In the late 1800’s, occupational therapy (OT) was mainly in psychiatric hospitals. OTs worked with the mentally unstable population using purposeful and meaningful activities giving these patients a sense of purpose. These activities mainly used arts and crafts. By using an activity, it allowed these patients a feeling of accomplishment and purpose.
It wasn’t until World War I, in the early 1900’s, that occupational therapy moved toward physical disabilities with the young men returning home from war wounded. It was then that OT focused away from arts and crafts and moved toward ADLs (activity of daily living) and IADLs (industrial activities of daily living). ADLs such as selfcare, transfers and mobility, and IADLs such as bathing, meal prep, laundry, driving, and work were the goals that OT targeted while the wounded were in the hospitals. The logic of focusing on ADLs and IADLs created a holistic approach to rehabilitating these patients back to family and society for a normal and productive life.
Throughout the 1900’s, occupational therapy went through many changes and added several areas, such as vocational training, industrial therapy programs, and clinical workshops. These programs were set up to help the newly discharged patients adjust into society. OT also branched out into many diagnoses, such as orthopedic, neurological, cardiac, TBI along with psychiatric diagnoses.
It wasn’t until the 1980’s that occupational therapy branched out in the community and home care. In this area OT moved away from the medical model and moved toward focusing on promoting health, safety, independence and preventing illness.
A major area the community can benefit from OT is in a person’s home. As the population ages and medical insurance changes, one way a person can stay at home is to remain as strong and healthy as possible. This is where occupational therapists can assist the aging population. Each treatment plan is individualized based on the person's needs, deficits and abilities. Helping patients overcome their everyday struggles is our main goal. Many elderly people find themselves having difficulty completing their everyday activities such as getting dressed, washed, and bathed. Some have balance deficits preventing them from moving around in their home safely. Because of these difficulties, these people often find themselves staying home more, not being able to see their families, or go on outings other than doctor’s appointments. This isolation can lead to feelings of depression, loneliness, and sadness.
This is where the role of an occupational therapist comes into play working with the elderly in the home environment. As occupational therapists, we teach them exercises, rehabilitation techniques, introduce adaptive devices and teach coping skills that make completing daily tasks, such as dressing, eating, and bathing, much easier. OT can improve their fine and basic motor skills, strength, balance, dexterity, and their range of motion. Even minimal improvements in one or more of these areas can make all the difference when it comes to completing an everyday task.
One area OT’s target is fall prevention. Many elderly patients have decreased balance and have a history of multiple falls. By teaching balance and muscle building exercises, OT can help patients stay strong and safe in their homes.
Another way OT’s help keep patients safe in their home is by recommending home modifications and adaptive equipment. These modifications will make the patient's home safer and promote independent living. Modifications may include ramps for entrances, grab bars in the tub/shower area and around toilet area, removing or taping down area rugs, stair lift to second floor, and installing rails on steps into home or stairs to 2nd floor.
Some elderly people have vision loss or eye disease such as macular degeneration. Having vision loss can prevent elderly patients from moving around their own home safely. Feelings of frustration, anxiety and depression can set in preventing them from being productive. OT’s can help in this area too. Recommendations OT’s can make is removing clutter in the home, adding more lighting, use magnifiers to reach labels on medicine, and putting color tape on steps to reduce risk of falls.
The most important role an OT can play working with the elderly in their home is being a trusted friend and confidant to them. By talking about their concerns, worries, and frustrations with their OT, it will make them feel they are not alone. OT can collaborate with the patient to help them overcome their concerns about not functioning the way they used to.
Since the inception of this profession, the one common denominator in all the areas that OTs work in is treating the person not the disability or diagnosis. Focusing on a holistic treatment plan, making the patient feel like a person and blending all aspects of their life are the goals. By working in the home, OTs can assist the elderly, adjust to life’s hardships, overcome their anxiety, and promote health, safety, and independence.
Written by Constance VolpeMS, OTR/L
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