Have you considered an OT practice specializing in older adults?  This population was my absolute favorite population as an OT and serving older adults in home health was incredibly rewarding.

Demand is there.  As we all know, the over 65 age cohort is the largest growing segment of the population not only in the U.S. but worldwide.  In more than 1,400 U.S. counties older adults outnumber children – that’s almost 1/2 of the counties in the country.   In addition, older adults overwhelmingly want to stay in their home.  Aging in place is an attractive option because older adults can remain in a place where they have community and memories; they continue to have control over daily decisions and can maintain their privacy; and it is often less expensive than senior living.

So, as an OT, what expertise do you need to serve this population well?

Key to good care is developing a keen understanding of the needs of older adults.  A multitude of physical, cognitive, and emotional changes occur with aging that will drive the OT treatment plan.  The most common physical challenges include issues with bones, joints and muscles; balance and mobility challenges; chronic health conditions and a decline in senses and fine motor skills.  Older adults commonly experience normal cognitive slowing that can be exacerbated by medical issues, medications and nutrition.  Age is also the biggest risk factor for MCI, dementia and Alzheimer’s.   Finally, while many older adults report greater happiness later in life, the physical and cognitive challenges listed can also weigh on emotional health.  So listen to your patients and consider all the factors that may be roadblocks to their pursuit of their most important occupations.

Prepare for the appointment with appropriate assessment tools.  AOTA has a very comprehensive list with links on their website, but some of my go-to assessments are:

• Functional Independence Measure
• Performance Assessment of Self-Care Skills
• Patient Health Questionnaire
• Montreal Cognitive Assessment
• Timed Up and Go

As you listen to your older patients, one theme you will hear is the desire to maintain independence in daily living. Assistance with ADLs is a wonderful strength of occupational therapy!  Helping patients with techniques, adaptive equipment and even technology to improve their ability to toilet, dress, bath, and eat independently is magically rewarding for the OT and the patient.  OT can also support independence with more complex IADLs like medication management, meal prep, transportation, shopping, communication and leisure.  Technology supports can really be valuable with IADLs.  Underpinning these efforts, OT can build a functional strengthening program customized to the patient.  OT also brings a series of supports to the management of chronic conditions just as dementia, arthritis, COPD, Parkinson’s, and diabetes.

If you are providing OT via home health, you can have a tremendous impact in creating a safe home environment.  OT is expert in evaluating a patient’s home and environment for safety concerns and fall hazards.  In addition to suggesting modifications to the physical space, OT can evaluate the need for assistive devices.  One of the most common evaluations includes mobility and balance – aids that could be useful include walkers, rollators, canes or stair lifts.  OT can also offer valuable advice on safety in one of the home’s most dangerous rooms – the bathroom.  Grab bars, raised toilet seats or toilet frames and shower chairs or transfer benches are a few of the ways OT can help preserve independence and privacy for patients.  OT can also make recommendations to improve safety at home using smart home technology, medication organizers/reminder systems and medical alert devices.   Finally OT can recommend devices to compensate for fine motor skills deficits while dressing or cooking and ways to compensate for low vision.

Occupational Therapy brings a holistic approach to care that considers what the patient wants first.  With that lens, OT can put the supports in place for their patient to maintain independence and continue participation in important occupations.  Nowhere is this more important than for older adults.