Clients' Perspectives of the Effectiveness of Home Modification Recommendations by Occupational Therapists

Pilot evaluation of a digital approach to occupational therapy home assessments: acceptability and efficiency compared with usual practice in a hospital

INTRODUCTION

Pre-discharge home assessments by occupational therapists facilitate safe and timely discharge from hospital and are associated with better health outcomes. Digital technology offers the potential to reduce duplication of documentation and improve communication and sharing of home assessment findings.

OBJECTIVE

This quality improvement project evaluated time-cost; clinician satisfaction and confidence; and acceptability of the use of a digital approach to home assessments.

METHODS

A prospective, cross-sectional design was used to compare usual practice with the digital approach across two sub-acute wards in a large metropolitan hospital in Queensland, Australia. Time to document and conduct home assessments as well as clinician satisfaction and confidence were compared using descriptive statistics. Clinician perspectives about the home assessment approaches were collected through a survey and analyzed using content analysis.

RESULTS

Home assessment and documentation time were significantly lower for the home assessments conducted using the digital approach compared with usual practice assessments. Clinician satisfaction with using digital technology was higher.

CONCLUSIONS

The introduction of this simple technology reduced clinicians' time to conduct home assessments and document home assessment reports. The project was well received by occupational therapy clinicians.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A187.

Development and Validation of the Protocol for Administering Telehealth Home (PATH) Assessments

Home safety assessments and subsequent modifications can prevent hospitalization, institutionalization, and death among older adults. Telehealth has been shown to be an effective means to administer home safety assessments. However, a structured approach to synchronous telehealth home assessments has not been examined. This study involved development and validation of a structured telehealth home assessment protocol. The Protocol for Administering Telehealth Home (PATH) assessment was developed based on literature review, clinical experience with in-person and telehealth home assessments, and interviews with content experts. Six older adults participated in the validation phase of the protocol using a quasi-experimental, mixed-methods, one-group research design. The validation process resulted in modifications to the protocol to enhance its utility in practice. The PATH protocol provides a valid, structured approach to conducting synchronous telehealth home assessments and can be used by occupational therapists to administer home assessments for older adults desiring to age in place.

Ageing in place - exploring the safety of the environment of Slovenian older adults

Objective

The importance of subjective and objective living environment was investigated.

Methods

A new questionnaire was developed, validated and distributed to community-dwelling adults in various Slovenian counties. Data were analysed using descriptive statistics and t-tests in SPSS Statistics 24. Older adults (N = 358), 33% men and 67% women, mean age 74.3 years, participated in the cross-sectional study.

Results

Statistically significant differences (at 5% significance level) in subjective opinions of older adults regarding views on appropriate design of the living environment between the group with and without risk factors exist only for the statement that a thermostat to regulate room temperature should be placed in a visible and accessible location (p = 0.014).

Conclusion

The living environment has some risk factors, but they are not statistically significant between groups. The results may prompt occupational therapists to develop innovative strategies to facilitate occupational participation of users, increase participation in preventive services and obtain policy support.

Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review

INTRODUCTION

Low implementation rates of occupational therapy home assessment recommendations have previously been reported. The objective was to identify and describe the barriers and facilitating factors that influence implementation of home assessment recommendations.

METHODS

A mixed methods systematic review consisting of studies involving adults living in the community who received an occupational therapy home assessment was conducted. Seven databases were last searched in August 2021. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools (SUMARI) dependent on study design. Data synthesis followed the convergent integrated approach. Findings were mapped to the theoretical Capability Opportunity Motivation Behaviour (COM-B) model of health behaviour change.

RESULTS

From 5,540 citations, 22 articles met the criteria for the systematic review. Implementation of occupational therapy home assessment recommendations ranged between 55% and 90%. Six synthesised findings were identified. Capability barriers included a patient's cognitive and physical ability. Motivation barriers included a perceived lack of need and stigma; patient reported decreased involvement and lack of choice. Opportunity barriers included limited family or carer involvement, carer stress, level of service provision available, including funding, therapy dosage and timing and environmental restrictions. Overall facilitators included patient-centred care, including choice and understanding need, individualised tailored recommendations, involvement of families and carers, provision of written record and strategies to support implementation. Results were limited by methodological weaknesses in identified studies and heterogeneity in the definition and measurement of implementation impacting on comparison. Specific intervention components were often poorly described.

CONCLUSION

The theoretical model elucidates priority factors to address for promoting implementation of home assessment recommendations. Future high-quality research clearly defining intervention components is required to support short- and long-term implementation of recommendations in the home environment. Behaviour change techniques could be utilised to support home assessment practices in future research.

Evaluating a Novel Extended Scope of Occupational Therapy Service Aimed at Hospital Avoidance in Tasmania, Australia, from the Perspective of Stakeholders

The Australian state of Tasmania has seen a spike in Emergency Department presentations in recent years, particularly among the elderly. A novel extended scope occupational therapy (ESOT) service was implemented by the Tasmanian Health Service, aimed at supporting hospital avoidance. Clients were referred to the ESOT service by other services after being assessed as having a high risk of imminent hospital presentation. Occupational Therapists provided short-term interventions related to falls, mobility, nutrition, and initiated onward referrals to other services. A convergent parallel mixed methods design was used to evaluate the ESOT service. Quantitative data from routinely collected administrative records and a purpose-built survey of referring clinicians were used alongside qualitative data from semi-structured interviews with clients/carers, to enable the triangulation of data. Quantitative data were analysed using descriptive statistics, while qualitative data collected in interviews were thematically analysed. A total of 104 extended scope interventions were provided to 100 clients. Most clients were able to stay at home. Qualitative data revealed that mobility, support, and facilitating access to support services were factors which added value to the client and carer experience. In conclusion, the ESOT program contributed to potentially avoiding hospital admissions and to improving the quality of life of participating clients.

Unmet Need for Equipment to Help With Bathing and Toileting Among Older US Adults

IMPORTANCE

Home modification through seemingly mundane equipment, such as grab bars and shower seats, mitigates injury, dependence, and reduced quality of life in older adults coping with increasing disability. However, whether these interventions are underused in the US is unclear.

OBJECTIVE

To estimate how many older adults who need equipment to help with bathing and toileting do not have it, describe factors associated with not having equipment, and describe how many who did not initially have equipment acquired equipment over time.

DESIGN

This observational cohort study of participants 65 years or older used secondary data from the 2015 to 2019 waves of the US National Health and Aging Trends Study. Participants included community-dwelling older adults who would unequivocally benefit from equipment, defined as those with poor physical performance or substantial difficulty bathing, toileting, transferring, or walking. Respondents were representative of the US population 65 years and older. Data were collected from May 2015 to October 2019 and analyzed from August 1, 2019, to February 24, 2021.

EXPOSURES

Population characteristics (eg, age, sex, income, health conditions, and physical performance), environmental factors (eg, home ownership and living arrangement), and health behaviors (eg, prior knee and/or hip surgery).

MAIN OUTCOMES AND MEASURES

Prevalence of any unmet need for equipment, defined as either needing bathing equipment (bath grab bars and shower seat) but having none or needing toileting equipment (toilet grab bars and raised toilet seat) but having none and the cumulative incidence of equipment acquisition during 4 years of follow-up.

RESULTS

A total of 2614 participants representing 12 million US individuals would benefit from equipment. The mean (SD) age was 80.5 (8.2) years, and 1619 individuals (62%) were women. Of these, an estimated 5 million individuals (42%; 95% CI, 39%-44%) had an unmet need. After adjustment for age, sex, and race/ethnicity, unmet need was associated with younger age (49% if aged 65-74 years, 37% if aged 75-84 years, and 29% if aged ≥85 years; P < .001), having fewer health conditions (55% if none vs 39% if ≥3; P = .002), non-White race/ethnicity (40% if White vs 51% if Black, 54% if Hispanic, and 55% if other; P < .001), no recent hospitalization (46% vs 37% if hospitalized; P = .001), and no prior knee and/or hip fracture or surgery (46% vs 35% if prior fracture or surgery; P < .001). After 4 years of follow-up, 35% of those with bathing equipment needs and 52% of those with toileting equipment needs never received equipment.

CONCLUSIONS AND RELEVANCE

This cohort study suggests that in the US, 42% of older adults with impairments that would make bathing or toileting difficult lack equipment to assist. This situation is a missed opportunity to help 5 million individuals live independently and safely.

Current Condition of Home Environment and Necessary Home Modifications for Elderly in Community

This study aimed to investigate the home environment conditions of the elderly living in the community and to confirm the needs of the residential environment. This study was conducted from January 15th to 25th, 2018, in 12 elderly households in Chungcheongnam-do, using a structured questionnaire and a home environment checklist. The elderly did not feel uncomfortable with their current home, but they wanted to modify their home environment to improve their quality of life. Investigation using home environment checklists showed that demands for supportive design were lacking in the overall areas. On the results of this study, it was confirmed that it is essential to reflect the residents’ occupation, physical characteristics, and needs when constructing the home environment for the healthy life of the elderly in the community.

An Economic Evaluation Framework for Government-Funded Home Adaptation Schemes: A Quantitative Approach

The ability to live independently plays a crucial role in the mental and psychological wellbeing of the disabled. To achieve this goal, most governments spend a substantial budget on home adaptation projects. It has been observed that schemes with different target clients (residents versus landlords) are different in efficiency and effectiveness. To understand why and how these schemes differ in performance, this paper develops and applies a generic economic evaluation framework for government-funded home adaptation schemes. Based on the individual-level surveys collected in the United Kingdom, an empirical model was formulated to quantify the determinants for various performance indicators, including money costs, time costs and client satisfaction. Robust estimation procedures were applied to deal with the heteroscedasticity and outlier problems in the data. Results showed that a specialized independent living scheme dedicated to disability adaptations (e.g., the Physical Adaptations Grant, PAG) had higher efficiency and effectiveness than general-purpose schemes (e.g., the Disabled Facilities Grant, DFG), because the funds were provided to the landlords who had a stronger motivation to minimize the time cost in the short run and maximize the future rent potential in the long run. A "unified system" approach to adaptations should be a guiding principle for policy development, regardless of who actually delivers the service.