The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

Introduction:

Older people are the main users of adult social care services in Great Britain. Evidence suggests that occupational therapists employed by local authorities are providing interventions that promote and maintain older people's independence, and decrease dependency on other services. However, such evidence is disparate in nature and lacks synthesis.

Method:

This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services.

Findings:

Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received.

Conclusion:

Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services.

‘I Feel So Much Safer’: Unravelling Community Equipment Outcomes

Health and wellbeing outcomes are the new currency of health and social care commissioning. To explore the extent to which community equipment had an impact on the health and wellbeing outcomes of choice and control, quality of life and personal dignity, a postal survey was carried out among a sample of adults who had been prescribed community equipment by social or primary care services to meet mobility, domestic, personal care or sensory needs. A response rate of 52% (251) was achieved.

Seventy-eight per cent of respondents reported that they were using all the equipment prescribed. Bathing equipment tended to be either very successful or not used at all. Of those who had used all or some of the equipment prescribed, 91% reported feeling safer and over 80% said that it made a positive difference to their independence, quality of life or ability to do things when they wanted. The provision of equipment had less of an impact on reducing the need for assistance at home, particularly from paid carers.

The practice implications highlighted by the findings focus on the need to review the opportunities available for maximising effective use of bathing equipment.

Assistive devices among very old people in five European countries

The aim of this study was to investigate the use and need of assistive devices (ADs) in a cross-national European sample of very old persons, focusing on national similarities and differences as well as similarities and differences according to age and level of health status. Data from the ENABLE-AGE research project were utilized involving very old persons in Sweden, Germany, Latvia, Hungary, and the United Kingdom (UK). Personal interviews with single-living old persons were conducted (n = 1918). Of the total sample 65% reported that they had and used one or more ADs, and 24% reported unfilled need. The most commonly used ADs were devices for communication, followed by devices for mobility. Participants in Hungary and Latvia used a lower total number of ADs. Comparisons among sub-groups according to age between the Western and the Eastern European national samples showed significant differences. The result can to some extent be explained by different welfare systems and presumably differences in knowledge and awareness of ADs, and further research is called for. However, the result can serve as input for future planning and development of information, services, and community-based occupational therapy, to improve healthcare and social services for older people.