Well Elderly I participant.
Well Elderly I & II are studies that began in the 1990s and have provided high quality evidence that preventative occupational therapy can improve health related quality of life and satisfaction for older people. These benefits are sustained over time and so have potential to reduce older peoples' use of health and social care services.
There have now been a number of publications about these studies. I am not going to attempt a lengthy explanation of each but will try to give an overview of the important points and references for those who would like to read further.
Well Elderly I
In Well Elderly I, a randomised controlled trial(RCT) was carried out with 360 low income seniors in Los Angeles. They were divided into 3 groups, one received a specially developed (Lifestyle Redesign) occupational therapy(OT) programme consisting of group and individual sessions, one received a non-professionally led social activity programme and the third group had no intervention. The results were evaluated at beginning, end and 6 months later. The group who received the OT intervention showed significant gains in various health, function and quality of life factors and fewer declines than the other groups. Interestingly the two control groups showed no significant differences in results.
This study demonstrated that:
|'The Manual' conceptual & practical framework.|
- preventative OT can help older people remain healthy and independent longer, reducing the need for hospital admissions or care services and improving quality of life
- OT has potential to be used in preventative health care to reduce costs
- Social activity was not shown to be beneficial on it's own. This supports the argument that the professional skills of OTs are required to gain the full therapeutic effects that engagement in therapeutic activity can bring.
Well Elderly II
Well Elderly II went on to develop the work further and to try to address some of the methodological issues, particularly in demonstrating that the intervention can be effective in real life situations. This was again a RCT, this time involving 460 ethnically diverse participants from a range of community settings. They received the Lifestyle Redesign occupational therapy intervention in groups 2 hours per week over 6 months, plus up to 10 hours individual OT intervention, this time using a different study design. Once again, occupational therapy intervention was shown to have beneficial effects for maintenance of health and well-being. This study supported the conclusions of Well Elderly I, addressed some of the methodological issues and demonstrated that this intervention can be cost effective and widely applicable.
Use in the UK
One of the criticisms of research in OT has been that it has not had enough RCTs, these are seen as the 'gold standard' for research and results are therefore taken seriously. Because the Well Elderly studies were RCTs and showed such positive results, they have attracted interest outside the US.
Two significant UK publications to be aware of are:
NICE is the National Institute for Health & Clinical Excellence. It produces reports on a wide range of clinical activities and makes evidence based recommendations for practice. Well Elderly I is referenced in the costing report that was carried out for NICE Public Health Guidance 16 ' Occupational Therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary care and residential care' Follow this link for a summary of the guidance .
|Lifestyle Matters, UK|
A feasibility study of an 'occupation-based health-promoting intervention' inspired by the Well Elderly study and delivered by OTs was carried out by Gail Mountain and colleagues based at Sheffield Hallam University, UK. It included the development of a manual similar to the Lifestyle Redesign one, but intended for UK readers and clients. This was a smaller, qualitative study intended as preparation for future research. It showed that delivering the programme was feasible and that particpants benefited.
My interest in Lifestyle Redesign began with hearing about the Well Elderly studies carried out by Dr Florence Clark and the research team of the Division of Occupational Science and Occupational Therapy at the University of Southern California (USC) in Los Angeles. I undertook a study visit to USC in Jan/Feb 2012 thanks to a Winston Churchill Memorial Trust travel award to learn more about Lifestyle Redesign and to investigate how it could be used to improve the hospital to home interface for older people.
I hope this post has got others interested too.
References/ Further Reading
Clark et al (2011) Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial. Journal of Epidemiological Community Health doi:10.1136/jech.2009.099754
Clark et al (2001) Embedding Health-Promoting Changes Into the Daily Lives of Independent-Living Older Adults: Long Term Follow-Up of Occupational Therapy Intervention. Journals of Gerontology 56B 1 pp60-63
Clark F et al (1997) Occupational Therapy for independent living older adults: a randomized controlled trial. Journal of the American Medical Association 278, 1321-1326
Craig G & Mountain G (...) Lifestyle Matters: An Occupational Approach to Healthy Ageing.UK
Hay J et al (2002) Cost-Effectiveness of Preventive Occupational Therapy for Independent-Living Older Adults. JAGS 50:1381-1388
Jackson et al (2009) Confronting challenges in intervention research with ethnically diverse older adults: the USC Well Elderly II Trial. Clinical Trials 6 90-101
Jackson J (1996) Living a Meaningful Existence in Old Age. In Zemke R & Clark F (eds) Occupational Science: the Evolving Discipline (pp 339-361) Philadelphia: FA Davis. USA
Jackson et al (1998) Occupation in Lifestyle Redesign: The Well Elderly Study Occupational Therapy Program. American Journal of Occupational Therapy. 52(5).
Mandel, D et al (1999) Lifestyle Redesign. Implementing the Well Elderly Program. American Occupational Therapy Association. USA.
Mountain G et al (2008) Occupational Therapy Led health Promotion for Older People: Feasibility of the Lifestyle Matters Programme. British Journal of Occupational Therapy Oct 2008 71(10) pp 406-413
National Institute for Health & Clinical Excellence (2008) Mental Wellbeing and Older People: Costing Report. London.