Abstract
Natalie E. Leland, PhD, OTR/L, BCG
Sharon J. Elliott, DHS, GCG, OTR/L, BCG, FAOTA
In 1983, Robert Butler introduced the idea of productive aging in an effort to highlight the contributions of older adults in the United States (Butler & Gleason, 1985). This sociological concept broadly refers to activities that mark the multiple ways in which people contribute to their own health, to their families, to their communities, and to society as they age (Butler, 2002; Butler & Gleason, 1985). The principles of participation, highlighted in Butler’s definition of productive aging, are closely associated with the foundations of occupational therapy (Meyer, 1922; Peloquin, 1991a, 1991b). Yet not until the introduction of the Centennial Vision did the occupational therapy profession embrace the term productive aging (American Occupational Therapy Association [AOTA], 2006a, 2006b).
The authors in this special issue of the American Journal of Occupational Therapy (AJOT), with the authors of the Occupational Therapy Practice Guidelines for Productive Aging (Leland, Elliott, & Johnson, in press), have striven to examine the literature through systematic reviews that focus on productive aging within the occupational therapy domain of practice (Arbesman & Lieberman, 2012). This examination, in turn, helps elucidate the effectiveness and benefits of occupational therapy interventions, as well as the implications for education and research, to support older adults’ participation and engagement in occupations as an avenue to achieve productive aging (Arbesman & Lieberman, 2012).
By 2030, approximately 20% of the U.S. population will be ≥ age 65 (U.S. Census Bureau, 2009), and chronic conditions will likely be the leading cause of disability (World Health Organization, 2011). Irrespective of existing chronic conditions, adults face challenges as they age as a result of normative aging processes (e.g., physical changes), contexts and environments that constrain optimal functioning (Gill, Williams, Robison, & Tinetti, 1999; Gitlin, 2003), community mobility changes (Dickerson et al., 2007), and alterations in social and caregiving resources (Neal, Wagner, Bonn, & Niles-Yokum, 2008). The cumulative impact of these vicissitudes affects older adults’ performance and places them at risk for institutionalization, disability, loss of independence in meaningful occupations, and greater health care use (Breyer, Costa-Font, & Felder, 2010; Christensen, Doblhammer, Rau, & Vaupel, 2009; Stel, Smit, Plumjim, & Lips, 2004; Stevens, Corso, Finkelstein, & Miller, 2006; Tinetti & Williams, 1997).
The aspiration of most older adults to age in place (Gitlin, 2003) and maintain their ability to participate in desired occupations challenges the occupational therapy profession to expand service delivery beyond traditional medical settings (e.g., hospitals, institutions) to fulfill the need for community-based services in which prevention, health, and wellness are the priorities. Abundant opportunities exist for occupational therapy researchers, educators, and clinicians in current and emerging settings to help older adults age productively by (1) retaining or enabling participation in meaningful occupations (e.g., instrumental activities of daily living [IADLs]) and (2) providing strategies to manage the sequelae of chronic disease, prevent injury, age in place, and maximize quality of life.
Effectiveness of Occupational Engagement in Supporting Productive Aging
One key factor that affects productive aging is the ability to engage in occupations. Stav, Hallenen, Lane, and Arbesman’s (2012) systematic review examines the effect of occupational engagement on productive aging among community-dwelling older adults. It highlights the health benefits and quality-of-life improvements older adults can realize through active participation in everyday activities (e.g., IADLs, sleep, and physical, social, and leisure activities) and the detrimental effects a lack of exercise and physical activity can have on occupational performance and health. The results of this systematic review illuminate opportunities for occupational therapy practitioners to work with older adults in community-based settings to promote health and prevent injuries during performance of everyday activities (Stav et al., 2012).
Effectiveness of Occupational Therapy Interventions in Supporting Productive Aging
Demonstrating the effectiveness of occupational therapy interventions within the framework of productive aging is essential if occupational therapy is going to play a key role in supporting the aging U.S. population. Guided by the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; AOTA, 2008), occupational therapy practitioners possess the skills and knowledge to evaluate, support, and facilitate the occupational performance and participation of older adults by positively influencing key factors that affect productive aging.
Older adults’ ability to engage in meaningful occupations, manage or maintain their health, and perform activities of daily living (ADLs) and IADLs is pivotal to their ability to age productively. Three articles in this special issue investigated the effect of occupational therapy interventions on key factors that influence the productive aging of community-dwelling older adults.
Orellano, Colón, and Arbesman (2012) examined interventions to support IADL participation and determined that occupation-based, client-centered, and multicomponent interventions can improve or maintain the IADL performance of community-dwelling older adults. In their systematic review, they also discuss the evidence related to functional task performance, simulated IADL interventions, and performance skill training to improve IADL performance (Orellano et al., 2012).
Arbesman and Mosley (2012) highlight the advantage and effectiveness of client-centered and occupation-based interventions for community-dwelling older adults in improving physical function and occupational performance related to health management. They discuss the effectiveness of health education and self-management programs to reduce pain, decrease disability, and improve ADL and physical activity performance (Arbesman & Mosley, 2012). In addition, Arbesman and Mosley analyze the effectiveness of cognitive–behavioral interventions to improve older adults’ exercise adherence, which can in turn affect people’s sleep and rest.
Falls and injuries can also affect community-dwelling older adults’ ability to productively age. Chase, Mann, Wasek, and Arbesman’s (2012) systematic review describes the effectiveness of occupational therapy interventions for fall prevention. The results of their review support occupational therapy practitioners’ essential role in fall prevention and aging in place and use of a multifactorial approach to intervention that may encompass evaluating and modifying the home, providing education, recommending technology, advising on exercises to reduce fall risk, and referring to other health care professionals as needed (Chase et al., 2012).
Summary
The systematic reviews included in this special issue of AJOT accentuate the health benefits of occupational engagement (Stav et al., 2012), support the effectiveness of occupational therapy interventions in facilitating productive aging, and strengthen occupational therapy’s role in fall prevention and home modification (Chase et al., 2012; Stav et al., 2012). Evidence tables summarizing the studies reviewed in each article in this special issue are available online at http://ajot.aotapress.net (navigate to the article, and click on “supplemental materials”). The results of the systematic reviews also highlight how occupational therapy practitioners can be catalysts in chronic disease self-management, wellness, and prevention by developing, implementing, or leading community education programs (e.g., arthritis, diabetes) for older adults (Arbesman & Mosley, 2012). Occupational therapy practitioners can and should work together to improve the quality of life of the aging population.
Footnotes
Acknowledgments
Natalie E. Leland was funded by National Institutes of Health Rehabilitation Research Career Development Program Grant K12 HD055929 at the time the manuscript of this article was developed.