1. Horowitz, Beverly P. PhD, CSW, OTR/L, BCG
  2. Chang, Pei-Fen J. MSG, OTR/L


Research supports both the role of lifestyle to promote health and well-being for older adults and preventive occupational therapy lifestyle redesign to promote engagement in life activities and enhance health for "at risk" community living elders. Occupational therapy lifestyle redesign programs seek to provide older adults with strategies and opportunities to increase participation in identified meaningful activities for life satisfaction and to positively impact physical and mental health. This article reports on a 16-week lifestyle redesign pilot study conducted within medical model adult day programs with cognitively intact frail older adults. Data analysis found that experimental group subjects showed favorable results on Role Functioning, Bodily Pain, and General Health on the 36-item Short Form Health Survey (SF-36); Social Activity on the Functional Status Questionnaire; and on the Center for Epidemiologic Studies Depression Scale (CES-D). No statistically significant differences were noted between groups upon posttests after adjusting for covariates; however, a small sample resulted in limited statistical power. Further studies with a larger sample are recommended for convincing conclusions.


PREVENTIVE occupational therapy lifestyle design programs have been successful in promoting functional capabilities and quality of life among community living older adults. 1-3 Lifestyle changes such as the use of environmental modifications or different methods of performing everyday activities can maximize independence and improve quality of life. Chronically ill, frail older adults are at high risk for functional decline, and have reduced opportunities to participate in family and community events. This article presents the outcome of a randomized, experimental pilot program conducted within adult day programs. Group-oriented prevention programs led by occupational therapists aimed to provide the setting and opportunity for adult day program clients to problem-solve and share experiences and develop the confidence to tackle 21st century challenges. These challenges range from using a microwave oven for cooking to learning the intricacies of the Internet to e-mail grandchildren and shop on-line. This study was the first of its kind among clients attending New York State medical model adult day care programs.


It is well-recognized that our population is aging and that the majority of today's older adults are enjoying their senior years because of improved health and opportunities to enjoy varied pursuits. 4,5 However, while the majority of adults 65 to 74 years old are living independently in the community, the proportion of persons 85 years and older who need assistance in activities of daily living is more than double that of persons 84 and younger. 6,7 While overall disability rates are declining for adults 65 years and older, more and more of those who are 85 and older are coping with the symptoms of chronic illness, often in combination with functional limitations. 4,8 Recent data indicates that 58% of those over 80 have a major disability. 9 Disability often results from the multiple interactions of disease processes in combination with age-related factors. 10 Disabled older adults face daily challenges in performing once simple everyday activities. 11,12 When disabilities markedly restrict functional capabilities, assistance is needed to perform personal care, to ensure safety, and to maintain community living. Older adults and their families commonly struggle to develop caregiving routines and strategies that meet care recipient and family needs. Family caregiving efforts are often supplemented by paid in-home assistance. 13-15


Older adults prefer to live in their communities and own homes, regardless of chronological age or need for assistance with activities of daily living or instrumental activities of daily living. 16,17 However, individual circumstances or necessity often encourages or requires relocation to senior housing complexes, assisted living settings, coresidence with family members or friends, or to adult foster homes. 4,18,19 As of 1997, 20.9 million households were headed by older persons, 79% of whom were homeowners. Thirty-one percent of noninstitutionalized elders lived alone as of 1998. This represents 41% of older women and 17% of older men. Only 4.3% of adults 65 years and older live in nursing homes, and among the oldest-old (85 years and older) 19% resided in nursing homes. 20 Thus, the vast majority of older adults, including persons with functional impairment and disability, live in their own homes. However, successful community living typically requires individuals to achieve some level of self-care capability, particularly for individuals who live alone. 21 For those with chronic illness, functional impairment or disability, independent mobility and self-care is achieved through perseverance and physical and emotional effort. Daily tasks that once were easy to accomplish commonly require more mental and physical effort, planning, and sometimes help from family, friends, or paid caregivers. 13-15


Families provide the first line of support for older individuals, such that the entire family unit is affected when an older adult faces illness or disability and difficulties caring for household and personal needs. This situation can happen gradually or suddenly as a result of physical or cognitive impairments. Formal care and programs optimally complement informal caregiving provided by family and friends, especially when older adults need daily supervision and assistance, or when individuals live alone and are at risk for isolation. 9,11,14,22 However, changing family dynamics and societal changes increases the need for a sharing of functions and integration of informal and formal care and supports, including use of community-based services and programs.