) model. General therapeutic approaches used in client-centred and occupation-based occupational therapy were included as well as specific strategies with two different aims: 1) to improve and maintain occupational performance and 2) to deal with persistent performance problems.

Home-based, client-centred, and occupation-based occupational therapy can be useful for older adults with multiple chronic and mainly physical health issues who have the energy and motivation to participate in the intervention. The developed strategy chart can serve as a tool to inspire occupational therapists’ tailored-to-the-individual interventions with older adults. The results of the PhD study are applicable to home-dwelling older adults with performance problems who live in a Scandinavian welfare state. The studied intervention seems readily applicable to Danish municipal practice, if due consideration is given to possible needs for a theoretical brush-up among occupational therapists, and to the allocation of sufficient therapist resources.
Further development of interventions that emphasise the generalisation and transfer of strategies from occupational therapy to everyday life is recommended. Future research should examine the short- and long-term effectiveness of the interventions as well as health economic perspectives.

Translated title of the contributionErgoterapi i hjemmet for ældre borgere: Et studie af effekt og af deltagernes perspektiver
Original languageEnglish
Place of PublicationAarhus
PublisherAarhus Universitet
Number of pages170
Publication statusPublished - 9 Apr 2018

Keywords

  • occupational therapy
  • activity-based occupational therapy
  • client-centred occupational therapy
  • home-based occupational therapy

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