Date Presented 04/05/19
A thematic synthesis of the implications for practice related to OT and aging in place found across available literature revealed six themes: client-centered care, autonomy, home modifications, community mobility, social participation, and caregiving. Clinicians should provide client-centered practice that emphasizes autonomy and individualized home modifications, reduces isolation, promotes accessibility within communities, and reduces caregiver burden.
Primary Author and Speaker: Beth Ann Walker
Additional Authors and Speakers: AJ Ehrlich, Hannah Masemore, Kristen Taft, Carolyn Tuttle, Hannah Young
PURPOSE: The purpose of this thematic synthesis was to examine the implications for practice across the evidence on the use of occupational therapy to facilitate aging in place.
BACKGROUND: Currently, 96% of older adults live in their homes (Lozell, 2014) and 90% would prefer to stay within their homes (Kochera, Straight, & Guterbock, 2005). When it comes to a point that an older adult’s home may not meet their safety and functional needs, it may be necessary for an occupational therapist to modify the environment to allow for greater independence (Chippendale & Bear-Lehman, 2010). There is a need for collective evidence which provides a comprehensive guide to practice using the evidence available on the use of occupational therapy to support older adults aging in place.
DESIGN: A thematic synthesis was used to analyze the implications for practice and establish themes in order to provide an adaptive and practical resource for research by arranging and describing the data in adequate detail (Braun & Clarke, 2006). Twenty-three articles met the inclusion criteria of empirical research regarding occupational therapy and aging in place. Researchers utilized all databases available via ERIC Ebscohost using the following search terms: occupational therapy, aging in place, older adults, elderly, seniors, home modifications, aging at home, and productive aging.
ANALYSIS: Implications for practice were discussed, finalized, extracted, and coded. Codes were discussed and refined as a group until a consensus was reached. Using a constant comparative approach, codes were reviewed until themes emerged. A total of 6 themes emerged to explain the implications for practice regarding aging in place: client-centered care, autonomy, home modifications, community mobility, social participation and caregiving.
FINDINGS: Client-Centered Care should begin with the practitioner viewing a person’s home as a place of meaning, being mindful of the client’s perceptions, habits, and routines, and using language easy to understand by the client. Autonomy is a primary goal which should be a thread in all interactions. Clients should be involved in all meaningful decisions which thoroughly reflect the client’s needs. Technical aids, modifications, and equipment should enhance self-sufficiency, provide a sense of security, and be introduced at an appropriate time. Home Modifications should be individualized, usable, cost effective, support performance, and directed to supporting client participation and promotion of overall well-being of the client. Social Participation continues to be linked to quality of life and services should aim to enhance occupational engagement and prevent social isolation. Community Mobility can be negatively impacted without reliable and safe transportation or within communities which have been poorly designed. It is essential for practitioners to advocate and connect older adults to resources in their community to promote healthy lifestyles in the most accessible way. Caregiving can be extremely stressful and through collaboration, OT practitioners can enable caregivers to provide the best care possible.
CONCLUSION: It is imperative for practitioners to provide client-centered practice emphasizing autonomy. Home modifications should be carefully considered and aspects of social participation and community mobility should not be neglected. Together with caregivers, caregiver strain can be reduced, quality of life enhanced, and the person-environment fit optimized.
IMPACT: Older adults and their caregivers want the opportunity to engage in meaningful occupations within their homes for as long as possible. Occupational therapy intervention plans should be based on available evidence to help clients reach desired outcomes (AOTA, 2014).
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl. 1), S1-S48.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. doi: 10.1191/1478088706qp063oa
Kochera, A., Straight, A., & Guterbock, T. (2005). Beyond 50.05: A report to the nation on livable communities-creating environments for successful aging. Washington, DC: AARP Research Institute.
Lozell, B. (2014, November 14). Aging in place: Is your association ready for the next challenge? [Webinar]. Chicago, IL: Institute for Real Estate Management.
