Walking for wellness: a collaborative program to maintain mobility in hospitalized older adults

To prevent the functional decline in older patients that often results from restricted activity during hospitalization, the Walking for Wellness program was designed to educate patients about remaining mobile during their stay and to provide daily walking assistance from cross-trained transportation staff. Screening procedures often identified patients who could benefit from physical therapy, and the medical and therapy staff used the program to maintain gains accomplished for patients who remained hospitalized after being discharged from therapy.     

An occupational therapy program for adults with developmental disabilities

This paper describes an occupational therapy independent living skills programs for adults with developmental disabilities living in group homes. Four clients have participated in this program for 1 year. Verbal reports from house and workshop staffs and written documentation in the clients' records were examined to see if the clients' behaviors changed over the course of their first year in the program. These reports indicate that the clients have moved toward increased independence by showing greater initiative in directing their own care. Treatment issues in group home systems are also discussed.     

Feasibility of mobile mental wellness training for older adults

Mobile technology has been increasingly adopted in promotion of mental health among older people. This study assessed the feasibility of a mobile mental wellness training application for individual use and for group work from the perspectives of older adults and social care professionals. The older individuals recruited for the study were participants in a Circle of Friends group and family caregivers' peer support group offered by the communal senior services. The qualitative and quantitative results of interviews, questionnaires, observation, and application usage were reported. Seven older adults started using the application independently at home in parallel with the group activity. This study revealed new information regarding the barriers to the older adults' full adoption of such mobile technologies. The results indicated that there may be potential in the incorporation of mobile technologies in promotion of mental health of older people at group settings.     

Outcomes of primary care-based Medicare annual wellness visits with older adults: A scoping review

The increasing aging population creates many challenges for countries around the world. Keeping this population healthy to prevent frailty and functional decline requires a stronger focus on health promotion and disease prevention. Maximization of well-being and quality of life of older adults can occur if determinants of health are addressed and preventive behaviors are supported. Primary care-based preventive visits such as the Medicare annual wellness visit can be used with older adults to enhance health promotion efforts. A scoping review of studies was conducted to identify current evidence concerning the impact of this visit on preventive practices, risk reduction and lifestyle behavior changes for community-dwelling older adults. A total of 11 studies were included in this review. Preventive services use outcomes including vaccinations and screenings were most frequently reported. Visits such as these can provide a platform for development of strategies to provide ongoing support for health promotion efforts.     

Garden walking and art therapy for depression in older adults: a pilot study

The purpose of this pilot study was to compare garden walking (either alone or guided) with art therapy in older adults with depression. Depression was measured using the Geriatric Depression Scale (GDS) and stories of sadness/joy. Prior to the intervention, 47% of participants had depression scores in the severe range and 53% in the mild range. At the end of the intervention, none of the participants had scores in the severe range, 89% had scores in the mild range, and 11% had scores in the normal range. Results of the GDS data using repeated measures analysis of variance indicated significant decreases in depression for all three groups from pretest to posttest. All participants, regardless of group assignment, had a lower percentage of negative-emotion word use and a higher percentage of positive-emotion word use over time. This study provides evidence for nurses wishing to guide older adults in safe, easy, and inexpensive ways to reduce depression.     

Strategies for community occupational therapy program development.

Occupational therapists who wish to see services expand in community settings must be prepared to take an active role in program development. The article examines 12 program development strategies which are illustrated using the experience of developing a rural program in a social service system. Community occupational therapy services in Prince Edward Island were initially developed, from 1977 to 1979, by a small group of occupational therapists. The group obtained Federal Welfare Demonstration Grant funding for a pilot project which was administered by the provincial Department of Social Services. In 1979, the Prince Edward Island Provincial Government approved on-going funding for an Island-wide community occupational therapy service.     

An occupational therapy perspective on falls prevention among community-dwelling older adults

BACKGROUND: Prevention of falls among community-dwelling older adults is an important area of research because of the serious consequences that can result from falls for this population. The risk factors associated with falls tend to be categorized into two groups: intrinsic, or personal factors, such as fear of falling, age, gender, and extrinsic, or environmental factors, such as lighting or slippery surfaces. METHOD: The current falls prevention literature was reviewed using an occupational therapy perspective. RESULT: It revealed that there are only a few brief examples of the relationship between occupation and falls in the literature. The profession of occupational therapy appears to be underrepresented in the current falls prevention literature. The review highlights the important contributions that occupational therapists could make to this functional problem. PRACTICE AND RESEARCH IMPLICATIONS: For occupational therapy, important areas for consideration when attempting to prevent falls among older adults living in the community include using a client-centred approach, compliance, and follow up on recommendations. There is a need for more occupational therapy research specifically on occupation and falls, that explores their relationship and influence upon one another.     

Evaluation of a peer-led falls prevention program for older adults

Waters DL, Hale LA, Robertson L, Hale BA, Herbison P. Evaluation of a peer-led falls prevention program for older adults.

Objective

To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group).

Design

Quasi-experimental evaluation with 12-month follow-up.

Setting

Community.

Participants

Older adults with increased fall risk (N=118; mean age, 75.5y; age range, 65–94y), with 23% drop out at 12 months.

Intervention

Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist–administered program and comparison group (n=25) 1-hour weekly seated exercise classes.

Main Outcome Measures

Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months.

Results

At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P<.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P<.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48–1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group.

Conclusions

This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.     

Development of a healthy bladder education program for older adults

The Healthy Bladder Program was developed as part of an academic and health care partnership and was designed specifically for older adults residing in independent and assisted living. Program content was based on best practices that can be used by nursing staff to provide information about promoting and maintaining bladder health. One hundred eighty older adults, recruited from long-term care retirement communities, attended the 1-hour program. Findings showed that the program was successful in providing bladder health information that older adults could use immediately; suggestions are given for best practice applications.     

Outcomes of a peer mentor implemented fitness program in older adults: A quasi-randomized controlled trial

Objectives

To investigate the effectiveness of different applications of mentoring in an older adult exercise program, this study compared the physical fitness scores, the retention and participation rates of older adults trained by student mentors, peer mentors, peer mentors working independently of the researchers, and a non-exercising control group.

Methods

106 older adults were recruited and assigned to one of the groups using quasi-randomization. All three experimental groups completed a 14-week intervention. Pre- and post-training assessments of fitness were completed, and retention and participation rates were compared.

Results

High retention and participation rates, as well as significant improvements in fitness scores from baseline to post-test were observed in all three mentored groups. While the control group showed improvement only in one fitness test, subjects in the mentored groups improved similarly in all measures, regardless of the type of mentoring received.

Discussion

These findings indicated effectiveness of the peer mentor model and suggested that with adequate preparation peer mentors may be capable of guiding older adult participants effectively without assistance from professional staff.     

Outcomes of an occupational therapy program for mothers of children with disabilities: impact on satisfaction with time use and occupational performance.

OBJECTIVE: This experimental research study evaluated the impact of an 8-week psychosocial occupational therapy intervention program for mothers who have children with disabilities. METHOD: Thirty-eight mothers of children with disabilities were randomly assigned to participate either in the treatment or the control group (19 in each). The occupational therapy intervention was designed to facilitate increased perceptions of satisfaction with time use and occupational performance, thereby positively affecting maternal and family well-being. The Canadian Occupational Performance Measure (COPM) was administered to measure self-perceptions of occupational performance and satisfaction over time. RESULTS: No significant differences were found between the two groups on time use perceptions. Although no significant differences were found between the two groups on the COPM Performance subscale, the treatment group demonstrated significantly greater score increases (p < .05) on the COPM Satisfaction subscale. CONCLUSION: This preliminary study suggests that attending to the time use and occupational concerns of mothers of children with disabilities can have a positive impact on their satisfaction with occupational performance.     

Outcomes for older adults in inpatient specialist neurorehabilitation

BackgroundInpatient specialist neurorehabilitation in the United Kingdom is based on providing a service to “working-age” adults (<65 years), with little evidence for outcomes for older adults involved with these services.ObjectiveThe aim of this study is to determine any difference in outcome after inpatient neurorehabilitation between younger and older adults assessed as having rehabilitation potential.MethodsA two-centre retrospective review was performed comparing patients aged < 65 and ≥ 65 years by diagnostic group in terms of length of stay, changes in UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores and discharge destination.ResultsSix hundred and sixteen patients (32% ≥ 65 years) were included. The 2 age groups did not differ in length of stay (median difference 7 days, 95% confidence interval [CI] −2 to 15, P = 0.112), but both UK FIM + FAM change and efficiency were higher for the older than younger group (median difference 7, 95% CI 2–13, P = 0.006 and 0.10, 0.01–0.19, P = 0.031 respectively). Older age was associated with discharge to long-term care (6% < 65 years; 11% ≥ 65 years, x² = 4.10, P = 0.043). Results and trends were similar in patients with acquired brain injury (n = 429), spinal cord injury (n = 59) and peripheral neuropathy (n = 34) but not progressive neurological disorders (n = 70).ConclusionOlder adults considered to have rehabilitation potential may have greater functional gains from inpatient specialist inpatient rehabilitation than younger adults. Age alone should not exclude admission to inpatient specialist neurorehabilitation.     

Examination of selection criteria for a program in occupational therapy

The purpose of this study was to determine if the results of preselection interviews in combination with preselection academic performance offer better predictions of academic performance in occupational therapy than either of these criteria taken singly. The sample consisted of 48 high school students and 31 university students admitted to the program in occupational therapy at the University of Western Ontario from 1978 to 1980. The results indicated that for university students, previous academic performance alone was the best predictor for their performance in first-year occupational therapy. For high school students, the combination of 5 of the 12 interview items with previous academic performance produced the best predictor of successful academic performance in occupational therapy. This implies that for high school students at least, the interview and previous academic performance should both be considered as important selection criteria.     

Outcomes of inpatient rehabilitation for older adults with debility

OBJECTIVE: To determine the functional outcomes and discharge setting of older patients receiving inpatient rehabilitation for debility (ICD-9-CM, 799.3). DESIGN: Retrospective cohort study of 63,171 individuals >or= 65 yrs old with a primary (23%) or comorbid (77%) debility diagnosis from the Uniform Data System for Medical Rehabilitation (UDSMR) database for 2002-2003. RESULTS: Patients with a primary diagnosis of debility (PDD) had a lower mean rehabilitation efficiency score (functional change per day) as compared with the rest of the subjects (1.7 vs. 1.9, P<0.001), including those with a Centers for Medicare & Medicaid Services (CMS) 75% rule primary diagnosis (1.8, P<0.001). The PDD group was less likely to be discharged home (68% vs. 73%, P<0.001) and more likely to be discharged to a hospital (13% vs. 11%, P<0.001). CONCLUSIONS: From a clinical perspective, the functional recovery of older patients with debility is essentially the same, regardless of whether this is a primary or comorbid diagnosis. Their functional improvement is also comparable with that reported for other CMS 75% rule diagnoses, although the debility patients are less likely to be discharged home. More than 10% of these patients were discharged to acute hospital settings. Further research is warranted to identify the most appropriate rehabilitation setting for patients with debility.