Horticultural Therapy Education and Older Adults

Abstract

Horticulture has been identified as the number one leisure pursuit of older Americans and as a therapeutic activity which enhances physical and mental health. Instrumental to the involvement of older adults with horticulture is the professional horticultural therapist (HT). Horticultural therapist education, competency skills and professional challenges related to older persons are explored using data from two surveys. The primary method used is a 42-item survey administered in 1995 to 33 American Horticultural Therapy Association (AHTA) members who reported specialties in “education” and “older adults” in the AHTA 1994 Directory. A secondary method is a 55-item question survey administered in 1994 to directors of 41 educational programs associated with AHTA (return rate 76%). Specific topics discussed include educational programs that address aging in their curricula; competencies that should be taught with specific content on older adults; the importance of introductory gerontology courses in HT curriculum; and firlure challenges in teaching about older adults in terms of curriculum, faculty, students, and employment. Survey results provide a basis for proposing ways in which the HT profession can enhance its educational programs to address the future needs of a growing population of older adults.     

Fife Rheumatic Diseases Unit 10 years on: a personal perspective

May 2004 marked the 10th anniversary of the Fife Rheumatic Diseases Unit (FRDU) based at the Sir George Sharp Unit, Cameron Hospital in Fife. This article aims to share with the reader FRDU's particular model of service delivery, how FRDU, and the occupational therapy service in particular, has evolved over the past 10 years.     

Long-Term Effect on Mortality of a Home Intervention that Reduces Functional Difficulties in Older Adults: Results from a Randomized Trial

OBJECTIVES: To evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.
DESIGN: Two-group randomized trial with survivorship followed up to 4 years from study entry.
SETTING: Homes of urban community-living elderly people.
PARTICIPANTS: Three hundred nineteen adults aged 70 and older with difficulties performing daily activities.
INTERVENTION: Occupational and physical therapy sessions to instruct participants in compensatory strategies, home modifications, home safety, fall recovery techniques, and balance and muscle strength exercises.
MEASUREMENTS: Survival time was number of days between baseline interview and date of death, as determined using data from the National Death Index or December 31, 2005. Participants were stratified according to baseline mortality risk (low, moderate, high) using a prognostic indicator.
RESULTS: At 2 years, intervention participants (n=160) had a 5.6% mortality rate (n=9 deaths) and controls (n=159) a 13.2% rate (n=21 deaths; P =.02). Mortality rates remained lower for intervention participants up to 3.5 years from study entry. At 2 years, intervention participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths/96), compared with 28.2% for equivalent control group participants (n=24 deaths/85; P =.02). By 3 years, mortality rates were not statistically significantly different between the experimental and control groups.
CONCLUSIONS: The intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. Subjects at moderate mortality risk derived the most intervention benefit. Findings suggest that the intervention could be a low-cost clinical tool to delay functional decline and mortality.     

Drug Therapy for Hypertrophic Cardiomypathy: Physiology and Practice

HCM is the most common inherited heart condition occurring in 1:500 individuals in the general population. Left ventricular outflow obstruction at rest or after provocation occurs in 2/3 of HCM patients and is a frequent cause of limiting symptoms. Pharmacologic therapy is the first-line treatment for obstruction, and should be aggressively pursued before application of invasive therapy. Beta-blockade is given first, and up-titrated to decrease resting heart rate to between 50 and 60 beats per minute. However, beta-blockade is not expected to decrease resting gradients; its effect rests on decreasing the rise in gradient that accompanies exercise. For patients who fail beta-blockade the addition of oral disopyramide in adequate dose often will decrease resting gradients and offer meaningful relief of symptoms. Disopyramide vagolytic side effects, if they occur, can be greatly mitigated by simultaneous administration of oral pyridostigmine. This combination allows adequate dosing of disopyramide to achieve therapeutic goals. Verapamil utility in obstructive HCM with high resting gradients is limited by its vasodilating effects that can, infrequently, worsen gradient and symptoms. As such, we tend to avoid it in patients with high gradients and limiting heart failure symptoms. In a head-to-head comparison of intravenous drug administration in individual obstructive HCM patients the relative efficacy for lowering gradient was disopyramide > beta-blockade > verapamil. Severe symptoms in non-obstructive HCM are caused by fibrosis or severe myocyte disarray, and often by very small LV chamber size. Severe symptoms caused by these anatomic and histologic abnormalities, in the absence of obstruction, are less amenable to current pharmacotherapy. New pharmacotherapeutic approaches to HCM are on the horizon, that are to be evaluated in formal therapeutic trials.     

When Life Exceeds Safe Driving Expectancy: Implications for Gerontology and Geriatrics Education

ABSTRACT

Research findings suggest that life expectancy exceeds safe driving expectancy after age 70 by about 6 years for men and 10 years for women; yet few people plan for a time when driving is no longer possible. Transportation planning should be considered along with financial, legal, health care, and housing issues during preretirement in the range of advice gerontologists and geriatricians provide to older adults and their families. The message is that we all should be planning for our nondriving years. Myriad issues of potential concern exist for gerontologists and geriatricians from the screening and assessment of functional impairments that may affect critical driving skills, to licensing and renewal and the monitoring of driver safety, to driving restriction and cessation, and to the introduction of senior friendly community mobility options. Transportation, after all, is critical for connecting us to goods and services as well as to employment, volunteering, and civic engagement opportunities. This theme issue brings together representatives from the research community, licensing authority, allied health profession of occupational therapy, and community transit. All have important messages for gerontology and geriatrics education.