OT? So What?

During the week I attended the College of Occupational Therapists Conference in Glasgow. The College of Occupational Therapists Specialist Section- Older People (COTSS-OP) conference ran simultaneously. It was really inspiring to hear many of the main keynote speakers, such as professor Michael Iwama, talking about preventative work and public health being important future arenas for OTs. The vital role OTs play in acute and emergency care settings was very much acknowledged, but the importance of linking well with community based services was very much at the forefront of the discussions.

I presented a facilitated poster discussion about my study visit to the University of Southern California. I outlined the background to the visit and then went on to the following:
 

'...Current hospital discharge practice can be frustrating for both OTs and older people themselves. It can be reductionist, grounded in a medical model and emphasise ‘safety’ at the expense of occupational engagement and enablement of valued daily activities. A paradigm shift on the part of policy makers, service managers and individual OTs is needed to change this. An understanding of the principles of the LRD model can provide a way forward.

I want to leave you with some points to ponder based on the opening plenary speech given by Professor Iwama and Jacqui Lunday Johnstone’s Keynote address to the COTSS-Older People’s conference. Professor Iwama challenged us to re-examine how and where we work and to look at the preventative and public health arenas as the future of Occupational Therapy. He asked us to consider the relevance of our services to the lives of the people and communities we serve. Jacqui Lunday Johnstone emphasised the need to demonstrate outcomes or the ‘added value’ that occupational therapists provide- what she termed the ‘So What?’. Both affirmed that the unique skills of OTs, if fully utilised can have real impact on the hospital to home interface. Using an approach inspired by Lifestyle Redesign® could help to make this a reality.

Imagine the older people who use your service being asked two questions:

1. Was the OT service you received relevant to your life?
2. If you received a service, So What? What was the added value it brought?

If the answers you think you would get are not what you would wish them to be, then it is time to begin looking at the reasons and to think about whether using aspects of Lifestyle Redesign® could be a way to change the answers in future.'

Never too late...

"It's Never too late to go healthy. Anybody, young or old, can successfully redesign the way they live to be healthier. While we don't have a say in our own genetic makeup, greater than 50 percent of our mental and physical health status is related to lifestyle. You can even start small: ride public transportation, reconnect with a long-lost friend, join a ballroom dance class, or follow guidelines on how to safely move around the community. The point is, try something new and be willing to learn."

Dr Florence Clark, University of Southern California

I love this quote from Dr Clark, key developer of the Lifestyle Redesign approach in Occupational Therapy. It emphasises the way in which a variety of things, such as socialising with friends contribute to overall health and well-being, not only the obvious things like diet and exercise. It also shows how being open to new ideas and ways of doing things can help to Age Proof your life.

This 'tip' was published in the Atlantic magazine last year. For the full article and all 5 Tips, follow this link:

http://www.theatlantic.com/health/archive/2012/02/professional-help-5-tips-for-senior-citizens-on-simple-healthy-living/252556/http://www.theatlantic.com/health/archive/2012/02/professional-help-5-tips-for-senior-citizens-on-simple-healthy-living/252556/

Lifestyle..

L
 

Lifestyle Redesign®

“..is a process of acquiring health promoting habits & routines in daily life” (Clark et al 1997)

“…is the process of incorporating health promoting habits & routines in your daily life. OTs look at how you ‘occupy’ your time and how the daily activities you engage in affect your overall health, wellness & life satisfaction” University of Southern California Faculty Practice

Four core beliefs of the Occupational Therapy profession informed the development of Lifestyle Redesign®:

• Occupation is life itself
• Occupation can create new visions of possible selves
• Occupation has a curative effect on physical and mental health and on a sense of life order and routine
• Occupation has a place in preventive care (Mandel et al 1997)

The concept is now widely recognised in occupational therapy and health literature (see report tab at top of page for more detailed information). The term ‘Lifestyle Redesign’ is trademark protected, but any OT can draw upon the methodology. I suggest reading the report as above as a starting point.

Age Proof Your Life

 

A

Age Proof Your Life

The population of the developed world is getting older.

• One in 4 babies born today will live to be 100
• The number of people aged over 65 is expected to rise by 50% in the next 20 years
• The number of over 85s is predicted to double in the next 20 years and treble in the next 30 years
• 3.8 million older people live alone, 70% of these are women
• These figures are based on the UK, but other comparable countries may be ‘ageing’ even faster!

My theme for this year’s A-Z Challenge is Age Proof Your Life.

As an Occupational Therapist (OT) with over 20 years experience, mainly in working with older people, I have had the privilege of witnessing at close hand the ways that many people cope with the challenges of growing older, whether in good health or poor, whether surrounded by family or alone and whether financially comfortable or not.

Last year I used the A-Z Challenge to reflect on a study visit I had just completed to the USA (I am UK based) to study Lifestyle Redesign®, an occupational therapy approach that enables people to make changes in their lives that are long lasting and health promoting. Research has shown that this approach has benefits for the health and wellbeing of older people that are sustainable and reduce the need to use health and social services. Lifestyle Redesign® is based in the theories of the OT profession and also those of Occupational Science. To read my report click the WCMT Study Visit report tab above.

I will draw on this experience as well as the theories and evidence that underpin the profession of Occupational Therapy. An OT can help you to live life your way. OTs believe that you are what you do and we look at ‘occupations’ as the meaningful activities in your everyday life. OTs look at the whole person and how occupation shapes your life. An OT can help find ways to incorporate health promoting activities and routines into daily life resulting in greater life satisfaction, health and wellbeing.

An OT can help you continue to have an active life as you get older by finding ways to make everyday tasks easier or by helping you to try something new to aid independence. An OT can offer solutions and alternative ways of doing things when everyday activities become difficult to help you to get the most from life.

When illness, injury, disability prevent you from doing the activities that are meaningful in your life, an OT can help restore health, independence and wellbeing.

OTs are experts in understanding and working with the complex interaction between an individual with all their preferences, abilities, limitations and aspirations, their home situation and lifestyle and their occupations.

So whether you are an older person, looking to the future, an OT yourself or just interested- I hope you will find my posts this month interesting and stimulating.

I will not be presenting lots of ‘heavy duty’ theory, but where relevant I will try to provide links or references for further reading for those who do want to read further.

Key References

Craig, C & Mountain G (2007) Lifestyle Matters. An Occupational Approach to Healthy Ageing. Speechmark. UK

Jackson, J. (1996). Living a meaningful existence in old age. In R. Zemke & F. Clark (Eds.), Occupational science: The evolving discipline (pp. 339-361). Philadelphia, PA: F.A. Davis Company.

Mandel, D. R., Jackson, J. M., Zemke, R., Nelson, L. & Clark, F. A. (1999). Lifestyle redesign®: Implementing the well elderly program. Bethesda, MD: The American Occupational Therapy Association.

World Congress on Active Ageing

 

Last month I attended one day of the WCAA in Glasgow to present a poster about my study visit to the University Of Southern California to investigate using a Lifestyle Redesign® based approach to improve the hospital to home interface for older people.

The congress was held at the armadillo (otherwise known as the Scottish Exhibition & Conference Centre- but it looks like an armadillo!). Delegates included academics, various health and social care workers and professionals and a lot of older people. In addition to the serious presentations there were lots of fun activities going on in the main hall. I met one older couple who had arrived on their bikes and I last saw as I left playing a highly competitive game of table tennis together!

The day that I attended, the focus was on falls and bone health. Many of the presentations were about exercise, it’s benefits for falls prevention and bone health and a lot of discussion about problems with uptake and adherence to exercise programmes. My main reason for attending was to present my poster, and I had many interesting conversations with delegates viewing the poster but the presentations I attended got me thinking about how a Lifestyle Redesign® based approach could help to deliver a more holistic and lifestyle management orientated approach to falls prevention for older people. OTs sometimes find that their role becomes one of advising about environmental hazards and recommending equipment, but these factors on their own have only a limited impact. Incorporating health-promoting changes into daily routines could have a more significant and longer lasting impact on falls prevention- and on health and well being.

I intend to look at this in more detail in a later blog post- so watch this space.

Study Visit Report

At last my report is completed and available through the Winston Churchill Memorial Trust website. I have added a link to the web page- go to the tab at the top of this page and you will find it, or use this link in your browser:

http://goo.gl/6KaFm

 

W is for Winston Churchill Memorial Trust…

 

Winston Churchill is an iconic figure in British history, best known for having been Prime Minister during the Second World War. On his death in 1965, a memorial fund was set up and the decision was made that instead of a building or statue, a ‘living memorial’ would be created. The Winston Churchill Memorial Trust (WCMT) funds travel awards for British citizens to travel abroad to learn and share knowledge and skills for the benefit of themselves, for Britain and for the countries they visit. WCMT’s slogan is ‘travel to make a difference’.

The study visit to Los Angeles that I undertook earlier this year has been the subject and inspiration for this blog. I owe a great debt of thanks to the WCMT for funding my visit and for their support throughout the whole process.

Last weekend I attended the Scottish Winston Churchill Fellows AGM. Three recent fellows gave presentations that demonstrated the wide range of subjects that are included. One was about hydro-electric schemes in Africa, one about early years parenting skills in Italy and the Netherlands and one about reducing losses in fishing vessels in North America. They were all fascinating and it was clear why the speakers had chosen their topic and how they planned to make use of their learning.

WCMT is developing the ways that it supports fellows once they return from their studies and is working to develop links and mentorship for key areas of study.

The whole experience has been a real once in a lifetime opportunity, and in many ways, the visit is only a beginning. I would very much encourage you to follow this link to the WCMTwebsite for more information.

V is for Value....

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‘Valuing the ordinary’ is a concept used in the development and use of the Lifestyle Redesign® approach in Occupational Therapy (OT). It can be incorporated into any OT intervention.

Valuing the ordinary simply means taking note of and seeing as important, the everyday ‘trivia’ of someone’s life. Our lives are all made up of a patchwork of everyday small tasks and concerns that create a whole.

Allowing some time to focus on small and seemingly unimportant matters, can have positive effects in that it allows the person, rather than the illness or problem to be the focus. Exploring the ordinary may give the starting point that allows someone to begin to envision a new possible self as the OT uses the opportunity to be positive about progress and to help someone see new possibilities for the future.

Reading about this, I was reminded of the quote from one of the OTs working in the Pressure Ulcer Prevention Study at the University of Southern California during my recent study visit there: “If it’s valuable to you, it’s valuable to me”.

U is for University of Southern California...

 

The University of Southern California (USC) is a privately funded university located across 2 campuses in central Los Angeles. Occupational Therapists (OTs) have been educated here since 1942 and many of the profession’s famous names are alumni e.g.Mary Reilly and Gary Kielhofner.

Mission and Vision

‘The mission of the USC Division of Occupational Science and Occupational Therapy is to maximize the potential of people to construct healthy, satisfying and productive lives by generating knowledge of value to society, advancing the profession and educating generations of practitioners, researchers and leaders.

Our Vision

We envision the Division of Occupational Science and Occupational Therapy as a hub of innovation and leadership where we study participation in daily activities defined in the discipline as “occupation” and its relationship to healthy living over the lifespan. We aim to establish occupation as an essential component in health and well-being. We promote this perspective by educating a global community of researchers and practitioners and advancing practice models about occupation that are science-driven and address health and societal needs.’

(Division website at http://ot.usc.edu/)

In addition to the two University owned hospitals, close links are maintained with clinical partners at Rancho Los Amigos National Rehabilitation Centre, Children’s Hospital and others. A global network of contacts including Ghana, Hong Kong & Romania is well established.

There are 3 main ‘arms’ of the Division’s work:

·      Research- the Division is currently operating with a research ‘portfolio’ of over $8 million. The studies in progress have potentially powerful implications for OT practice and range from community based lifestyle interventions to neuro-imaging following stroke to improve rehabilitation methods. Numerous peer reviewed publications have contributed to the aim of generating ‘rigorous science with clinical relevance’

·      Clinical Practice/Care Services- clinical OT staff work within the USC Occupational Therapy Faculty Practice and Keck Medical Center at USC Hospital. Lifestyle Redesign® forms the basis for the Faculty Practice programmes. In addition to meeting patient needs, the clinical practitioners are closely involved with the teaching and research ‘arms’.

·      Training/Education- the entry-level Masters programme has recently been remodeled and includes foundations and essential core studies, practice ‘immersions’ (Paediatrics, Mental Health & Adult Physical Rehabilitation/Geriatrics), academic fieldwork, leadership development and specialty focused elective placements.

 During my visit I had the opportunity for involvement in all three areas and was able to gain an appreciation of how closely interwoven they are and how Lifestyle Redesign® is applied in many different situations.

The opportunity to have this in depth experience was made possible by a Winston Churchill Memorial Trust travel award (more about this when we reach W). The purpose of my visit was to investigate how Lifestyle Redesign® could be used to improve the hospital/home interface for older people. This blog began as a record of my experiences during the visit and now continues as a reflection and record of progress since my return to the UK.

T is for Tips...

5 Tips for Senior Citizens on Simple, Healthy Living from Dr Florence Clark, Professor at the Division of Occupational Science & Occupational Therapy, University of Southern California (USC).
This easy-read article was published on The Atlantic web based news page the atlantic.com during my study visit to USC earlier this year.

Image: Monkey Business Images/Shutterstock.

Great to see an OT advising on healthy living and wellbeing. And great to see activity or occupation being championed as a way to keep healthy and happy.
The 5 Tips are based on the results of the Well Elderly 2 study (see my post for E on 5th April)

Follow this link for the 5 Tips:

http://www.theatlantic.com/health/archive/2012/02/professional-help-5-tips-for-senior-citizens-on-simple-healthy-living/252556/