Low Vision Rehabilitation for the Elderly

            As older adults age it is quite a common occurrence for them to experience changes in their vision. What was once may have appeared clear is now blurry. These older adults might take this as a sign that they need to get their glasses changed.  However, for some individuals this vision loss is more severe and cannot be corrected by glasses or contacts. In older adults, macular degeneration is an age related disease that destroys one’s central vision, leading to low vision (Medline Plus).  A new specialty of occupational therapy is looking to teach individuals with low vision how they can improve their engagement in occupations such as reading and writing.

            Low vision can greatly affect how one can perform daily activities such as reading, writing, and even dressing. Being unable to perform these significant daily tasks could be devastating to an older adult. Therefore, a new occupational therapy intervention program is seeking to introduce tools and exercises that can assist them through these occupations.

            The occupational therapist can provide patients with low vision exercises that can help to improve the accuracy and speed of their reading. Therapists can also suggest devices such as certain magnifying glasses that can help these individuals be more successful at reading and also show them how to properly use the devices. By improving their participation in such occupations, the program promotes independence and can raise the individuals overall sense of well being. This area of occupational therapy is relatively new but very promising in helping older adults live with and improve their vision problems.

Marowitz, M. (2006). Occupational therapy interventions in low vision rehabilitation. Canadian Journal of Ophthalmology, 41, 340-347.

Medline Plus. Macular degeneration. Retrieved 29 April 2009. http://www.nlm.nih.gov/medlineplus/maculardegeneration.html 

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Benefits of Occupational Therapy for Older Adults with Dementia

Dementia is defined as a loss of mental functions such as thinking, memory, and reasoning that can interfere with a person’s daily activities (WebMD). There are many diseases that can cause dementia but the most common and debilitating cause is Alzheimer’s disease.  Dementia is estimated to affect 5-8% of the elderly population over 65 and over 50% of older adults in their 80s. A recent study published in The Journals of Gerontology reveals several benefits that community occupational therapy can have on dementia patients and on their caregivers.

  The participants in this study consisted of community-dwelling patients who were aged 65 or older and had mild-to-moderate dementia. The patients were randomly assigned to either the intervention, which included providing the patient with occupational therapy sessions at home, or the control group, which received no occupational therapy. The therapy sessions consisted of compensatory strategies to adapt a person’s daily activities with their level of ability and environmental strategies in which the therapist modified the patient’s environment to allow them to be more successful with their disabilities.

After just 6 weeks of intervention, the group who received occupational therapy had an overall better health status and mood. The caregivers of these patients also showed improvements in their mood and expressed improvements in their sense of control over life.

These results could prove very helpful to both patients and caregivers of individuals suffering from dementia. This can provide hope to families who are feeling the devastating affects that the disease has caused to their loved one as well as to the rest of the family. Although the occupational therapy program does not promise a cure from dementia it helps both caregivers and patients learn on how to adapt one’s life around the symptoms. The therapists provide the tools for these individuals to live healthier lives with their disability.

Graff, M. J. L., Vernoij-Dassen M. J. M., Thijssen, M., Dekker J., Hoefnagels W. H. L. & OldeRikkert M. G. M. (2007). Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: A randomized controlled trail. The Journals of Gerontology, 62A, 1002-1009.

WebMD. Alzheimer's disease. http://www.webmd.com/alzheimers/guide/alzheimers-dementia.

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Occupational Therapy: The New Fountain of Youth?

     Occupational therapy has been gaining popularity in recent years for many of the benefits that it can provide for older adults. Many occupational therapists have been helping older adults to live safer and more independent lives. One recent study shows that occupational therapy may in fact help the elderly live longer.

http://www.healthnewsdigest.com/news/Research_270/Occupational_Therapy_Physical_Therapy_Intervention_Extends_Lifespan_and_Quality_of_Life.shtml      

     A recent randomized trial published in the Journal of the American Geriatrics Society looked at the mortality rates for a group of individuals enrolled in an intervention program called ABLE which combined preventive occupational therapy and physical therapy for older adult subjects.  Through this intervention program the subjects learned strategies such as home modifications, safety techniques, fall recovery techniques and balance and strength exercises. In a preceding study ABLE was shown to reduced many functional difficulties for older adults such as the fear of falling and introduced the use of assistive technology and home safety modifications. A randomized trial was conducted on subjects up to 4 years from the entry into the study. The results showed that at 2 years the participants who took part in the ABLE program had a mortality rate of 5.6% compared to a rate of 13.2% for the controls.  The results also showed that participants with a moderate mortality risk had a 16.7% mortality rate compared to 28.2% for controls with a moderate mortality risk.  Overall, the results from this randomized trial showed that the intervention group had up to a 3.5 year longer survival rate compared to the control group.

While the study could not state what exactly caused this increase in survivorship, one reason could be the education provided to the older adults through such programs as home safety and fall prevention.  According to the Center for Disease Control and Prevention, in 2005 15,800 people over the age of 65 died as a result of unintentional falls (CDC). Therefore, if occupational therapy fall prevention programs can help older adults learn about ways to change their environment for optimal safety then many of these deaths could be prevented. So while it cannot be proved that occupational therapy is the new fountain of youth, many studies are showing the benefits that it can have for older adults. Perhaps more fall preventive programs could be provided for at risk older adults. By enrolling in such programs, older adults may be able to live happy, healthier, and even longer lives.

American Occupational Therapy Association. Occupational therapy, physical therapy intervention extends lifespan and quality of life. http://www.healthnewsdigest.com/news/Research_270/Occupational_Therapy_Physical_Therapy_Intervention_Extends_Lifespan_and_Quality_of_Life.shtml

Gitlin, L. N., Hauck, W. W., Dennis, P. M., Winter, L., Hodgson, N. & Schnifeld, S. Long-term effect on mortality of a home intervention that reduces functional difficulties in older adults: Results from a a randomized trial. Journal of the American Geriatrics Society, 57, 417-481.

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Preventive Occupational Therapy May Provide Both Physical and Financial Benefits for the Elderly

            As the number of baby boomers reaching old age is increasing a lot of focus is being placed on aging successfully. While every person’s aging cycle is unique, studies have shown that engaging in meaningful activities helps to keep older adults healthy longer. Whether it is gardening or doing crafts, engaging in activities that have importance to the individual can significantly benefit their overall health as well as process of aging. Occupational therapy is now being used on healthy older adults in hopes of prolonging this healthy aging and preventing future health problems.

A study published in the Journal of the American Geriatrics Society observed a group of individuals who were enrolled in preventive occupational therapy and compared them with those who were not enrolled in such a group. (http://www3.interscience.wiley.com/cgi-bin/fulltext/118936796/PDFSTART)

The results showed that individuals enrolled in the preventive occupational therapy spent less on their healthcare costs after having completed the nine-month occupational therapy program. Individuals in this program spent about $967 on post intervention healthcare compared to $1726 for the active control group, $3334 for the passive control group, and $2593 for a combination of the control groups. 

This decrease in overall healthcare spending could be a result of increased education about successful aging. Occupational therapists help individuals to engage in activities that are meaningful to them. Perhaps this education to find a hobby proved to be a good coping mechanism for these individuals, in turn, increasing their overall health. More research needs to be done to determine what exactly is beneficial about the occupational therapy program. Perhaps just having someone to talk with on a weekly basis can help overall health outcomes. Whatever the reason, research shows that preventive occupational therapy is both cost effective as well as beneficial to health for older adults. 

Hay, J., LaBree, L., Lu,o R., Clark, F., Carlson, M., Mandel, D., et al. (2002), Cost-effectiveness preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society, 50, 1381-1388.

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Fall Prevention for the Elderly

According to the Centers for Disease Control and Prevention, more than one third of elderly persons over 65 years old fall every year in the United States (CDC). In 2005 about 1.8 million older adults were treated in emergency rooms for nonfatal injuries from falls and more than 433,000 of these patients were hospitalized (CDC). In fact the leading cause of injury deaths in the elderly are a result of falls.  

Due to this high prevalence of cases, it does not come as a surprise that falling is a major concern reported by elderly adults.  According to a study published in Physical and Occupational Therapy in Geriatrics, older adults fear falling because of fear of social embarrassment, getting hurt, and fear of losing their independence. So while physical injury is major concern, many older adults also fear the psychological effects of falling. A fall can result in feeling of inadequacy and embarassment. This fear can also lead to avoidance of everyday activities in hopes of preventing a fall. This abandonment of everyday activities can affect the individual's quality of life and their feeling of independence. 

So what, if anything, can be done about this fear of falling? Well for several years now occupational therapists have been working with elderly patients in programs designed to prevent falls. These occupational therapists address the patient’s fear of falling and ways that it could be prevented. According to the study, the most common fears regarding falls were fear of physical injury, the feeling of falling, becoming an invalid, losing one’s independence and being institutionalized, a long lie and being unable to reach someone once they have fallen, and being confined to a wheelchair or being unable to walk (ibid).  This study could shed light to some of the assistive tools that occupational therapists could suggest to calm their client’s fears of falling and tools that could even help to prevent future falls. 

 One promising tool may in fact be a popular video game that many children play.  According to the article Wii-habituation 'could prevent elderly from falls' published in CNN health, researchers at the University of Aberdeen in Sweden are studying to see if the popular video gaming system the Wii-fit can improve balance in elderly individuals.

http://www.cnn.com/2009/HEALTH/02/11/wii.fit.elderly/index.html

If this does prove to be successful numerous occupational therapists could help develop treatment plans using the gaming system to help improve an elderly patient’s balance as well as confidence. Other assistive devices such as medical alarms are becoming popular. These alarms can be worn around the person’s neck and can allow the older adult to call for help with the touch of a button. This can help to calm the fear that many older adults have of falling and not being able to contact anyone. This can help to boost the older adult’s confidence and chance of getting medical assistance much faster in the case of a fall. Hopefully more can be done in this field to prevent the number of falls suffered from elderly adults. 

CDC. Falls among older adults: An overview. Retrieved 28 February 2009, from http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Lorie, A. (2009). Wii-habilitation could prevent elderly from falls. Retrieved Febrauary 28, 2009, from http://www.cnn.com/2009/HEALTH/02/11/wii.fit.elderly/index.html

Tischer, L., Hobson, S. (2005). Fear of falling: A qualitative study among community-dwelling older adults. Physical and Occupational Therapy in Geriatrics, 23, 37-53. 

Can Alzheimer's Disease Affect the Safety of the Road?

A recent study conducted by the University of Iowa indicates that people with early Alzheimer’s disease can show impairments in their driving ability compared to people without the disease. (http://www.usatoday.com/news/health/2009-02-09-alzheimers-driving_N.htm) The study observed 40 older adults diagnosed with early Alzheimer’s and compared them to a group of 115 older adult drivers without the disorder.

During a road test, the Alzheimer’s subjects showed an

average of 42 mistakes while the subjects without the disease showed an average of 33 mistakes. The most common of these mistakes was lane violations, which was about 50% higher in the Alzheimer’s subjects. This study helps to bring light to the potential danger that the Alzheimer population faces when driving. While many older adults in the early stages of the disease may show very little cognitive impairment, they may in fact manifest impairments in their abilities to drive safely.

This raises the question. Should people with Alzheimer’s disease be driving? People diagnosed with other neurological disorders such as epilepsy must follow a strict set of rules in order to drive, which can include obtaining a doctor’s note stating that they are fit to drive safely. Similar rules could be applied to people with Alzheimer’s disease to improve their safety on the road.

In combination with these laws, occupational therapy can help to improve the safety of this population on the road. One emerging area of occupational therapy is looking to help elderly patients modify their driving to ensure safety on the road. According to the Alzheimer’s Association, as many as 5 million Americans currently have the disease. Occupational therapists could greatly help this population by identifying their specific needs. Perhaps new tools and warning devices can be made for these patients. For example, sensors that could identify the driver of the cars that may be in their blind spot when switching lanes. With these added measures, the safety of these drivers as well as others on the road could be greatly improved.

Marcus, B. M. (2009). Early Alzheimer's can erode erode driving skills. Retrieved 28 February 2009, from http://www.usatoday.com/news/health/2009-02-09-alzheimers-driving_N.htm

Keeping Elderly Drivers Safe

Driving is an occupation that allows individuals to get from point A to point B. It also allows individuals the freedom to go where they please without the assistance of others. However, as people age driving can become more difficult. Street signs may not be as visible as they once were and reflexes may be slower. In order to help meet these difficulties occupational therapists have been studying the limitations that are interfering with a patient's optimal driving performance.

According to an article published in the American Journal of Occupational Therapy, many therapists believe that larger fonts on street signs, especially warning signs, can be very helpful to the elderly driving population. This will allow them to see the street signs from farther away and gives them more time to react appropriately. Therapists also suggest better reflective signs that can be seen during the night can be helpful to the elderly driving population.

Although this research included many great suggestions on how to improve roadways for the elderly, these changes can be costly and restructuring current roadways and signs is unlikely. With many baby boomers; however, quickly approaching older adulthood it is important that these suggestions be taken into consideration. Occupational therapists can help by influencing the making of new roadways with these modifications. Along with these street modifications, the article suggests that occupational therapists must also come up with their own modifications for their clients to drive safely in the current state of roadways. Perhaps new tools and services will arise out of this growing need. However, in order for this to occur more research needs to be done on exactly how aging affects ones ability to drive.

Bohr, C. P. (2008). Critical review and analysis of the impact of the physical infrastructure on the driving ability, performance, and safety of older adults. American Journal of Occupational Therapy, 62, 159-172.

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