Establishing and Maintaining a Healthy Lifestyle

     Focusing on productive aging and maintaining a healthy lifestyle not only helps to improve quality of life for older adults, it is essential for good health outcomes and managing costs. The occupational therapist can support participants by creating individualized client-centered goals to establish and maintain healthy habits, roles, and routines (Halle et al., 2018; Smallfield et al., 2019). When considering the PACE participant who may be frail and with multiple comorbidities, this remains an important, but often overlooked, focus of care. Additionally, some participants may present with a lifetime of “bad” habits that have contributed to multiple chronic conditions. Focusing not just on disease management, but more broadly on promoting and maintaining a healthy lifestyle is an important role for the occupational therapist.

 

Role of Occupational Therapy. Health management and maintenance is considered an instrumental activity of daily living and includes “developing, managing, and maintaining routines for health and wellness promotion” (AOTA, 2014, p. S19). Occupational therapists are experts at identifying and addressing barriers to integrating healthy habits into a daily routine. The occupational therapist is also skilled at collaborating with the participant to identify realistic goals and developing interventions and treatment plans to support these goals.

 

     Key areas of health promotion that can be addressed include:

 

Sleep – Getting adequate sleep has been linked to improvements in overall health and wellness, however this is commonly cited as an issue with many older adults (Smallfiedl et al., 2019). There is strong evidence to support the use of occupational therapy to improve sleep through sleep hygiene, exercise, meditation and relaxation, sleep diaries, and cognitive-behavioral therapy. Interventions in group and individual settings have both been effective (Smallfield et al., 2019).

 

Nutrition – Poor nutrition can increase the risk of obesity, diabetes, pain, stroke, cancer, depression, among many other chronic diseases and complications (AOTA, 2013). Of note, specific dietary guidelines should be provided by the primary care provider and registered dieticians and is outside of the scope of practice of an occupational therapist. Once guidelines are established, the occupational therapist can be instrumental in helping participants follow them. Participants can face physical and cognitive challenges with meal prep or shopping. They may not understand their guidelines or know how to integrate them into their daily routine with good food choices. There could be cultural or social barriers to healthy eating. Participants may also be unmotivated to prepare healthy meals if they live alone. The occupational therapist can provide assessment and interventions to address any of these barriers to promote healthier eating (Bailey, 2019). It is likely that several disciplines can collaborate to support better nutrition including home care, the dietician, the primary care provider, and the social worker.

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Exercise and activity – Regular exercise has been shown to have many health benefits such as improving cardio-pulmonary function, cognition, mood, decreasing pain, falls, and depression, and improving mobility and occupational participation (Ambrose & Golightly, 2015). In the setting of the complex medical needs of PACE participants, having an occupational therapist design and help implement a regular exercise program would likely have many benefits. The occupational therapist can create an exercise program that matches the person’s abilities and can be accomplished within the person’s environment and routine. There is evidence to support task-specific exercises such as a walking program or focusing on “chair rising or bed rising” exercises particularly for those with activities of daily living (ADL) deficits and the frail elderly (Smallfield et al., 2019). Additionally, decreasing sedentary behaviors by modifying daily routines and increasing overall activity level throughout the day has also been shown to be beneficial (Bailey, 2017).

 

Social participation – social isolation has been linked to increased morbidity and mortality rates. Having a strong social network has a direct impact on physical and psychosocial wellbeing (Dury, 2014; Nicholson, 2012). Many older adults face barriers to social participation such as experiencing difficulty with community mobility, cognitive, sensory, and language deficits, and psychosocial impairments. Occupational therapist collaboration with the social worker and PACE day center manager will likely be useful when promoting increased social participation.

 

Leisure participation – Engaging in leisure activities has been directly linked to a higher quality of life and improvements with overall health and wellness (Paggi, Jopp, &  Hertzog, 2016; Smallfield et al., 2019). The occupational therapist should collaborate with the recreational therapist to best meet the needs of PACE participants. The occupational therapist’s expertise can be particularly useful when needing to adapt the task or environment to promote participation for a person with cognitive, physical, or psychosocial deficits. Specific leisure education programs have been shown to improve leisure participation in older adults in the community (Smallfield et al., 2019).