In follow-up research to the groundbreaking “Well Elderly” study, occupational therapy researchers at the University of Southern California (USC) have found that small, healthy lifestyle changes—coupled with involvement in meaningful activities—are critical to healthy aging.
Guided by occupational therapists, seniors participating in the study made sustainable changes in their routines (such as visiting a museum with a friend once a week) that led to measurable gains in quality of life, including lower rates of depression and better reported satisfaction with life.
The study validates the current trend in public health strategies to focus on preventing illness and disability, as opposed to treating issues once they have already begun to negatively impact health, according to lead investigator Florence Clark, PhD., OTR/L, FAOTA.
“What is critical is that, as we age, we continue to be engaged in life through a sustainable mix of productive, social, physical, and spiritual activities. This goal of prevention and wellness is really a key to health care reform, and results in cost savings to society,” said Clark, professor and associate dean of the Division of Occupational Science and Occupational Therapy at the Herman Ostrow School of Dentistry of USC, and president of the American Occupational Therapy Association.
Jeanne Jackson, PhD, OTR/L, FAOTA, a co-investigator on the Well Elderly research and an associate professor at USC, said occupational therapy practitioners are the perfect professionals to help people implement lifestyle changes because of OT’s emphasis on the whole person and engagement in valued activities. “We understand how, through doing something, people can actually see themselves continuing to do it in the future. We break down the barriers and understand the small steps that it takes to create healthy lives through what people do on an everyday basis,” Jackson said.
The Well Elderly 2 trial was performed between 2004 and 2009, with the results appearing in the June 2 issue of the Journal of Epidemiology and Community Health. During 6-month periods, occupational therapists assisted more than 200 individuals aged 60 and older to develop sustainably healthy lifestyles to see whether these changes improved the participants’ overall quality of life.
Deborah Mandel, OTD/OTR, the study’s director of operations, recalled one participant, a 75-year-old woman, who overcame her embarrassment of having to use a cane. The woman’s study group had planned to catch a bus and go shopping. Poor mobility usually prevented the woman from leaving the house, but she decided enough was enough. She said to the therapist, “I realize that being ashamed of using a cane has kept me from doing things, and using the cane helps me do more, safely,’” Mandel explained. So the woman went shopping, cane in hand. “That’s a very interesting small picture because she had gained a shift in how she thought about using adaptive equipment and in increasing her value on getting out and having adventures,” Mandel said.
Jackson also recalled a man who hardly left his home because of a prosthetic nose that he had to flush out every 2 hours. When he refused to go with his research group to the mall, the therapist asked to see the man without his prosthetic nose. He obliged. “The therapist didn’t make a big deal out of it. She said, ‘Oh, that’s interesting,’ and she watched him irrigate and everything and she said, ‘Come with us, and I promise I will find a place where you can irrigate,’” Jackson said. So the man came to the mall and later detailed how excited he was just to have left his house. The occupational therapists also provided guidance for using public transportation, which is a key component in getting many seniors off of the couch and out into the world.
“You’re able to go to a museum, you’re able to go to a park… [transportation] can open up a whole world of opportunities,” Clark said. In one instance, the therapists helped a woman who had taken an embarrassing fall while boarding a bus to work up enough confidence to ride again. Eventually, she was able to take the bus to go do many activities that she had sorely missed, Clark said. The older adult participants were described as “well” because they were living in the community, not in a skilled nursing facility or other institutional setting.
To determine the results of the trial, quality of life was measured using a variety of indicators, including physical health, mental health, social well-being, and life satisfaction. The program participants were compared to a control group that did not receive the intervention.
Though the two groups started out roughly equivalent, the intervention group showed significant improvement in lessening bodily pain and depression while improving vitality, social function, mental health, and overall life satisfaction.Lesser, though still measurable, gains were made in general health and physical abilities.
At the end of the first phase of the trial, the control group was provided with the same treatment that had been given to the intervention group—and made identical progress.The study findings replicate the outcomes of the influential Well Elderly 1 trial, but extend them to a more ethnically diverse population living in a wide range of community settings, demonstrating the lifestyle program’s value for the general public.
The results of the Well Elderly 1 trial, conducted in 1997, were used by the London- and-Manchester-based National Institute for Health and Clinical Excellence to develop recommendations for British public health policies.
“Although people are living longer, it is important that they also live better. This intervention results in improved quality of life and provides a vehicle for maintaining health as we age,” Clark said.The Well Elderly 2 trial demonstrated that, compared with other interventions, this lifestyle intervention was cost-effective. For every dollar spent, there was a significant enough gain in health outcomes to justify the expenditure, according to Clark. “Making positive changes in how we live each day, and sustaining those changes over the long term, is critical for maintaining independence and healthy aging,” Clark emphasized.
Jackson said one study participant’s story epitomizes the value of the research. The participant used to be an avid golfer, but vision troubles caused him to give up the game, Jackson detailed. The man recognized golf’s physical, cognitive, social, and even spiritual value, but he was too intimidated to go back to a course, especially after having moved to a new community and not being sure of a good place to play. So, during a lifestyle redesign intervention, a therapist told the man to grab his clubs—they were going golfing.
With the confidence of having someone at his side, the man was able to find his way to the course, go into the pro shop to purchase a bucket of balls, and get information from a golf course employee about senior golf leagues.
“Why it was so groundbreaking for him was that he re-experienced being engaged in the world of golf. He was able to embody this self image, this re-sense of himself as a golfer. The golf course became a safe place for him to be,” Jackson said. “It’s often very intimidating for elders to go into a new place by themselves, and what the occupational therapist does is provide that bridge to an engaging experience in the world.”
(Source:AOTA)
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