Effectiveness of Two Occupational Therapy Treatments for the Elderly
Principal Investigator: Florence Clark PhD, FAOTA
Feb 1994 – Apr 1997
In response to this need, we conducted between 1994 and 1996 a randomized controlled trial, the Well Elderly Study, to evaluate the effectiveness of preventive [Occupational Therapy] specifically targeted for urban, multi-ethnic, independent-living older adults. Typically, OT is provided to older individuals to facilitate independence after catastrophic illness or accidents when significant functional impairment or disability is present. However, we reasoned that many of the principles of OT intervention, given their focus on fostering productive and meaningful activity (occupation), maximizing independence, and enhancing function, constituted a potentially effective approach to preventing illness and disability and promoting health in this vulnerable population.
|Federal||NIH / National Institute on Aging (NIA) / Agency for Healthcare Research and Quality (AHRQ) / Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)||5R01AG011810-03||$279,882||Feb 1996 – Apr 1997|
|Federal||NIH / NIA||3R01AG011810-02S1||$18,177||Apr 1995 – Jan 1996|
|Federal||NIH / NIA / AHRQ / NICHD||5R01AG011810-02||$266,206||Mar 1995 – Jan 1996|
|Federal||NIH / NIA||3R01AG011810-01S1||$26,624||Jun 1994 – Jan 1995|
|Federal||NIH / NIA / AHRQ / NICHD||1R01AG011810-01||$220,001||Feb 1994 – Jan 1995|
Hay, J., LaBree, L., Luo, R., Clark, F. A., Carlson, M. E., Mandel, D., Zemke, R., Jackson, J. M., & Azen, S. P. (2002). Cost-effectiveness of preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society, 50(8), 1381-1388. https://doi.org/10.1046/j.1532-5415.2002.50359.x Show abstract
Objectives. To evaluate the cost-effectiveness of a 9-month preventive occupational therapy (OT) program in the Well-Elderly Study: a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.
Design. A randomized trial.
Setting. Two government-subsidized apartment complexes.
Participants. One hundred sixty-three culturally diverse volunteers aged 60 and older.
Intervention. An OT group, a social activity group (active control), and a nontreatment group (passive control).
Measurements. Use of healthcare services was determined by telephone interview during and after the treatment phase. A conversion algorithm was applied to the RAND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group.
Results. Costs for the 9-month OT program averaged $548 per subject. Postintervention healthcare costs were lower for the OT group ($967) than for the active control group ($1,726), the passive control group ($3,334), or a combination of the control groups ($2,593). The quality of life index showed a 4.5% QALY differential (OT vs combined control), p < .001. The cost per QALY estimates for the OT group was $10,666 (95% confidence interval = $6,747–$25,430). For the passive and active control groups, the corresponding costs per QALY were $13,784 and $7,820, respectively.
Conclusion. In this study, preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures.
Clark, F. A., Azen, S. P., Carlson, M. E., Mandel, D., LaBree, L., Hay, J., Zemke, R., Jackson, J. M., & Lipson, L. (2001). Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 56(1), 60-63. https://doi.org/10.1093/geronb/56.1.P60 Show abstract
The Well Elderly Study was a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to a 9-month program in preventive occupational therapy (OT). All participants completing the trial were followed for an additional 6 months without further intervention and then reevaluated using the same battery of instruments. Long-term benefit attributable to preventive OT was found for the quality of interaction scale of the Functional Status Questionnaire and for six of eight scales on the RAND SF-36: physical functioning, role functioning, vitality, social functioning, role emotional, and general mental health (p < .05). Approximately 90% of the therapeutic gain observed following OT treatment was retained in follow-up. The finding of a sustained effect for preventive OT is of great public health relevance given the looming health care cost crisis associated with our nation's expanding elderly population.
Jackson, J. M., Kennedy, B. L., Mandel, D., Carlson, M. E., Cherry, B. J., Fanchiang, S. P., Ding, L., Zemke, R., Azen, S. P., LaBree, L., & Clark, F. A. (2000). Derivation and pilot assessment of a health promotion program for Mandarin-speaking Chinese older adults. The International Journal of Aging & Human Development, 50(2), 127-149. https://doi.org/10.2190/9V9H-E4L7-BTJP-9WMJ Show abstract
As the percentage of older adults of diverse ethnicities increases in the United States, the call for culturally sensitive health care service strategies that target the special needs of older people grows. The present report describes methods used to adapt a health care program so that it would better meet the needs of a group of well, older Mandarin-speaking Chinese residents of Los Angeles. The specific qualitative research procedures that we used to adapt the treatment program are described, along with the particular adaptations that emerged. Additionally, outcomes from a randomized pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among older Mandarin-speaking men and women. The overall outcome of this project is in agreement with other reports in the health care literature that address the importance of providing culturally sensitive health care service for elders.
Azen, S. P., Palmer, J. M., Carlson, M. E., Mandel, D., Cherry, B. J., Fanchiang, S. P., Jackson, J. M., & Clark, F. A. (1999). Psychometric properties of a Chinese translation of the SF-36 Health Survey Questionnaire in the Well Elderly Study. Journal of Aging and Health, 11(2), 240-251. https://doi.org/10.1177/089826439901100206 Show abstract
Objectives. To evaluate the psychometric properties of a Chinese translation of the 36-item Short Form Health Survey (SF-36) in the Well Elderly Study—a randomized clinical trial designed to evaluate the effectiveness of preventive occupational therapy services specifically tailored for multiethnic, independent-living, older adults.
Methods. Translation and back-translation procedures were used to obtain appropriate meanings for the SF-36 survey questions and to ensure face, functional, and conceptual equivalence.
Results. Statistical analyses demonstrated satisfactory reliability and validity, with the results generally similar to those reported for older Anglo adults.
Discussion. As the percentage of older adults of diverse ethnicity increases, the need for health care research and service strategies that can effectively include multiple ethnicities becomes paramount. The results of this study suggest that a Chinese-translated SF-36 can be used to assess multiple dimensions of health in a Mandarin-speaking population of older adults.
Jackson, J. M., Carlson, M. E., Mandel, D., Zemke, R., & Clark, F. A. (1998). Occupation in lifestyle redesign: The Well Elderly Study occupational therapy program. American Journal of Occupational Therapy, 52(5), 326-336. https://doi.org/10.5014/ajot.52.5.326 Show abstract
This article describes an innovative preventive occupational therapy intervention for well older adults, the Well Elderly Treatment Program. In a previously reported large-scale randomized effectiveness study, this intervention was found to be highly successful in enhancing the physical and mental health, occupational functioning, and life satisfaction of multicultural, community-dwelling elders. In this article, the philosophical background, manner of development, topical content, methods of program delivery, and mechanisms underlying the program's positive effects are discussed, along with implications for occupational therapy practice. The treatment was based on application of occupational science theory and research and emphasized the therapeutic process of lifestyle redesign in enabling the participants to actively and strategically select an individualized pattern of personally satisfying and health-promoting occupations. The wide-ranging effectiveness of the program supports the occupational therapy profession's emphasis on occupation in affecting health and positions practitioners to extend their services to the realm of preventive interventions.
Clark, F. A., Azen, S. P., Zemke, R., Jackson, J. M., Carlson, M. E., Mandel, D., Hay, J., Josephson, K., Cherry, B., Hessel, C., Palmer, J., & Lipson, L. (1997). Occupational therapy for independent-living older adults: A randomized controlled trial. Journal of the American Medical Association, 278(16), 1321-1326. https://doi.org/10.1001/jama.1997.03550160041036 Show abstract
Context. Preventive health programs may mitigate against the health risks of older adulthood.
Objective. To evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults.
Design. A randomized controlled trial.
Setting. Two government subsidized apartment complexes for independent-living older adults.
Subjects. A total of 361 culturally diverse volunteers aged 60 years or older.
Intervention. An OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months.
Main Outcome Measures. A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms.
Results. Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Questionnaire (P=.03), Life Satisfaction Index-Z (P=.03), Medical Outcomes Study Health Perception Survey (P=.05), and for 7 of 8 scales on the RAND 36-Item Health Status Survey, Short Form: bodily pain (P=.03), physical functioning (P=.008), role limitations attributable to health problems (P=.02), vitality (P=.004), social functioning (P=.05), role limitations attributable to emotional problems (P=.05), and general mental health (P=.02).
Conclusions. Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains. Because the control groups tended to decline over the study interval, our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood.
Clark, F. A., Carlson, M. E., Zemke, R., Frank, G., Patterson, K., Ennevor, B. L., Rankin-Martinez, A., Hobson, L. A., Crandall, J., Mandel, D., & Lipson, L. (1996). Life domains and adaptive strategies of a group of low-income, well older adults. American Journal of Occupational Therapy, 50(2), 99-108. https://doi.org/10.5014/ajot.50.2.99 Show abstract
Older adults are at increased risk for a variety of physical and functional limitations that threaten their ability to lead independent and fulfilling lives. Consequently, they stand to benefit from personalized strategies of adaptation that enable them to achieve successful outcomes in their daily activities and desired goals. In the current investigation, a qualitative descriptive methodology was used to document the perceived life domain of importance and associated strategies of adaptation of 29 residents of Angelus Plaza, a federally subsidized apartment complex in downtown Los Angeles for low-income, well older adults. On the basis of interview data, 10 life domains were identified, and within each domain, a typology of adaptive strategies was derived. The domains were activities of daily living (ADL), adaptation to a multicultural environment, free time usage, grave illness and death–spirituality, health maintenance, mobility maintenance, personal finances, personal safety, psychological well-being and happiness, and relationships with others. Although the typology should not be generalized to a geriatric population, therapists may wish to refer to it to gain a sense of the extent to which certain adaptive strategies may be applicable to the lives of particular older adults to whom they deliver services. The teaching of these adaptive strategies could then be incorporated into an individualized treatment plan.
The typology also provides a broad picture of the kinds of adaptive strategies used by the older adults as a way of coping and adapting to their setting. Although some of the domains do not differ from those typically addressed in occupational therapy textbooks on geriatric care (e.g., ADL, health maintenance), others seem uniquely tailored to the specifics of the Angelus Plaza context (e.g., personal safety). Finally, certain domains emerged that may be highly relevant to older adults in most settings but are not typically the focus of occupational therapy programs (e.g., grave illness and death–spirituality, relationships with others). The emergence of these domains from our data suggests that therapists may wish to consider them more in treatment if they are convinced that they possess local relevance.
Carlson, M. E., Fanchiang, S. P., Zemke, R., & Clark, F. A. (1996). A meta-analysis of the effectiveness of occupational therapy for older persons. American Journal of Occupational Therapy, 50(2), 89-98. https://doi.org/10.5014/ajot.50.2.89 Show abstract
Given the current health care debate, it is imperative to document the usefulness of various health services for older persons, a rapidly growing population at increased risk for a wide variety of physical and functional impairments. A meta-analysis was conducted to examine the degree of effectiveness of occupational therapy for older persons. For a sample of 15 distinct tests of occupational therapy, a positive unweighted mean effect size of .51 (54 when corrected for instrument unreliability) was obtained, along with a highly significant cumulative result for treatment success (p < .001). Beneficial treatment effects extended to activities of daily living—functional and psychosocial outcomes. The results for physical outcomes suggested a beneficial effect, although not every meta-analytic test yielded significant results. It was concluded that factors such as publication bias or poor study design are incapable of accounting for the positive meta-analytic result and that occupational therapy represents a worthwhile treatment option for older persons.