Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention

The impact of combined age-related vision loss and dementia on the participation of older adults: A scoping review

INTRODUCTION

There are a growing number of older adults with combined age-related vision loss (ARVL) and dementia. Existing literature shows the pervasive impact that both diagnoses have separately on the participation of older adults, however, little is known about the societal participation of older adults with both conditions. As such, the aim of this scoping review was to explore the combined impact of ARVL and dementia on the participation of older adults, with a specific focus on highlighting strategies that help mitigate the impact of ARVL and dementia on participation.

METHODS

This study utilized a scoping review, informed by the framework by Arksey and O'Malley [1]. Two researchers independently ran a total of 62 search terms across four categories in six databases (PubMed, CINAHL, Scopus, Embase, Medline, PsycINFO), with an initial yield of 2,053 articles. Grey literature was also included in this scoping review and was retrieved from organizational websites, brochures, conference proceedings, and a Google Scholar search. The application of study inclusion criteria resulted in a final yield of 13 empirical studies and 10 grey literature sources.

RESULTS

Following detailed thematic analysis of the empirical and grey literature sources, four themes emerged regarding the impact of combined ARVL and dementia on the participation of older adults including: 1) Managing the pragmatic aspects of a dual diagnosis; 2) Diverse approaches to risk assessment and management; 3) Adopting a multi-disciplinary approach to facilitate care and; 4) Using compensatory strategies to facilitate participation.

CONCLUSIONS

The four themes highlight the challenges older adults with these combined diagnoses experience, which limit their opportunities for meaningful participation. Given the scarcity of research on this topic, future research should identify the type of ARVL and dementia diagnoses of study participants, conduct qualitative research about the lived experiences of older adults with a dual diagnosis, and broaden the geographic scope of research.

Primary Care Occupational Therapy: How Can We Get There? Remaining Challenges in Patient-Centered Medical Homes

Passage of the Patient Protection and Affordable Care Act in 2010 mandated reform of the United States' existing primary care system. As part of this reform, advanced practice models, including the Patient-Centered Medical Home model, expanded, with the goal of increasing the use of interprofessional teams. Integrating occupational therapy was promoted as an opportunity to enhance the value of care provided in these redesigned primary care practices. However, occupational therapy's presence in primary care is still extremely limited.

Effectiveness of Health Promotion, Management, and Maintenance Interventions Within the Scope of Occupational Therapy for Community-Dwelling Older Adults: A Systematic Review

OBJECTIVE

This systematic review examined the effectiveness of health promotion, management, and maintenance interventions within the scope of occupational therapy to improve occupational performance and quality of life (QOL) and decrease health care utilization for community-dwelling older adults.

METHOD

Thirty-eight articles representing 36 studies were included in the review. Articles were published 2008-2015 and described studies of participants with a mean age of 65 or older who were living in the community.

RESULTS

Strong evidence supports the use of group, individual, or a combination of group and individual interventions to improve occupational performance. Group interventions were also effective at improving QOL. The evidence was insufficient that any of these interventions decreased health care utilization.

CONCLUSION

Addressing health promotion, management, and maintenance is within the scope of occupational therapy practice and has been shown to improve occupational performance and QOL for older adults. Implications for practice and future research are discussed.

Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review

BACKGROUND

As the population is aging, the number of persons living with multiple chronic conditions (MCC) is expected to increase. This review seeks to answer two research questions from the perspectives of older adults with MCC, their caregivers and their health care providers (HCPs): 1) What are the health and social care needs of community-dwelling older adults with MCC and their caregivers? and 2) How do social and structural determinants of health impact these health and social care needs?

METHODS

We conducted a scoping review guided by a refinement of the Arksey & O'Malley framework. Articles were included if participants were 55 years or older and have at least two chronic conditions. We searched 7 electronic databases. The data were summarized using thematic analysis.

RESULTS

Thirty-six studies were included in this review: 28 studies included participants with MCC; 12 studies included HCPs; 5 studies included caregivers. The quality of the studies ranged from moderate to good. Five main areas of needs were identified: need for information; coordination of services and supports; preventive, maintenance and restorative strategies; training for older adults, caregivers and HCPs to help manage the older adults' complex conditions; and the need for person-centred approaches. Structural and social determinants of health such as socioeconomic status, education and access influenced the needs of older adults with MCC.

CONCLUSION

The review highlights that most of the needs of older adults with MCC focus on lack of access to information and coordination of care. The main structural and social determinants that influenced older adults' needs were their level of education/health literacy and their socioeconomic status.

Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system.