Update on Productive Aging Research in the American Journal of Occupational Therapy,2013,and Overview of Research Published 2009

Abstract

In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists’ mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.

Keywords

aging geriatrics occupational therapy research review literature as topic

The Centennial Vision target date of 2017 is a mere 3 years away. This vision created a road map to the future of occupational therapy to commemorate the American Occupational Therapy Association’s (AOTA’s) upcoming 100th anniversary. The vision statement projects a healing profession that “is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (AOTA, 2007, p. 613). AOTA’s mission as stated in the Centennial Vision is to promote research that supports the effectiveness of occupational therapy services, and according to Gutman (2008), the following types of research do so:

Effectiveness studies supporting practice

Development and testing to establish reliability and validity of occupational therapy assessments

Correlational and descriptive studies that demonstrate linkages between occupational engagement and health

Basic research studies that provide information about disabilities and their impact on functional participation

Studies that answer important questions about topics related to the direction of the profession’s growth.

Also contained in the Centennial Vision is a call to sustain existing practice areas to meet society’s needs. Productive aging is one of the practice areas singled out for examination (AOTA, 2007; Baum, 2006). As the occupational therapy profession strives to fulfill the vision and follow the road map, it is necessary to continue to measure progress along the way. To that end, the editorial board of the American Journal of Occupational Therapy (AJOT) annually endeavors to assess its success in accomplishing the goal of increased quantity and quality of research studies it publishes. This year, the board is taking the opportunity to look at the past 5 years in aggregate as well. In this article, I review AJOT articles related to productive aging published in 2013 and provide an overview of this research from 2009 to 2013.

Method

The editor-in-chief of AJOT at the time (Sharon A. Gutman) screened all research articles published or accepted for publication in AJOT in the 2013 volume. She identified 13 articles describing research related to productive aging practice, which represented nearly 20% of all research studies published in AJOT in 2013. I read and reviewed these articles and the 63 articles on productive aging research published from 2009 to 2013 in light of my broad experience in productive aging, occupational therapy, and evidence-based practice. I identified the research level of each article using the AOTA Evidence-Based Literature Review Project Levels of Evidence Rating System (Table 1; Lieberman & Scheer, 2002) and assigned one of the following categories: effectiveness study, basic research, instrument development and testing, link between occupational engagement and health, professional education, or professional question. Table 2 summarizes the 13 articles published in 2013, and Table 3 indicates the category of all 63 articles published from 2009 to 2013.

Table 1.

American Occupational Therapy Association Evidence-Based Literature Review Project Levels of Evidence Rating System

Level of Evidence	Rigor of Research Design
I	Systematic reviews, meta-analyses, or randomized controlled trials
II	2-group nonrandomized controlled trials (e.g., cohort designs, case-control studies, or 2-group pretest–posttest designs)
III	1-group nonrandomized noncontrolled trial (e.g., 1-group pre- or posttest designs)
IV	Single-subject design, descriptive studies, case series, or case reports
V	Expert opinions

Source. From “From the Desk of the Editor—State of the Journal,” by S. A. Gutman, 2008, American Journal of Occupational Therapy, 62, p. 620. Copyright © 2008 by the American Occupational Therapy Association. Reprinted with permission.

Table 2.

Summary of Evidence From Studies Published in 2013

Author	Study Objectives	Level/Design/Participants	Intervention and Outcome Measures	Results	Study Limitations
Berger, McAteer, Schreier, & Kaldenberg (2013)	To synthesize the research literature to identify interventions that maintain, restore, or improve leisure or social participation for older adults with low vision	Level I Systematic review N = 13 studies: 9 Level I, 1 Level II, 3 Level III Inclusion Criteria Studies describing older adults age ≥65 yr, published after 1990, providing evidence at Level III or higher, using interventions addressing low vision within the scope of OT practice Exclusion Criteria Studies not written in English, not peer reviewed, published before 1990, or providing evidence lower than Level III	Interventions Problem-solving approach used in interventions such as participant education and strategy development; combination of services involving problem solving, education, skills training, and environmental adaptations; skills training involving scanning, peripheral viewing, and eye–hand coordination strategies; home visits and environmental adaptations involving lighting adjustments Outcome Measures Health and Impact Questionnaire, Activity Questionnaire, Perceived Quality of Life, NEI VFQ–17, FAQ, study-specific surveys	Strong evidence supports a problem-solving approach to improve leisure and social participation in adults with low vision. Moderate evidence supports the delivery of a combination of services. Evidence for skills training, home visits, and home adaptations was mixed.	Authors were unable to differentiate intervention specifics in complex studies with multiple components of service. Many studies did not use outcome measures specific to leisure or social participation. Samples were limited primarily to people with age-related macular degeneration, limiting generalization to other populations.
Classen, Wang, Crizzle, Winter, & Lanford (2013)	To determine whether the UFOV or Trail Making Test Part B is a better predictor of on-road driving outcomes among older drivers	Level IV Descriptive study comparing data N = 198 older drivers (mean age = 73.86 yr, age range = 65–85 yr) recruited through convenience sampling (data obtained from the Institute for Mobility, Activity and Participation’s data pool collected 2004–2006 and 2010–2011)	Intervention No intervention; administration of UFOV and Trail Making Test Part B Outcome Measures Demographic information from intake form, vision acuity using Optec 2500, UFOV for vision cognition, MMSE, Trail Making Test Part B, UFOV Risk Index (RI; Subtest 1, central vision attention; 2, selective attention; and 3, divided attention), on-road driving test with the Global Rating Scale (a pass–fail measure of driving)	UFOV RI was the best predictor of on-road outcomes. Trail Making Test Part B and UFOV Subtests 1–3 are comparable to one another.	Sample lacked representation of minorities and people with low educational status. Some data were incomplete and inconsistent because they were collected at two different points.
Classen, Wang, Winter, et al. (2013)	To determine concurrent criterion validity of the Safe Driving Behavior Measure (SDBM) for on-road outcomes in older drivers	Level II Prospective quasi-experimental design N = 168 older drivers and 168 family members or caregivers recruited through convenience sampling from two sites Inclusion Criteria Age 65–85 yr, driving at 3 mo before recruitment, cognitive and physical ability to complete the SDBM and on-road driving test, and having family members able to report on participant’s driving behaviors Exclusion Criteria Advised not to drive for medical reasons, uncontrolled seizures in the past year, use of medications that cause central nervous system impairments, or having family members with physical or mental conditions that impaired ability to participate	Intervention No intervention; administration of SDBM Outcome Measures For all participants: Demographics, health-related characteristics, and SDBM results For older drivers: On-road driving test; visual acuity and contrast sensitivity tests; UFOV; MMSE; Rapid Pace Walk for motor performance of gait, postural control, balance, and speed of walking	Older drivers’ ratings showed statistically significant yet poor concurrent criterion validity. Family members’ and caregivers’ ratings showed good concurrent criterion validity for the on-road driving test. Further studies are needed, but the SDBM may be useful for generalist practitioners to use in making decisions about driving recommendations.	Convenience sample recruited from only 2 sites. Sample consisted mostly of healthy White men and women. Sample was not representative of the general population because of the low representation of minorities and of people with lower education and socioeconomic status.
Dickerson (2013)	To describe the use of assessment tools by North American driver rehabilitation specialists (DRSs)	Level IV Descriptive study N = 227 self-identified DRSs	Intervention No intervention; survey administered Outcome Measures Results of a self-administered survey about DRSs’ driver evaluation process, assessment tools used, and process for making recommendations on fitness to drive; data on respondents and practice settings	Eighty percent of DRSs reported testing visual acuity, range of motion, muscle strength, and fine motor coordination. Cognitive–perceptual tests primarily used included the Trail Making Test (Parts A and B), Motor-Free Visual Perception Test–Revised, and short cognitive screening tests. Clients’ behind-the-wheel, on-road performance was the main factor in making recommendations on fitness to drive. Few DRSs used computer-based tests or interactive driving simulators.	Survey did not ask for reasoning behind assessment choices. Survey was administered in two different formats: online and on paper. Lengthy format of survey may have limited the number of respondents.
Hwang (2013)	To determine reliability of the Health Enhancement Lifestyle Profile–Screener (HELP–Screener) with community-dwelling older adults	Level IV Descriptive study N = 483 community-dwelling older adults age ≥55 yr with adequate cognitive and English- or Spanish-language capabilities to respond to a questionnaire; recruited through convenience, snowball, network, and quota sampling from a wide range of community sites	Intervention No intervention; administration of HELP–Screener Outcome Measures HELP–Screener results, Cronbach’s α for internal consistency, intraclass correlation coefficient (ICC), confidence interval, κ statistic	Cronbach’s α of .74 indicated an acceptable level of internal consistency. Test–retest reliability for 90 participants yielded an ICC of .93, indicating a high degree of temporal stability of the instrument at the scale level. Good to excellent agreement was indicated by κs of .76–.96 and 96%–99% agreement between test and retest scores on each item.	HELP–Screener is a self-report instrument. HELP–Screener is relatively new and requires further studies to establish validity and reliability.
Justiss (2013)	To identify and critically appraise the effectiveness of interventions affecting safety, performance, navigation, and participation to improve or maintain driving performance and community mobility (including pedestrian status) of older adults with low vision	Level I Systematic review N = 8 studies: 4 Level I, 2 Level II, 2 Level III Inclusion Criteria Participants with a mean age of ≥65 yr (age ranges were broad) and a visual deficit, interventions within the scope of OT practice, driving outcomes of simulated and on-road performance or reported crashes, outcomes identifying means of outdoor mobility that excluded driving, evidence at Level III or higher, and published after 1990 Exclusion Criteria Studies not written in English, not peer reviewed, published before 1990, or providing evidence lower than Level III	Intervention Multidisciplinary vision rehabilitation for community mobility using bioptics or prisms, driving simulator training, driver education programs, orientation and mobility training Outcome Measures On-road test performance, fitness-to-drive evaluation classification, IVI, Driver Perceptions and Practices Questionnaire, Driving Habits Questionnaire, orientation and mobility assessment, visual skills tasks, driving simulator assessment	Evidence is insufficient for the effectiveness of these interventions in improving or maintaining the driving performance or community mobility of older adults with low vision.	Sample characteristics were heterogeneous; the studies reviewed did not address all the same interventions. Interventions and outcome measures used differed across studies.
Kratz, Schepens, & Murphy (2013)	To determine how long cognitive task demands affect symptoms and occupational performance in people with osteoarthritis (OA)	Level IV Descriptive study N = 31 community-living older adults age ≥65 yr with knee or hip OA (19 women; 24 White, 2 African-American, 5 declined to indicate race or ethnicity) Inclusion Criteria Pain and fatigue 3 days/wk that interfered with functioning, adequate cognition, and English speaking Exclusion Criteria History of medical conditions that interfered with functioning or caused pain or fatigue, knee or hip surgery in the past 6 mo, current rehabilitation for OA, or nonambulatory and therefore unable to operate the accelerometer	Interventions 10-min computer tasks separated by a 5-min simple response-time task (15-min circuits) for maximum of 2.5 hr or until participant fatigued, Psychological Experiment Building Language (PEBL) test battery (Version 0.09), Berg Card Sorting Test, Digit Span, Four Choice Response Time, Implicit Association Test, Lexical Decision, PEBL Perceptual Vigilance Task, Spatial Cuing, Stroop task, Tower of London, simple response time of pressing a key as fast as possible for 5 min Outcome Measures Timed Up and Go, Multidimensional Fatigue Inventory, Center for Epidemiologic Studies–Depression Scale, wrist-worn accelerometer readings, participant-rated OA fatigue and pain levels	Pain was lower and fatigue higher on the task day and the next day. No changes in activity levels were found. Daily fatigue and activity patterns changed relative to baseline, lasting 1–5 days postactivity. Cognitive task demands may contribute to fatigue and pain for people with OA.	Small sample size with limited diversity.
Liu, Brost, Horton, Kenyon, & Mears (2013)	To identify the effectiveness of interventions to maintain, restore, and improve performance in daily activities at home for older adults with low vision	Level I Systematic review N = 17 studies: 9 Level I, 5 Level II, 3 Level III Inclusion Criteria Participants with mean ages ranging from 69 to 82 yr and low vision, published after 1990, and providing evidence at Level III or higher Exclusion Criteria Studies not written in English, not peer reviewed, published before 1990, or providing evidence lower than Level III	Interventions Multicomponent, single-component, and multidisciplinary interventions, including training in use of both optical and nonoptical low vision devices for application to daily activities; environmental modifications; facilitation of independence in ADLs and IADLs with adaptive devices and techniques; education on lighting, contrast, size, patterns, and organization; promotion of use of cognitive and sensory functions Outcome Measures Modified Multilevel Assessment Instrument, ADL and IADL ability; NEI VFQ–25; self-reported performance; Low Vision Quality of Life Questionnaire; ADL staircase test; perceived security in performing daily activities questionnaire; Activity Card Sort; scaled interview questionnaire; IVI; FAQ, ADLs and IADLs; adapted version of the Measure of Function and Psychosocial Outcomes of Blind Rehabilitation, IADLs; FVPT; ability to read the newspaper and text on the CCTV; Functional Independence Measure for Blind Adults; task performance; selected items on the Manchester Low Vision Questionnaire; MLVAI; VA LV VFQ–48	Strong evidence of effectiveness was found for the use of multicomponent approaches that involve teaching knowledge and skills that older adults need to help overcome the disablement process. Evidence suggested that multiple sessions of training with low vision devices and for special viewing skills to compensate for vision loss are necessary to have a positive effect on daily activities. Evidence supports use of multidisciplinary interventions that focus on personalized goals.	Sample sizes were small. No reliability and validity data were provided on outcome tools. Lower level studies applied interventions inconsistently. Attrition rates were high. Some measures had poor psychometrics. Some outcome measures were nonstandardized. Time lapses between assessment and intervention were inconsistent. Samples had limited diversity. In one study, the same researcher both provided training and collected data.
Lysack, Leach, Russo, Paulson, & Lichtenberg (2013)	To assess the effect of DVD training on occupational therapists’ mental health knowledge and attitudes and clinical practices in work with older adults	Level I Two-group, randomized, wait-list control design N = 75 occupational therapists recruited through convenience sampling from two institutions N = 960 chart reviews	Intervention Viewing of educational DVD with aging and mental health content, provision of a binder containing educational resources, clinical competency training in depression and cognition screening and assessment tools, and strategies to implement new knowledge and skills in the workplace Outcome Measures Knowledge testing specific to the training, chart reviews	DVD-based training helped improve mental health practice in OT for older adults. Use of a standardized depression screen was the greatest clinical practice change.	Data were incomplete. Outcome measures were specifically designed for the study and did not have validity and reliability testing. Occupational therapists and patients could not be matched in chart reviews, limiting ability to determine specific changes to specific therapists. The initial intervention group and the wait-listed group may have differed in demographics, disability, cognition, etc.
Mortenson, Clarke, & Best (2013)	To determine how prescribers make decisions regarding provision of powered mobility for older adults	Qualitative study Ethnographic, qualitative study N = 10 occupational therapists recruited through convenience sampling (i.e., who prescribed powered mobility and who volunteered to participate)	Intervention No intervention; in-depth interviews Outcome Measure Thematic analysis of interviews to identify contextual factors	Three themes emerged: (1) therapists’ considerations in deciding who is entitled to powered mobility, (2) disagreement between therapists and clients about the decision of who is entitled to powered mobility, and (3) ways contextual factors shape provision of powered mobility. Improvements are needed in the ways powered mobility is funded, provided, and accommodated so that more older adults have access to these devices and can use them to their full potential.	Sample was small. Experiences of Canadian occupational therapists may not be generalizable to therapists in other countries.
Perlmutter et al. (2013)	To develop an objective, comprehensive, near-task home lighting assessment (the Home Environment Lighting Assessment [HELA]) and evaluate interrater and test–retest reliability	Level IV Descriptive study N = 22 older adults with low vision recruited through convenience sampling N = 5 occupational therapists with expertise in low vision rehabilitation recruited through convenience sampling	Intervention Lighting modifications Outcome Measures Light meter, MNRead, reported quality of near-task experience	Interrater reliability was high; test–retest reliability was moderate. The HELA has the potential to improve low vision assessment and intervention and improve near-task performance of people with low vision.	Small sample of clients and clinicians limited the power of psychometrics. Screens were for near tasks only.
Sanders & Van Oss (2013)	To describe medication adherence strategies used by a sample of community-dwelling older adults who take four or more medications	Phenomenological qualitative study N = 149 community-dwelling older adults Inclusion Criteria Age ≥50 yr, English speaking, taking four or more medications on a long-term basis, and living at home or in a retirement community Exclusion Criteria Not reported	Intervention No intervention; semistructured interviews with open- and closed-ended questions Outcome Measures Demographics, descriptive information about timing, location, location decisions, routines used for medication adherence, observation of routine	Medication habits were primarily embedded in daily routines around meals and bedtime. Primary locations for storing medications were the bathroom and kitchen. Pill boxes or self-made adaptations were used most frequently. Half of participants required some type of assistance for medication adherence. Occupational therapists have a role in collaborating with clients to develop individualized medication routines.	Data were collected from participants’ self-reported verbal descriptions based on memory. The graduate student researchers had different interviewing styles. Data were descriptive and from a small group of older adults, so findings are not generalizable to others.
Smallfield, Clem, & Myers (2013)	To examine the effectiveness of OT intervention in improving reading required for performance of occupations by older adults with low vision through the use of optical, nonoptical, and electronic magnifying devices	Level I Systematic review N = 32 studies: 16 Level I, 8 Level II, 8 Level III Inclusion Criteria Study participants age ≥65 yr and having low vision, interventions within the scope of OT practice, published after 1990, and providing evidence at Level III or higher Exclusion Criteria Not written in English, not peer reviewed, published before 1990, or providing evidence lower than Level III	Intervention Training in the use of optical and nonoptical devices, illuminated and nonilluminated handheld and stand magnifiers, electronic magnifiers (CCTVs), telescopes, directed illumination, overlays, eccentric reading, OT, environmental modifications, education about condition and resources, training in problem-solving strategies, group-based interventions Outcome Measures Performance of ADLs and IADLs, reading, reading endurance and speed, MNRead, visual tracking, label identification, perception of ease or difficulty of using magnifiers, modified FAQ, FVPT, VA LV VFQ–48, Bailey–Lovie Reading Card near print size, performance of ADLs using MLVAI, NEI VFQ–25	Strong evidence supports the inclusion of OT in low vision programs. Moderately strong evidence supports the use of electronic magnification. Moderate evidence supports the use of illumination to improve reading ability.	Personnel were trained inconsistently in use of the devices. Length of training was inconsistent. Training providers were not identified. Evaluators were not blinded to participants. Follow-up was limited. Attrition rates were high. Geographic area was limited. Hawthorne effect may have been present. Small samples were used.

Note. ADLs = activities of daily living; CCTV = closed-circuit television; FAQ = Functional Assessment Questionnaire; FVPT = Functional Vision Performance Test; IADLs = instrumental activities of daily living; IVI = Impact of Vision Impairment; MLVAI = Melbourne Low-Vision ADL Index; MMSE = Mini-Mental State Examination; MNRead = Minnesota Low Vision Reading Test; NEI VFQ–17 = National Eye Institute Visual Function Quality of Life Questionnaire–17; NEI VFQ–25 = 25-item National Eye Institute Visual Functioning Questionnaire; OT = occupational therapy; UFOV = Useful Field of View; VA LV VFQ–48 = Veteran Affairs Low Vision Visual Functioning Questionnaire–48.

This table is a product of AOTA’s Evidence-Based Practice Project and the American Journal of Occupational Therapy. Copyright © 2014 by the American Occupational Therapy Association. It may be freely reproduced for personal use in clinical or educational settings as long as the source is cited. All other users require written permission from the American Occupational Therapy Association. To apply, visit www.copyright.com.

Suggested citation: D’Amico, M. (2014). Update on productive aging research in the American Journal of Occupational Therapy, 2013, and overview of research published 2009–2013 (Table 2). American Journal of Occupational Therapy, 69, e247–e260. http://dx.doi.org/10.5014/ajot.2014.013581

Table 3.

Research Studies in Productive Aging Published in the American Journal of Occupational Therapy, 2009–2013, by Category

Author	Effectiveness Study/Level of Evidence	Basic Research	Instrument Development and Testing	Link Between Occupational Engagement and Health	Professional Education	Professional Question
Arbesman & Mosley (2012)	•/I SR
Berger, McAteer, Schreier, & Kaldenberg (2013)	•/I SR
Chase, Mann, Wasek, & Arbesman (2012)	•/I SR
Chippendale & Bear-Lehman (2012)	•/I RCT
Classen, Shechtman, Awadzi, Joo, & Lanford (2010)		•
Classen, Wang, Crizzle, Winter, & Lanford (2013)			•
Classen, Wang, Winter, et al. (2013)			•
Classen et al. (2012a)			•
Classen et al. (2012b)			•
Classen, Winter, et al. (2010)			•
Dalchow, Niewoehner, Henderson, & Carr (2010)			•
Deacy, Yuen, Barstow, Warren, & Vogtle (2012)					•
Dickerson (2013)		•
Dickerson, Reistetter, Davis, & Monahan (2011)		•
Di Stefano & Macdonald (2010)						•
Donovan & Corcoran (2010)		•
Elgin et al. (2010)		•
Elliott et al. (2012)	•/III
Finlayson, Shevil, & Cho (2009)		•
George & Crotty (2010)			•
Haltiwanger (2012)	•/III
Hersch et al. (2012)	•/II
Hunt, Brown, & Gilman (2010)		•
Hwang (2010)			•
Hwang (2012)			•
Hwang (2013)			•
Jensen & Padilla (2011)	•/I SR
Justiss (2013)	•/I SR
Katz, Averbuch, & Bar-Haim Erez (2012)			•
Kay, Bundy, & Clemson (2009)			•
Korner-Bitensky, Menon, von Zweck, & Van Benthem (2010)						•
Kratz, Schepens, & Murphy (2013)		•
Leland, Elliott, O’Malley, & Murphy (2012)						•
Letts, Edwards, et al. (2011)	•/I SR
Letts, Minezes, et al. (2011)	•/I SR
Liu, Brost, Horton, Kenyon, & Mears (2013)	•/I SR
Lysack, Leach, Russo, Paulson, & Lichtenberg (2013)	•/I RCT
Mortenson, Clarke, & Best (2013)		•
Mullen, Weaver, Riendeau, Morrison, & Bédard (2010)		•
Murphy, Lyden, Smith, Dong, & Koliba (2010)	•/I RCT
O’Brien, Bynon, Morarty, & Presnell (2012)	•/II
Orellano, Colón, & Arbesman (2012)	•/I SR
Padilla (2011a)	•/I SR
Padilla (2011b)	•/I SR
Painter, Allison, Dhingra, Daugherty, & Cogdill (2012)		•
Peralta-Catipon & Hwang (2011)		•
Perlmutter, Bhorade, Gordon, Hollingsworth, & Baum (2010)		•
Perlmutter et al. (2013)			•
Sanders & Van Oss (2013)		•
Schepens, Panzer, & Goldberg (2011)	•/I RCT
Schepens, Sen, Painter, & Murphy (2012)	•/I MA
Schmid et al. (2011)		•
Shaw, Polgar, Vrkljan, & Jacobson (2010)		•
Shechtman, Awadzi, Classen, Lanford, & Joo (2010)			•
Smallfield, Clem, & Myers (2013)	•/I SR
Stav, Arbesman, Hallenen, & Lane (2012)	•/I SR
Stav, Snider Weidley, & Love (2011)		•
Thinnes & Padilla (2011)	•/I SR
Unsworth, Pallant, Russell, Germano, & Odell (2010)			•
Vrkljan et al. (2010)					•
Wang, Holliday, & Fernie (2009)	•/V
Wood, Womack, & Hooper (2009)				•
Yuen & Burik (2011)					•
Total	24	17	15	1	3	3

Note. N = 63. MA = meta-analysis; RCT = randomized controlled trial; SR = systematic review.

Effectiveness Studies

In 2013, 5 effectiveness studies were published in AJOT: 4 systematic reviews and 1 randomized controlled trial (RCT). The 4 systematic reviews focused on different aspects of low vision intervention. Berger, McAteer, Schreier, and Kaldenberg (2013) evaluated what interventions were most effective for maintaining, restoring, and improving leisure and social participation for older adults with low vision. Their findings identified strong evidence for helping clients develop problem-solving skills and for providing a combination of services, including problem-solving training, skills training, and home and environmental adaptations, to sustain and improve leisure and social participation. Justiss (2013) assessed driving adaptations and interventions, finding insufficient evidence to support current interventions. However, studies by Liu, Brost, Horton, Kenyon, and Mears (2013) and Smallfield, Clem, and Myers (2013) found strong evidence supporting occupational therapy services, adaptive techniques and devices, skills training in addressing instrumental and personal activities of daily living (ADLs), and use of optic and nonoptic devices for reading and participation in ADLs for older adults with low vision. Lysack, Leach, Russo, Paulson, and Lichtenberg (2013) conducted a two-group RCT to investigate the effectiveness of DVD training for occupational therapy clinicians to address mental health issues in older adults and found that such training was beneficial to the clinicians and the quality of care for their patients.

From 2009 to 2013, AJOT published 24 effectiveness studies: 19 at Level I, 2 at Level II, 2 at Level III, and 1 at Level V. Fourteen of the Level I studies were systematic reviews conducted in collaboration with AOTA’s Evidence-Based Practice Project. The other Level I studies were 4 RCTs and 1 meta-analysis. Ten effectiveness studies related to productive aging were published in 2012. These included 4 systematic reviews (Arbesman & Mosley; Chase, Mann, Wasek, & Arbesman; Orellano, Colón, & Arbesman; Stav, Arbesman, Hallenen, & Lane), 1 RCT (Chippendale & Bear-Lehman), 1 meta-analysis (Schepens, Sen, Painter, & Murphy), 2 two-group non-RCTs (Hersch et al.; O’Brien, Bynon, Morarty, & Presnell), and 2 pretest–posttest single-group studies (Elliott et al.; Haltiwanger). These studies primarily focused on the effectiveness of occupational therapy interventions, occupation- and activity-based interventions, health management, and fall prevention programs for community-dwelling older adults.

In 2011, AJOT published 1 RCT (Schepens, Panzer, & Goldberg) that addressed the effectiveness of a specific fall prevention program and 6 systematic reviews related to the effectiveness of interventions used with people with Alzheimer’s disease and related dementias (Jensen & Padilla; Letts, Edwards, et al.; Letts, Minezes, et al.; Padilla, 2011a, 2011b; Thinnes & Padilla). From 2009 to 2010 there were 2 effectiveness studies: 1 RCT and 1 case study. The RCT investigated tailored activity and the effect on pain and activity for adults with osteoarthritis (Murphy, Lyden, Smith, Dong, & Koliba, 2010). The case study investigated the effectiveness of powered mobility for a nursing home resident with dementia (Wang, Holliday, & Fernie, 2009).

Basic Research

In 2013, 4 basic research studies were published in AJOT. Dickerson (2013) explored the types of assessments used by clinicians and driver rehabilitation specialists (DRSs) to determine which assessments provided the best determinants of on-road driving ability of clients. Dickerson also explored the types and effectiveness of assessments used by DRSs in decisions regarding driving recommendations for clients. She found that DRSs used a variety of vision, perceptual, and cognitive tests to determine driving potential; however, on-road performance was the primary assessment used to determine fitness to drive. Kratz, Schepens, and Murphy (2013) examined the effects of cognitive and physical task demands on older adults with osteoarthritis and found that performing these tasks lowered pain and increased fatigue but that no change occurred from baseline in participant activity levels. In a qualitative study, Mortenson, Clarke, and Best (2013) explored the factors required for making decisions about prescribing powered mobility for older adults. In another qualitative study, Sanders and Van Oss (2013) analyzed medication adherence strategies embedded into daily routines used by older adults taking four or more medications. Both studies identified the contextual factors of environment and routines as impacts on decision making (Mortenson et al., 2013) and performance (Sanders & Van Oss, 2013).

From 2009 to 2012, 13 basic research articles were published in AJOT. Dickerson, Reistetter, Davis, and Monahan (2011) identified the beneficial use of the Assessment of Motor and Process Skills (Fisher, 2003) to predetermine on-road performance. Peralta-Catipon and Hwang (2011) assessed healthy lifestyles of older adults and the number of self-reported chronic diseases and impairments. Schmid et al. (2011) described fear of falling in people with stroke at baseline and 6 mo after services. Perlmutter, Bhorade, Gordon, Hollingsworth, and Baum (2010) explored factors that affect participation in older adults and found that mild levels of decreased hearing and vision, depression, and decreased cognition accounted for decreased participation in social and daily activities. Finlayson, Shevil, & Cho (2009) explored cognitive changes related to aging of individuals with multiple sclerosis and recommended education of patients and caregivers about symptoms related to declining cognitive function. Donovan and Corcoran (2010) discussed the importance of uplifts, or positive aspects of giving care, for caregivers of people with dementia and ways in which occupational therapy practitioners can address this subject during intervention. Elgin et al. (2010) and Hunt, Brown, and Gilman (2010) explored the challenges faced by drivers with hemianopia and quadrantanopia and dementia, respectively, determining that occupational therapists need to be alert to these challenges. Classen, Shechtman, Awadzi, Joo, & Lanford (2010) explored driving errors related to crashes by age and gender. They recommended program development of safety and prevention strategies, especially for women. Stav, Snider Weidley, and Love (2011) looked at barriers to driver training programs across clinical and community contexts. Shaw, Polgar, Vrkljan, and Jacobson (2010) looked at older adults’ perceptions of vehicular safety and advocated for education programs to train older adults in vehicle safety and fit. Mullen, Weaver, Riendeau, Morrison, and Bédard (2010) examined the relationship between driving performance and simulator sickness.

Instrument Development and Testing

In 2013, 4 articles on instrument development and testing were published in AJOT. Two were related to driving and driving assessment outcomes (Classen, Wang, Crizzle, Winter, & Lanford, 2013; Classen, Wang, Winter, et al., 2013); both studies addressed the effectiveness of assessments to determine the best tool for ascertaining whether a person is suited to an on-road driving evaluation. Their findings indicated that family or caregiver report on the Safe Driving Behavior Measure was a better indicator of driving behavior than client reports and that the Useful Field of View risk index (Ball & Owsley, 1993) was the best predictor of on-road driving outcomes. Hwang (2013) examined the validity of the Health Enhancement Lifestyle Profile (HELP)–Screener (Hwang 2012), which is used to assess health-risk behavior of older adults. Perlmutter et al. (2013) found that an in-home lighting assessment was useful in helping older adults with low vision participate in near-point reading tasks.

From 2009 to 2012, 11 articles on instrument development and testing were published in AJOT. Five focused on instruments that measure driving performance or predict on-road driving performance (Classen et al., 2012a, 2012b; Classen, Schectman, Awadzi, Joo, & Lanford, 2010; Dalchow, Niewoehner, Henderson, & Carr, 2010; George & Crotty, 2010; Kay, Bundy, & Clemson, 2009; Shechtman, Awadzi, Classen, Lanford, & Joo, 2010; Unsworth, Pallant, Russell, Germano, & Odell, 2010). Katz, Averbuch, and Bar-Haim Erez (2012) focused on the Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (Katz, Averbuch, & Bar-Haim Erez, 2011). Other instruments studied included the HELP (Hwang, 2010) and the HELP–Screener (Hwang, 2012). Findings from all of these studies indicated that these assessment tools are useful measures in work with community-dwelling older adults.

Link Between Occupational Engagement and Health

Only one study, published in 2009, addressed the link between occupational engagement and health. Wood, Womack, and Hooper (2009) discussed how lack of routines affected quality of life, affect, and time use of clients with dementia on Alzheimer’s special care units and called for occupational therapists to become involved in educating health care systems to improve quality of life by using daily living routines.

Professional Education

Three studies published from 2009 to 2012 addressed educational challenges in occupational therapy. Deacy, Yuen, Barstow, Warren, and Vogtle (2012) surveyed occupational therapy education programs and recommended they focus on better preparing occupational therapy practitioners to address the low vision rehabilitation needs of clients. Yuen and Burik (2011) explored occupational therapy programs and their content for education on driver rehabilitation and found inconsistent amounts of content across curricula. Vrkljan and colleagues (2010) developed a tool kit for both practitioners and consumers to use in improving driving safety.

Professional Question

Three studies, 2 published in 2010 and 1 in 2012, directly addressed directions for occupational therapy practitioners’ professional growth and education concerning older adults. Di Stefano and Macdonald (2010) and Korner-Bitensky, Menon, von Zweck, and Van Benthem (2010) called on occupational therapy practitioners to build their capacity to address the needs of older drivers. Leland, Elliott, O’Malley, and Murphy (2012) discussed evidence and future directions for the role of occupational therapy in fall prevention.

Discussion

From 2009 to 2013, 63 studies that addressed the area of productive aging were published. Thirteen articles were published in 2013, compared with 6 in 2009. The 2012 volume of AJOT had the most studies published, at 17. AOTA was the primary force behind the increased quantity and quality of Level I studies by sponsoring systematic reviews, but RCT studies published in AJOT also increased. Although descriptive studies are not as powerful in strength of evidence as Level I effectiveness studies, they are starting points for refining questions and developing methodological rigor for higher level studies addressing effectiveness of occupational therapy practice. In 2013, the number of studies published on productive aging decreased slightly, but the quantity of studies that inform practice increased. During the 5-year period, instrument development and testing of occupational therapy–based assessments increased, promoting their broad application both across professions and in occupational therapy practice.

Implications for Occupational Therapy Practice

The research published from 2009 to 2013 provides support for the following occupational therapy practices in work with the older adult population:

Use of specific assessments with older drivers

Use of specific assessments and rehabilitation techniques with older adults who have vision loss or low vision impairments

Use of routines to promote quality of life and healthy lifestyles for both community-dwelling older adults and adults with dementia or health challenges living in residential facilities

Attention to the psychosocial needs of older adults as part of routine practice.

Implications for Education

The review of AJOT articles from 2009 to 2013 indicates that occupational therapy education programs need to continually update their content to reflect new evidence supporting occupational therapy practice, including new assessments and interventions that address low vision, driving, quality of life, and participation of the growing population of older adults. These programs must include coursework that

Teaches students to be effective consumers and analyzers of journal articles,

Describes best practices for working with clients with dementia,

Addresses driving assessment and intervention,

Addresses low vision assessment and intervention,

Describes ways to create healthy environments using routines for both community-dwelling older adults and those in residential facilities, and

Provides instruction in the evaluation and intervention of the psychosocial needs of older adults.

Implications for Research

Research continues to be an area of need in occupational therapy. Although occupational therapy–driven research has increased, much of the literature supporting the effectiveness of intervention modalities continues to come from outside the field. Occupational therapy researchers need to continue their work and train students and practitioners in the research process at all levels of development. Potential directions for research include

Replication studies of occupational therapy interventions used with older adults;

Studies establishing the validity and reliability of occupational therapy assessment tools and other tools used in occupational therapy practice with older adults;

Basic research and qualitative studies that address occupation, occupational performance, and health of client populations to develop higher level effectiveness studies;

Continued development of new occupational therapy assessment tools that effectively assess occupational performance outcomes; and

Research directed at how occupational therapy practitioners’ decision making related to intervention informs education and practice.

Conclusion

Although the quality and quantity of articles on productive aging in AJOT increased from 2009 to 2013, the need remains for continued growth. As a profession, we must continue this productivity and momentum on evidence-based practice and research on productive aging. We must also include this evidence in professional education to sustain our power to move forward, especially as we approach the centennial celebration. Not only is the profession maturing in its capacity to improve research, education, and practice, but the people in the field are maturing as well, improving our competitive edge (Clark, 2011). Let’s continue the march forward to becoming “a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (AOTA, 2007, p. 613) by providing society with increased opportunities for productive aging.

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W. B.

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H. K.

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Update on Productive Aging Research in the American Journal of Occupational Therapy,2013,and Overview of Research Published 2009–2013

Abstract

Keywords

Method

Effectiveness Studies

Basic Research

Instrument Development and Testing

Link Between Occupational Engagement and Health

Professional Education

Professional Question

Discussion

Implications for Occupational Therapy Practice

Implications for Education

Implications for Research

Conclusion

References