Therapy Interventions For Older Adults Research Articles

IMPROVING COGNITIVE DECLINE FOR PERSONS LIVING WITH DEMENTIA: A RCT ART THERAPY BASED ON THE ETC FRAMEWORK

Abstract Abstract This randomized controlled trial explored the impact of Expressive Therapies Continuum (ETC)-based art therapy interventions for older adults with dementia living in a complex care home. The trial examined the efficacy of 10 art therapy intervention sessions over 4 months, comparing results with an active control group that participated in 10 art sessions. Pre- and post-assessments, including the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), and the Older People’s Quality of Life (OPQOL-Brief) questionnaires, were conducted. Results demonstrated that participants displayed similar visual expression elements, shared preferences for specific media types, and equivalent ETC-based intervention entry levels. In addition, participants in the experimental group showed significant increases in OPQOL-Brief scores. Finally, MMSE-Language scores demonstrated statistically significant increases in the experimental group and a decrease in the control group. The current study aligns with previous research demonstrating that art therapy can improve cognitive functioning and enhance the quality of life in older adults living with dementia. It expands on previous research by providing new insights into expressive and stylistic elements, ETC entry-level, and media preferences for engaging in artmaking. Keywords: Art therapy, dementia, older adults, Expressive Therapies Continuum, cognitive functioning, quality of life

Cost-effectiveness of occupational therapy for older adults: a protocol for an updated systematic review

IntroductionThe ageing populations in developed countries are a global concern, with increasing numbers of older adults facing physical, cognitive and psychological challenges, resulting in reduced quality of life and higher...

A Personalized, Telehealth Music Therapy Intervention for Lonely Older Adults: A Feasibility Study

<h3>Introduction</h3> Music listening interventions, facilitated by a qualified music therapist, have been shown to reduce late-life depression and anxiety but their impact on loneliness has not been well-studied. Risks associated with loneliness in older adults include depression, cognitive decline, poorer disease outcomes and premature mortality. This study evaluated the feasibility of a remotely-delivered, personalized music therapy intervention for older adults living alone during the COVID-19 pandemic, and assessed measures of socioemotional well-being before, during, and after the intervention. <h3>Methods</h3> We recruited community-dwelling cognitively unimpaired older adults who lived alone, endorsed loneliness and were able to use Zoom video conferencing. Individuals with cognitive impairment (TICS < 31), moderate-severe depression (GDS > 10), or hearing impairment were excluded. Eight weekly, individual music therapy sessions were conducted with a board-certified music therapist via Zoom to develop personalized music playlists and to learn specific music listening techniques. Participants listened to playlists for one hour daily, completed a daily journal, and answered online questionnaires at weeks 0 (pre), 4 (mid), and 8 (post). The primary outcome was the PROMIS Social Isolation Scale [PROMS] score. Other questionnaires included the Behavioral Activation for Depression Scale [BADS], Positive Affect and Well-Being Scale [PAWB], Perceived Stress Scale [PSS], Brief Symptom Inventory [BSI], and the Snaith-Hamilton Pleasure Scale [SHAPS]). Qualitative data were collected at week 8 for thematic analysis. <h3>Results</h3> From March to August 2021, 11 participants were enrolled (mean age 74.82 [66-85], 88% women), eight completed the study, and one dropped out, leaving two actively enrolled. Among those who completed, numerical scores for loneliness and all other outcomes changed in an improved direction. Pre- and post-study mean scores and baseline standard deviation for those who completed are reported: PROMS (x¯=20.0, 16.8; sd=5.88), BADS (x¯=36.3, 40.8; sd=10.48), PAWB (x¯=33.5, 37.1; sd=6.61), PSS (x¯=14.5, 11.6; sd=7.89), BSI (x¯=33.3, 23.5; sd=17.1), SHAPS (x¯=47.0, 50.62; sd=6.74). Qualitative interviews were notable for themes of joy and improvements in sleep, health, focus, and physical pain. Participants also reported increased connectedness to culture, country of origin, loved ones, and the music therapist. <h3>Conclusions</h3> Recruitment and participant acceptability of a virtual, personalized music therapy intervention have been positive. Interim data analysis points to a possible improvement in loneliness and other outcome measures, though limited by low statistical power. Music therapy appears to be a novel and feasible approach to address loneliness and emotional wellbeing in at-risk community-dwelling older adults.

Feasibility and Preliminary Efficacy of an Occupational Therapy Intervention for Older Adults With Chronic Conditions in a Primary Care Clinic.

Occupational therapy can play a role in primary care management of chronic diseases among older adults. To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. Family medicine clinic serving an urban, low-income, working-class community. Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. i-PROACTIF focuses on preserving functional independence, is based on the Person-Environment-Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Occupational Therapy Practice Guidelines for Older Adults With Low Vision.

The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision. This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation. We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research. Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice. Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation. This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.

Yoga as a Community-Based Recreational Therapy Intervention for Older Adults: A Pilot Study

The purpose of this multi-method pilot study was to ex-plore the efficacy of a yoga intervention on the leisure constraints and functional fitness of community-dwell-ing older adults. Seven community-dwelling older adults engaged in 16, 60-minute sessions of hatha yoga con-ducted twice a week for eight weeks at a local continuing education center. Individuals enrolled in either a seated yoga class (n=4) or a standing yoga class (n=3). Pre-/ post-measures included physical measures and a sur-vey of leisure constraints. A focus group was conducted with each group to determine their perspectives of par-ticipation. Results indicated significant improvement in lower-body strength and endurance. Balance, upper and lower body flexibility, upper-body strength, and self-re-ported leisure constraints did not show significant im-provements. Qualitative data showed that participants perceived psychosocial and physical benefits to yoga participation including increased energy and motivation to engage in other types of physical activities. Findings indicate the potential for the use of yoga to increase participation in other forms of leisure-time physical activity, but further evaluation of the influence of yoga on leisure constraints is warranted. Implications for recreational therapists are discussed, includ-ing helping clients identify community yoga classes that will best meet their needs based on class size, accessibility, and pace. Subscribe to TRJ

An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial

BackgroundAnxiety is among the most prevalent and disabling mental health problems in older adults. Few older adults with mild to moderately severe anxiety symptoms receive adequate interventions, putting them at risk for developing anxiety disorders, depression, and various somatic problems. Effective, low-threshold interventions should be developed. Blended care, in which a web-based intervention is combined with a limited amount of face-to-face contacts with a mental healthcare counselor at the general practice, is a promising option. The online self-help intervention “Living to the Full”—an Acceptance and Commitment Therapy (ACT) intervention—has been proven to reduce depression and anxiety in several patient groups, but has not yet been investigated in older adults. The aim of this study is to evaluate the (cost-)effectiveness of a blended form of “Living to the Full” in reducing anxiety symptoms in adults aged 55 to 75 years. Furthermore, moderators and mediators of the treatment effect are investigated.Methods/designThe (cost-)effectiveness of the ACT intervention will be investigated in a cluster single-blind randomized controlled trial (RCT). The blended intervention will be compared to treatment-as-usual. Thirty-six mental health counselors working at general practices in the Netherlands will be randomized to deliver blended care or treatment as usual. A total of 240 participants (aged 55–75 years) with mild to moderately severe anxiety complaints (defined as a total score of 5–15 on the GAD-7) will be recruited. There are four measurements consisting of online questionnaires (primary outcome: GAD-7) and a telephone interview: before the start of the intervention; directly following the intervention (14 weeks after baseline); and six and twelve months after baseline. Possible mediator variables will be assessed multiple times basis during the intervention.DiscussionThis RCT will evaluate the effectiveness of a blended ACT intervention for older adults with anxiety symptoms. If the intervention is shown to be effective, it will be implemented, thereby improving the accessibility and quality of preventive interventions for older adults with anxiety problems.Trial registrationNetherlands Trial Register, NTR6270. Registered on 21 March 2017.

Content Analysis of a Participant-Directed Intervention to Optimize Activity Engagement of Older Adult Cancer Survivors.

Many older adult cancer survivors reduce their activity level during and after cancer treatment. Occupational therapy interventions need to flexibly address various obstacles to occupational engagement that survivors may face. The aim of this analysis was to describe the content of a participant-directed occupational therapy intervention for older adults with cancer. Content analysis was used to describe the treatment session data from the experimental arm of a pilot randomized controlled trial in terms of activities addressed, obstacles reported, and treatment strategies utilized. Participants predominantly used the intervention to increase exercise engagement or address instrumental activities of daily living. The most common obstacles to occupational engagement included fatigue, finding time, weather, and pain. Regarding treatment strategies, 77% of participants chose to practice the activity with the occupational therapist, 42% requested a piece of equipment, and 11% modified the environment to increase activity engagement. Overall, the participant-directed intervention appears flexible enough to address various activities and obstacles to occupational engagement.

A Pilot Study of a Home-based Occupational Therapy Intervention for Older Adults With Cancer

A Pilot Study of a Home-based Occupational Therapy Intervention for Older Adults With Cancer

Treatment of dysphonia in older people: the role of the speech therapist.

This review addresses speech therapy interventions for older adults experiencing voice impairments. The prevalence, impact, and nature of voice impairments in older people are outlined. Intervention methods and their effectiveness are discussed, with particular focus on behavioral treatments for presbyphonia. The strength of current evidence is discussed and recommendations for future research are presented. There has been a substantial increase in the number of older people seeking voice management over the last 10-20 years. Reduced vocal effectiveness in older people is likely to be multifactorial and associated with normal physiological aging, maladaptive responses to vocal aging, and medical and psychosocial conditions that are common in older age. Although several authors have claimed that behavioral intervention for presbyphonia is effective, few studies were reported until 2008. Since then, 10 studies have been published as to the effectiveness of behavioral interventions for age-related dysphonia. Voice therapy techniques evaluated include vocal function exercises, phonation resistance training exercise, Lessac-Madsen resonant voice therapy, Lee Silverman voice treatment, neuromuscular electrical stimulation, semi-occluded vocal tract, and flow phonation. Findings suggest that behavioral interventions for presbyphonia have the potential to mitigate effects of vocal aging, but the overall evidence base is inadequate to allow definitive conclusions. Because vocal effectiveness diminishes as people age and because diminished vocal capabilities are associated with negative impacts, the importance of establishing whether behavioral interventions are effective is now acknowledged. Although the number of studies on speech therapy interventions has increased, the body of evidence is limited and further research is required.

Update on productive aging research in the American Journal of Occupational Therapy, 2013, and overview of research published 2009-2013.

In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists' mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.

Methodology for the Systematic Reviews on Occupational Therapy Interventions for Older Adults With Low Vision

Systematic reviews of the literature relevant to older adults with low vision are important to the practice of occupational therapy. This article describes the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults with low vision. We describe the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. In addition, we present the final number of articles included in each systematic review; a summary of the results, strengths, and limitations of the findings; and implications for practice, education, and research.

Effectiveness of Occupational Therapy Interventions for Older Adults Living With Low Vision

This issue of AJOT adds to the growing and evolving understanding of the effectiveness of occupational therapy interventions to meet the needs of older adults living with low vision; additional high-quality research is needed.

Evaluation of an Agency-Based Occupational Therapy Intervention to Facilitate Aging in Place

The United States faces a growing population of older adults and accompanying functional disabilities, coupled with constrained public resources and diminishing informal supports. A variety of interventions that aim to improve client outcomes have been studied, but to date, there is limited translational research that examines the efficacy of moving such interventions from clinical trials to agency settings. A randomized controlled trial was conducted to evaluate a restorative occupational therapy intervention relative to "usual care" among community-dwelling older adults. The intervention included a detailed assessment from a person-environment perspective and provision of adaptive equipment and home modifications where appropriate. The intervention (n = 31) and control groups (n = 29) were evaluated at 3 months and assessed for changes in functional status, home safety, falls, health-related quality of life (HRQoL; EQ5D), depression, social support, and fear of falling; a 4 subgroup analysis also examined outcomes by waiting list status. An informal economic evaluation compared the intervention to usual care. Findings indicated improvements in home safety (p < .0005, b = -15.87), HRQoL (p = .03, b = 0.08), and fear of falling (p < .05, b = 2.22). Findings did not show improvement in functional status or reduction in actual falls. The intervention resulted in a 39% reduction in recommended hours of personal care, which if implemented, could result in significant cost savings. The study adds to the growing literature of occupational therapy interventions for older adults, and the findings support the concept that restorative approaches can be successfully implemented in public agencies.

Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties.

BackgroundOlder adults experience activity and participation limitations that are associated with ageing. Activity and participation limitations affect an older adult’s ability to engage in meaningful daily activities and valued life roles. Occupational therapists provide interventions to reduce such limitations and monitor client change to ensure that interventions are effective. Client change should be measured through the use of valid and reliable assessments. Yet occupational therapists can favour the use of non-standardised assessments leading to inaccurate reflections of client change and difficulties in comparing the effectiveness of interventions. A number of reasons have been suggested as to why therapists may favour non-standardised assessments, including a lack of knowledge (of assessments and their properties) and lack of skill.Methods/designThis paper describes the systematic review protocol that will be used to identify functional assessments used in randomised trials of occupational therapy interventions for older adults (≥70 years of age). Interventions will focus on enhancing functional independence for either older adults transitioning from hospital to home, or community dwelling older adults. We will search Medline, EBSCO and OTseeker using a pre-determined search strategy to identify Functional assessments. These assessments will be recorded and, in phase two, their measurement properties analysed.DiscussionThis protocol provides a comprehensive guideline for conducting the proposed systematic review. The results of this systematic review will provide a thorough and unbiased identification and evaluation of measurement properties of functional assessment tools used in randomised trials to evaluate occupational therapy intervention. This information can be used to determine which assessment has superior measurement properties and will inform occupational therapy practice.

Methodology for the Systematic Reviews on Occupation- and Activity-Based Intervention Related to Productive Aging

Systematic reviews of the literature relevant to community-dwelling older adults are important to the practice of occupational therapy. We describe the four questions that served as the focus for the systematic reviews of the effectiveness of occupational therapy interventions for older adults living in the community. This article includes the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.

Is occupational therapy practice for older adults with lower limb amputations evidence-based? A systematic review

Although occupational therapists are integral to the rehabilitation process of people with amputations, the effectiveness of the occupational therapy intervention for older adults with lower limb amputations has not been investigated. To identify the effectiveness of the occupational therapy interventions with older adults aged 65 years and older with lower limb amputations. Systematic review. A systematic search was conducted in CINAHL, PUBMED, OTSEEKER and OTDBASE from January 1985 to January 2011. The eligible papers were critiqued using a typology, which involved designation of levels of evidence and quality markers. The databases yielded 2,664 potential publications. Of these, only two were included in the final review. These studies suggested that the frequency of the occupational therapy sessions was found to be statistically significantly related to prosthesis use and that service users perceived positive benefits about the provision of stump boards. Both studies had limitations resulting in a need for further investigation in these areas. Research evidence on the occupational therapy interventions with this population is limited and scarce. Occupational therapists need to take urgent action to address the identified evidence-based gaps in order to devise informed targeted rehabilitation programmes for this client group.

Working memory and older adults: implications for occupational therapy.

Atkinson and Shiffrin's (1968) modal model of memory is still commonly used by rehabilitation professionals to evaluate memory impairment in older adults. However, research to date has been unable to indicate that short-term memory declines with age. These findings have led some rehabilitation professionals to mistakenly conclude that short-term memory is not affected by the aging process. This article reviews both the traditional concept of short-term memory, as outlined by Atkinson and Shiffrin, and the more recent conceptualization of short-term memory in terms of Baddeley and Hitch's (1974) model of working memory. The implications of the concept of working memory has implications for occupational therapy interventions for older adults. For example, clients with dementia may experience difficulties in performing tasks that require drawing inferences. Similarly, language that contains vague references may present problems for these clients. In addition, changes in working memory in older adults suggest that they may experience difficulties with medication management and what Rule, Milke, and Dobbs (1992) called wayfinding. Therefore, evaluations of working memory would provide a better indication of older adults' memory performance than the modal model.