Lifestyle Interventions for Health Promotion and Prevention
Health Core ⟩
Well Elderly Study
Since 1993, when the USC Well Elderly Study was first launched, the USC Chan Division of Occupational Science and Occupational Therapy has been involved in studying the impact of a specific intervention called Lifestyle Redesign® on health in older Americans. The initial USC Well Elderly Study, led by Florence Clark from 1994 through 1996, made a number of notable contributions in the research on occupational therapy and its effect on the aging population. The largest outcomes research study conducted in the field to date, results of this research were published (Clark et al., 1997) in the Journal of the American Medical Association, the first occupational therapy study to ever earn a spot in the pages of the prestigious JAMA. The findings from this project showed that preventative occupational therapy intervention significantly slows the declines normally associated with aging, and is a cost-effective method of enabling older individuals to maintain their health and independence.
Clark and former professor Jeanne Jackson subsequently completed a study, referred to as “The USC Well Elderly Study 2,” which aimed to replicate previous study results which demonstrated that Lifestyle Redesign® cost-effectively slows the declines normally associated with aging. This research effort was also intended to build theory by simultaneously examining biological and social psychological mechanisms potentially responsible for the positive effects previously produced by the intervention. The findings of this study (Clark et al., 2012) provided new information about the process events by which activity-based lifestyle interventions can influence aging outcomes.
Lifestyle Redesign® for Pressure Ulcer Prevention in Spinal Cord Injury (PUPS)
The Lifestyle Redesign® for Pressure Ulcer Prevention in Spinal Cord Injury — also abbreviated as “PUPS” — study was a $2.8M NIH-funded R01 study conducted by Clark from 2008 to 2014. Faculty members Stanley Azen and Erna Blanche were key collaborators, and additional USC collaborators included Clinical Pharmacy and Pharmaceutical Economics & Policy Professor Joel Hay, Professor of Preventive Medicine Jennifer Unger, and Salah Rubayi and Michael Scott from Rancho Los Amigos National Rehabilitation Center (RLANRC).
Advanced pressure ulcers are a common and medically serious complication of spinal cord injury (SCI) and are associated with extremely high treatment costs and reduced quality of life. However, preventive interventions that address this problem have received very little research attention. To address this gap, PUPS investigated the efficacy of a promising lifestyle intervention designed to prevent pressure ulcers among at-risk members of the SCI population. The six-year study involved collaboration between researchers from USC and RLANRC who have developed the intervention based on the results of a qualitative investigation of lifestyle and ulcer risk among adults with SCI. The long-term objective of this project is the identification of an intervention option that can enhance the health and life quality of the population of adults with SCI while simultaneously diminishing the heavy healthcare burden that results from the problem of SCI-related pressure ulcers.
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Completed projects
Health Core ⟩
Advanced pressure ulcers are a common and medically serious complication of spinal cord injury (SCI) and are associated with extremely high treatment costs and reduced quality of life. However, preventive interventions that address this problem have received very little research attention. To…
Period: Sep 2008 – Jul 2014
Federal Funding
$3,035,996
Health Core ⟩
The Long Beach VA Health Care System is collaborating with the USC Division of Occupational Science and Occupational Therapy on a demonstration project to develop a sustainable Lifestyle Redesign® program tailored for pressure ulcer prevention in rural veterans with spinal cord injuries to be…
Period: Aug 2012 – Jan 2014
Federal Funding
$180,511
Health Core ⟩
Previous theory and research implicates participation in meaningful activity as an important factor in enhancing older adults' health-related quality of life. Consistent with this emphasis, a previous R01 grant completed by our study group demonstrated that an activity-based intervention (the Well…
Period: May 2004 – Apr 2010
Federal Funding
$2,247,187
Health Core ⟩
This project examines the beliefs and practices underlying the activities, habits, and daily routines of 18 ethnically diverse consumers with SCI. The intent is to document how personality, lifestyle patterns and choices, and environmental context mutually interact within the individually…
Period: Jan 2000 – Dec 2004
Federal Funding
$467,851
Health Core ⟩
Period: Jan 1998 – Dec 1999
Private Funding
$26,000
Health Core ⟩
Period: Jan 1994 – Dec 1997
Private Funding
$90,000
Health Core ⟩
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…
Period: Feb 1994 – Apr 1997
Federal Funding
$810,890
Selected publications
2012
Clark, F. A., Jackson, J. M., Carlson, M. E., Chou, C. P., Cherry, B. J., Jordan-Marsh, M., Knight, B. G., Mandel, D., Blanchard, J., Granger, D. A., Wilcox, R. R., Lai, M. Y., White, B. A., Hay, J. W., Lam, C., Marterella, A., & Azen, S. P. (2012). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomised Controlled Trial. Journal of Epidemiology and Community Health, 66(9), 782-790. https://doi.org/10.1136/jech.2009.099754 Show abstract
Background. Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.
Methods. A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60-95 years (mean age 74.9±7.7 years; 53% < $12,000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.
Results. Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps < 0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p < 0.02), which was achieved cost-effectively (US $41,218/UK £24,868 per unit). No intervention effect was found for cognitive functioning outcome measures.
Conclusions. A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.
1997
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.
In Chan News
November 24, 2008
USC OS/OT is awarded a grant to study Lifestyle Redesign® intervention for people with spinal cord injury. As discovered by a team of researchers led by USC OS/OT in a 3-year, NIDRR-funded qualitative study, "Daily Living Context and Pressure Sores in Consumers with SCI," the ordinary daily…
In the Media
Hans Villarica, in
The Atlantic | February 10, 2012
When it comes to their well-being, older adults shouldn't act like victims to aging. They should be active — physically, socially, and spiritually.
Robert Perkins, in
USC News | June 8, 2011
Small, healthy lifestyle changes and involvement in meaningful activities — going beyond just diet and exercise — are critical to healthy aging, according to a new USC study.
USC News | October 15, 2004
The National Institute on Aging has awarded USC occupational therapy researchers a four-year, $2.2 million grant to expand on their successful Well Elderly program.
Alicia Di Rado, in
USC News | October 8, 2004
The National Institute on Aging has awarded USC occupational therapy researchers a four-year, $2.2 million grant to expand on their successful Well Elderly program.
Alexis Bergen, in
USC News | September 13, 2002
Lifestyle redesign by an occupational therapist is a cost-effective health care intervention for independent-living senior citizens, according to a USC study published this month in the Journal of the American Geriatrics Society.
Alicia Di Rado, in
USC News | February 19, 2001
Occupational therapy can help senior citizens stay healthy and live independently, with lasting results even six months after seniors work with a therapist, according to a USC study.
Reuters, in
The New York Times | February 8, 2001
Helping the elderly make healthy changes in their daily lives may improve their well-being and keep them living independently, new research shows.
Eva Anderson, in
USC News | October 27, 1997
Occupational therapy (OT) can make a significant difference in helping seniors to experience healthier, more independent and satisfying lives, according to a recent study by researchers on the Health Sciences Campus.
Michael Byrne, in
USC News | June 27, 1994
The Department of Occupational Therapy has been awarded a $1 million federal grant to study the effectiveness of occupational therapy as a means of enhancing health and well-being and maintaining independence among elderly people.
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