Occupational Therapy Interventions to Improve Performance of Instrumental Activities of Daily Living for Community-Dwelling Older Adults: A Systematic Review

Hunter, Elizabeth; Kearney, Pamalyn

doi:10.5014/ajot.2018.031062

Cited by 44 publications

(53 citation statements)

References 49 publications

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“…Among the participants with AD, MCI, and healthy older adults, reduced executive performance has been particularly associated with poorer IADLs, 35,36 and interventions to improve executive functions have been suggested as a means to increase independence. 37 In PD, memory, executive function, processing speed, language, and visuospatial skills have been variably associated with complex IADLs, 10,11,38 although other studies that evaluate performance-based methods of IADL assessment have found no relationship between cognition and functional performance in participants with PD. 3,39 Here, we provide support for associations with both cognitive diagnosis and individual cognitive tests, particularly processing speed and working memory.…”

Section: Discussionmentioning

confidence: 99%

Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Cholerton

Poston

Tian

et al. 2019

Movement Disord Clin Pract

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Introduction Introduction: Cognitive dysfunction is common in Parkinson's disease (PD) and associated with reduced functional abilities and increased dependence. To date, however, little is known about the relationship between performance of instrumental activities of daily living (IADLs) and cognitive stages in PD, and there are conflicting reports as to whether declines in specific cognitive domains predict IADL impairment. Methods Methods: Participants with PD were drawn from the Pacific Udall Center and included in the study if both participant and study partner IADL ratings and cognitive tests were completed (n = 192). Logistic regression analyses were performed to determine whether participant and/or study partner rating predicted mild cognitive impairment or dementia. Correlations are reported for the relationship between participant/study partner IADL reports as well as for specific cognitive tests. ResultsResults: Although both participant and study partner ratings of IADL performance were associated with a diagnosis of PD with dementia, only participant self-rating of functional ability was significantly associated with a diagnosis of PD with mild cognitive impairment. Functional ability correlated most strongly with measures of processing speed, auditory working memory, and immediate verbal recall for both the participant and study partner ratings. Conclusion Conclusion: For participants with PD in the early stages of cognitive decline, self-rating may be more sensitive to the impact of cognitive changes on IADL function than ratings made by a knowledgeable study partner. Changes in executive function, processing speed, and learning may indicate a higher likelihood of IADL impairment. Careful assessment of cognition and IADL performance is recommended to permit individualized interventions prior to significant disability.Cognitive impairment is pervasive in Parkinson's disease (PD), often resulting in devastating impacts on quality of life, functional performance, and independence. 1 A decline in the ability to perform instrumental activities of daily living (IADL) related to cognitive impairment, although often initially subtle, can negatively impact disease outcome if not identified and adequately compensated. 2 Although significant functional impairment may be more apparent in PD-related dementia (PDD), subtle deficits in complex IADLs occur frequently among those with PDrelated mild cognitive impairment (PD-MCI), and the presence of such deficits may help to reveal the presence of early cognitive decline. 3 The assessment of functional change in PD presents challenges, however. Performance-based measures are not often

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Section: Discussionmentioning

confidence: 99%

Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Cholerton

Poston

Tian

et al. 2019

Movement Disord Clin Pract

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“…This article provided an example of how to apply evidence from systematic reviews on productive aging to inform and guide clinical decision making (Berger et al, 2018;Elliott & Leland, 2018;Hunter & Kearney, 2018;Liu et al, 2018;Smallfield & Lucas Molitor, 2018a, 2018b. For further evidence-based information on productive aging, see the American Occupational Therapy Association's (AOTA's) Occupational Therapy Practice Guidelines for Productive…”

Section: Resultsmentioning

confidence: 99%

Occupational Therapy Interventions for Productive Aging Among Community-Dwelling Older Adults

Smallfield

Elliott²

2019

The American Journal of Occupational Therapy

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Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult who was referred to outpatient occupational therapy services due to chronic back pain from herniated discs. Findings from the systematic review of occupational therapy for community-dwelling older adults were published in the July/

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“…For example, Cooper found that OT for adults with cancer reduced stress and increased sense of control, allowing for better management of psychosocial needs. OT services for older adults with other chronic conditions can decrease the likelihood of rehospitalization and use of skilled nursing services, and it was shown to improve functioning and confidence in participation in social life . De Groef and colleagues found that outpatient PT can improve physical health and decrease pain.…”

Section: Discussionmentioning

confidence: 99%

“…OT services for older adults with other chronic conditions can decrease the likelihood of rehospitalization and use of skilled nursing services, and it was shown to improve functioning and confidence in participation in social life. [46][47][48][49][50][51] De Groef and colleagues 52 found that outpatient PT can improve physical health and decrease pain. However, to our knowledge, ours is the first RCT to examine use of both OT and PT services for older adults with cancer and demonstrate clinical improvements in treatment groups, that is, the promise of the OT/PT team improving care.…”

Section: Discussionmentioning

confidence: 99%

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

Pergolotti

Deal

Williams

et al. 2019

J American Geriatrics Society

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OBJECTIVES The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown. DESIGN Two‐arm single‐institution randomized controlled trial of outpatient OT/PT. SETTING Comprehensive cancer center with two off‐site OT/PT clinics. PARTICIPANTS We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care. INTERVENTION Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs. MEASUREMENTS Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient‐Reported Outcomes Measurement Information System‐Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self‐efficacy (Possibilities for Activity Scale [PActS]). RESULTS Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow‐up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow‐up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided. CONCLUSION OT/PT may positively influence activity expectations and self‐efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953–960, 2019.

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Occupational Therapy Interventions to Improve Performance of Instrumental Activities of Daily Living for Community-Dwelling Older Adults: A Systematic Review

Abstract: Evidence supports tailored interventions designed to enhance IADL performance. More studies are needed that focus on IADLs specifically and that use IADLs in their interventions.

Cited by 44 publications

References 49 publications

Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Participant and Study Partner Reported Impact of Cognition on Functional Activities in Parkinson's Disease

Occupational Therapy Interventions for Productive Aging Among Community-Dwelling Older Adults

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

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