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In 1983, Robert Butler introduced the idea of ‘Productive Aging’ in an effort to highlight the contributions of older adults in the United States (Butler & Gleason, 1985). This sociological concept broadly refers to a variety of activities that mark the multiple ways people contribute to their own health, to their families, to their communities, and to society as they age (Butler, 2002; Butler & Gleason, 1985). The principles of participation, highlighted in Butler’s definition of productive aging, are closely associated with the foundations of occupational therapy (Meyer, 1922; Peloquin, 1991a, 1991b). Yet, it was not until the introduction of the Centennial Vision that the profession embraced the term productive aging (AOTA, 2006a, 2006b).
The authors of this special issue of the American Journal of Occupational Therapy, in conjunction with the authors of the AOTA Practice Guideline on Productive Aging (Leland, Elliott, & Johnson, In Press), have strived to examine the literature through systematic reviews which focus on productive aging within the occupational therapy domain of practice (Arbesman & Lieberman, 2012). This in turn helps elucidate the effectiveness and benefit of occupational therapy interventions, as well as the implications for education and research, to support older adults’ participation and engagement in occupations as an avenue to achieve productive aging (Arbesman & Lieberman, 2012).
By 2030, approximately 20% of the U.S. population will be 65 years of age and older (U.S. Census, 2009) and chronic conditions will likely be the leading cause of disability (World Health Organization, 2010). Irrespective of existing chronic conditions, adults face challenges as they age due to normative aging processes (e.g. physical changes), contexts and environments that constrain optimal functioning (Gill, Williams, Robison, & Tinetti, 1999; Gitlin, 2003), community mobility changes (Dickerson, Molnar, Eby, Adler, Bedard, Berg-Weger, et al., 2007), and alternations of social and caregiving resources (Neal, Wagner, Bonn, & Niles-Yokum, 2008). The cumulative impact of these vicissitudes affect the performance of older adults and place them at risk for institutionalization, disability, loss of independence in meaningful occupations, and greater health care utilization (Breyer, Costa-Font, & Felder 2010; Christensen, Doblhammer, Rau, & Vaupel 2010, Stel, Smit, Plujim, & Lips, 2004; Stevens, Corso, Finkelstein, & Miller, 2006; Tinetti & Williams, 1997).
The aspiration of the majority of older adults to age in place (Gitlin, 2003) and maintain their ability to participate in desired occupations challenges the occupational therapy profession to expand service delivery beyond traditional medical settings (e.g. hospitals, institutions) to fulfill the need for community-based services where prevention, health, and wellness are the priorities. Abundant opportunities exist for occupational therapy researchers, educators, and clinicians in current and emerging settings to help older adults productively age by (1) retaining or enabling participation in meaningful occupations (e.g. IADLs) and (2) providing strategies to manage the sequel of chronic disease, prevent injury, age in place, and maximize quality of life.
One key factor that affects productive aging is the ability to engage in occupations. Stav and colleagues’ (2012) systematic review, included in this issue, examines the effectiveness of occupational engagement on productive aging among community-dwelling older adults. It highlights the health benefits and quality of life improvements older adults can realize through active participation in everyday activities (e.g. instrumental activities of daily living (IADLs); sleep; and physical, social, and leisure activities), and the detrimental effects a lack of exercise and physical activity can have on occupational performance and health. The results of this systematic review illuminate opportunities for occupational therapy practitioners to work in community-based settings to promote health and prevent injuries of older adults during performance of everyday activities (Stav, et al., 2012).
Demonstrating the effectiveness of occupational therapy interventions within the framework of productive aging is essential if occupational therapy is going to play a key role in supporting the aging U.S. population. Guided by the Occupational Therapy Practice Framework, (AOTA, 2008), occupational therapy practitioners possess the skills and knowledge to evaluate, support, and facilitate the occupational performance and participation of older adults by positively influencing key factors that affect productive aging.
The ability of older adults to engage in meaningful occupations, manage/maintain their health, and perform activities of daily living (ADLs) and IADLs, is pivotal to their ability to productively age. The subsequent articles in this special edition investigated the effectiveness of occupational therapy interventions for key factors that influence the productive aging of community-dwelling older adults.
Orellano and Colon (2012) examined interventions to support IADL participation and determined that occupation-based, client-centered, and multicomponent interventions can improve or maintain the IADL performance of community-dwelling older adults. In their systematic review, they also discuss the evidence related to functional task performance, simulated IADL interventions, and performance skill training to improve IADL performance (Orellano & Colon, 2012).
Arbesman and Mosley (2012) highlight the advantage and effectiveness of client-centered and occupation-based interventions for community-dwelling older adults to improve physical function and occupational performance related to health management. They discuss the effectiveness of health education and self-management programs to reduce pain, decrease disability, and improve ADL and physical activity performance (Arbesman & Mosley, 2012). Additionally, Arbesman and Mosley (2012) analyzed the effectiveness of cognitive behavioral interventions to improve older adults’ exercise adherence, which in turn can impact an individual’s sleep and rest (Arbesman & Mosley, 2012).
Falls and injuries can also affect the community-dwelling older adults’ ability to productively age. Chase, Mann, and Wasek’s (2012) systematic review describes the effectiveness of occupational therapy interventions for fall prevention. The results of this review support occupational therapy practitioners’ essential role in fall prevention and aging in place, using a multifactorial approach to intervention which may encompass evaluating and modifying the home, providing education, recommending technology, advising in exercises to reduce fall risk, and referring to other health care professionals as needed (Chase, et al., 2012).
The systematic reviews encompassed within this special edition of AJOT accentuate the health benefits of occupational engagement (Stav et al, 2012); support the effectiveness of occupational therapy interventions to facilitate productive aging; and strengthen occupational therapy’s role in fall prevention and home modification (Chase, et al. 2012; Stav et al. 2012). The results of the systematic reviews also highlight how occupational therapy practitioners can be catalysts in chronic disease self-management, wellness, and prevention by developing, implementing, and/or leading community education programs (e.g. arthritis, diabetes) for older adults (Arbesman & Mosley, 2012). Let’s all work together to improve the quality of life of our aging population.
Dr. Natalie Leland was being funded through the National Institutes of Health Rehabilitation Research Career Development Program (K12 HD055929) at the time of this manuscript development.
Natalie Leland, Assistant Professor, Division of Occupational Science and Occupational Therapy Herman Ostrow School of Dentistry & Davis School of Gerontology at the University of Southern California, Los Angeles, CA 90089-9003.
Sharon J Elliott, Therapeutic Life Center, P.O. Box 2163, Greenville, NC.