This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults’ performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.

key words: aging, activities of daily living, leisure ABSTRACT Participation in everyday occupations influences people's health and well-being. To enable individuals to do the activities they want and need to do is the main concern of occupational therapy practice. Many daily occupations are universal, but they also depend on culture. The development of the Activity Card Sort in eight countries has offered the opportunity to describe occupations across cultures. In the developmental process of culturally relevant versions of the Activity Card Sort by occupational therapists in each country, the instrument versions included samples of older adults (N = 468). These data are used in the current description with the aim of identifying central activities across cultures and central activities for Asian and Western cultures. Ten activities were identified as being central across cultures (i.e., more than half of the older adults in all eight countries performed them). They were the following: shopping in a store, doing grocery shopping, doing dishes, doing laundry, reading books or magazines, sitting and thinking, watching television, listening to radio or music, visiting with friends and relatives, and talking on the telephone. Further, 16 additional activities central to Asian culture and 18 activities central to Western culture were identified. The identification of central activities deepens knowledge of activities with cultural significance. This knowledge is needed in clinical practice and multicultural research. This description provides a starting point for further exploration of everyday occupations among older adults.

The Activity Card Sort was developed to measure the level of participation of older adults in instrumental, social, and leisure activities. The purpose of this study was to determine the psychometric properties of the translated and culturally adapted Puerto Rican Spanish version of the Activity Card Sort (PR-ACS). This study included 106 community-dwelling older adults aged 60 years and older and 40 adults with multiple sclerosis aged 50 years and older. Results showed that the PR-ACS was able to discriminate between clients with different levels of functioning (t = 6.86; p < .001), and was positively associated with the Puerto Rican version of the p < .001). Good test-retest reliability (intraclass correlation coefficient = 0.82) and high internal consistency (Cronbach's alpha = 0.91) were demonstrated. Initial evidence of construct validity, concurrent validity, internal consistency, and test-retest reliability was found to support the use of the PR-ACS to assess occupational participation of Puerto Rican older adults living in the community.

Assistive technology (AT) is important for individuals with disabilities’ independence and participation in daily life, and there is a lack of valid AT outcome tools for the Puerto Rican population. This pilot study examined the content validity of a new adaptation of the Psychosocial Impact of Assistive Device Scale (PIADS): the Puerto Rican-Spanish PIADS (PR-PIADS). Following standard procedures, the cultural adaptation methodology included a bilingual multidisciplinary committee review of the original (English language) and Spanish versions of the PIADS and pilot testing of the preliminary version of the PR-PIADS with 20 AT users. The committee recommended a total of 58 semantic and conceptual modifications of the Spanish PIADS. Pilot data analysis resulted in 4 additional semantic and conceptual modifications of items that did not reach the minimum content validity ratio of 0.42 for a panel composed by 20 members: competence (0), efficiency (−0.6), performance (−0.95), and eagerness to take chances (−0.6). This pilot study demonstrated evidence of initial content validity of the PR-PIADS. Future research is required before using this tool with greater confidence to address the construct validity and reliability that are also critical to a successful cultural adaptation.

In this pilot study we explore the difference in the use of occupational competence strategies for daily participation between highly active and low active Hispanic older women. Twenty-nine women, living alone who were ≥ 70 years participated in this study. We employed a mixed method design through which the principal investigator administered a tool to measure participation restrictions during the quantitative phase and conducted in-depth interviews with a subsample of the quantitative phase. Active women predominantly used transportation resources, emotional social support, and spirituality to support participation in life activities. Less active women used more practical social support, assistive technology, and environmental modifications. Personal facilitators seemed to directly modify these strategies. These results suggest that older women with different activity levels use distinct internal and external resources to maintain or enhance daily participation. Future studies should explore whether these resources remain consistent across gender, living status, and ethnicities.