Occupational Therapy? But I’m retired!
Most people have HEARD of occupational therapy (OT), but few truly understand what it is. Even if you’ve experienced OT firsthand or with a loved one, chances are you only saw a small slice of what occupational therapists truly have to offer. OTs treat people across the lifespan, from prenatal through death. While some OTs are involved in actual workplace occupations, most have nothing to do with a job.
I’ll start with a little history lesson to explain why OTs do what they do. In the early 1900’s, patients with mental health ailments were typically locked away in “sanitariums”. When their symptoms or behaviors became unmanageable, they were physically restrained, frequently locked to beds or put in straight jackets. Eventually, it was realized that the behaviors in these scenarios got worse instead of better. They realized that, conversely, they saw improvements if they “occupied” these patients with jobs around the hospital, games, or arts and crafts. Later, they applied that knowledge during the World Wars with soldiers returning from battle with serious injuries and deformities. They came to realize that when provided with games or arts and crafts, not only did the mental health of these soldiers improve, but they also learned to adapt to their new disability. If a person can build a birdhouse with one arm, they can likely learn to dress with one arm as well. This is where occupational therapy was born—wellness through occupation. Current day occupational therapy looks much different, however still embraces the same foundation and goals. Occupational therapists provide education and training to improve or adapt for impairments or disabilities to maximize independence in daily occupations, thus improving overall health and quality of life. With young people, their occupations may be meeting developmental milestones, basic self care, school, and play. With the elderly, their occupations are also basic self care but may also be caring for loved ones, homemaking, healthcare management, finance management, and in the best scenarios, also play.
What’s the difference between physical and occupational therapy?
When attempting to understand OT, most people ask “what’s the difference between physical and occupational therapy”? To keep things simple, physical therapy mainly concentrates on mobility. It aims to improve a person’s ability to move their body and perform physical activities. They work on strengthening muscles, improving flexibility, and enhancing overall physical functioning. On the other hand, occupational therapy focuses on function. It takes a broader approach and aims to enhance a person’s ability to participate in daily activities. Occupational therapists work with individuals who may have physical, emotional, sensory, or cognitive challenges that affect their ability to perform tasks at home, school, or work. Occupational therapy considers the whole person and their support team (family and caregivers), including their physical and mental well-being, environment, roles, values, and personal goals. It’s all about equipping individuals with the skills and tools they need to live their lives to the fullest. In summary, physical therapy helps you get where you need to go and occupational therapy helps you do the things that are important to you once you get there.
Why is occupational therapy important?
“So why are occupations so important? Wouldn’t it be better to let older adults rest their weary bones and get help with their daily occupations?” Studies say otherwise. The Blue Zone study found 6 regions on the globe where people were living the longest and healthiest. One of the most fascinating findings of this study is that the more people remained engaged in their occupations, the longer they lived a healthier life. The study suggests that finding joy and purpose in our daily occupations is not only vital for our mental and emotional well-being, but it can also have a profound impact on our physical health. The study found that individuals who had a strong sense of fulfillment from their occupations were not only more likely to live longer, but they also experienced lower rates of chronic diseases such as heart disease, diabetes, and cancer. Having a sense of purpose and fulfillment in our occupations can significantly reduce stress levels. When they enjoy what they do and feel a sense of accomplishment, our bodies release endorphins, which are natural stress relievers. These endorphins not only boost our mood but also bolster our immune system, making us less susceptible to illnesses. Additionally, being engaged in our occupations often means maintaining an active lifestyle. Many occupations require physical activity, whether manual labor, walking, or simply staying on our feet for extended periods. Regular physical activity is known to improve cardiovascular health, strengthen muscles and bones, and reduce the risk of chronic conditions. Muscle mass decreases approximately 3–8% per decade after the age of 30 and this rate of decline is even higher after the age of 60, and higher yet with a sedentary lifestyle, which has implications for several conditions, including type 2 diabetes, obesity, heart disease, and osteoporosis. Furthermore, staying mentally stimulated through our occupations can have a positive impact on cognitive function and memory. Occupations that require problem-solving, critical thinking, and creativity help keep our brains sharp and agile, reducing the risk of cognitive decline as we age.
How does occupational therapy improve health?
Occupational performance also often goes a long way to combat depression and anxiety. Independence with our occupations is a fundamental aspect of our identity. It gives us a sense of control over our lives. Leisure activities are more than just pastimes; they are an essential outlet for self-expression and self-discovery. When people lose the ability to perform these activities, depression can set in, as their inability to engage in pleasurable activities decreases their motivation and joy. Anxiety can increase as they worry about the future and fear becoming burdensome to others. Feelings of isolation and loneliness grow, as they are cut off from the social connections that leisure occupations often bring. This declining mental health can manifest in various ways, including feelings of sadness, difficulty concentrating, low energy levels, and sleep disturbances.
While there is ample evidence as to why people need to remain engaged in occupations, this admittedly becomes very difficult in our later years. Seniors frequently experience pain, fatigue, decreased balance, falls or fear of falling, decreased vision, decreased hearing, decreased sensation, depression, anxiety, etc. It’s easy to fall into a trap of believing “I’m ___ years old or I have ____ chronic illness, and I can’t be helped. This is just how life is now and I just need to accept it.” Occupational therapists know this is not the case. When there is a will, there is a way, and OTs can help people remain engaged in the occupations that are important to them. They do this in two ways: improve and adapt. They can help improve strength, flexibility, balance, activity tolerance, coordination, cognition, environmental safety, safety awareness, pain, and stress management, just to name a few areas. Age and diagnosis frequently do not preclude anyone from being able to improve in some or all of these areas. However, when improving an impairment is not sufficient, they can adapt for it. For example, individuals with limited hand dexterity may benefit from using modified utensils or special devices that aid in buttoning clothes or opening jars. Long-handled tools such as reachers, long-handled sponges, shoe horns, and sock aids help someone who can’t bend down be able to bathe and dress their lower body. Furniture risers and transfer poles make it easier to stand from a bed, chair, or couch. The list of adaptive equipment is endless. Such equipment empowers individuals to continue participating in activities they enjoy, fostering a sense of normalcy and overall well-being. An occupational therapist assesses one’s living environment and identifies potential modifications to enhance safety and accessibility. This may involve rearranging furniture, installing grab bars, adding ramps, or increasing lighting. Occupational therapy also provides energy conservation training, which is particularly important for individuals with chronic conditions that cause fatigue. Through this training, patients learn techniques to manage their energy levels effectively and prioritize their activities to avoid excessive exhaustion. Occupational therapists educate individuals on pacing themselves, breaking tasks into manageable chunks, and incorporating rest breaks into their routines. By learning to conserve energy, patients can engage in daily activities without becoming overly fatigued, enabling a more fulfilling and balanced lifestyle.
“But this isn’t for everyone. My loved one has dementia. They can’t follow directions or remember anything that you taught them.” Dementia is a very difficult diagnosis. Caregivers get fatigued quickly and it frequently seems simpler to just do things for the person they’re caring for or that the person couldn’t possibly engage in their previous occupations. It can seem like a helpless situation, but help is available. What that help looks like may differ depending on the severity of the dementia. With mild dementia, the focus is on task simplification, teaching adaptive memory strategies, environmental adaptations (labeling, organizing, etc.), use of adaptive/smart technology, establishing routines, re-engagement in leisure activities, and connection with community resources. With moderate to severe dementia OT may focus on caregiver training/reducing caregiver burden, establishing sensory diets to aid with behaviors, identifying activities that a person can successfully complete, home modifications to aid with wandering and other safety concerns, and again establishing strong daily routines. With a thorough assessment of the person’s needs and the correct supports in place, even individuals with advanced dementia can engage in meaningful occupation.
How do I qualify for occupational therapy?
Yet another area of confusion that exists regarding occupational therapy is where it can be performed and how it is paid for. With older adults, therapy is typically performed in the hospital, a rehab center, the home, or an outpatient clinic. In a rehab center, therapy may be provided under short term (Medicare A) or long term care (Medicare B). In the home, therapy may be provided through home health (Medicare A) or a mobile outpatient provider (Medicare B). Each setting and each insurance provider has its own set of expectations as to what will qualify a person for therapy services. A few rules that apply to all settings are that the person has a medical diagnosis to explain their impairment, that a medical necessity for the services exists, and that the skills of a therapist (versus a caregiver) are required. Frequently, a patient will be discharged from one of these settings, being told “you’ve plateaued with progress” or “insurance won’t pay for more”. It’s important to remember that just because this may be true in one setting, the patient may qualify for more services in another setting. Additionally, if the patient’s status has changed since being discharged, they will likely qualify for additional services. For many older adults, therapy should be considered regularly, especially at the first sign of decline.
In summary, occupational therapists help anyone, regardless of age or type of disability, maintain engagement in occupations that are meaningful to them. Each person’s meaningful occupations are different from the next. Well-meaning caregivers, in their attempts to support their loved ones, may inadvertently decrease their engagement in meaningful occupations. This has negative effects on physical, cognitive, and emotional well-being. To maximize health and well-being, older adults must engage in meaningful occupations regularly. The use of adaptive tools and environmental adaptations may play a big role in maintaining independence with occupational performance. Occupational therapists are experts in improving skills and adapting for impairments to promote engagement in these occupations.
ABOUT BETH LOCKE:
Beth Locke is an occupational therapist with 20 years of experience. As a graduate of Towson University in Baltimore, MD, she started her career working with adolescents with emotional disturbance, followed by working in schools and clinics with children with developmental disabilities. She became a traveling therapist, exploring both sides of the country, which is when she began working in home health and fell in love with working with seniors in their homes. Beth feels passionate about helping seniors stay independent and safe in their homes as long as possible and also living a life of meaning and enjoyment.
Beth is a wife and mother to two young children as well as two furry children. She owns Quality Independence Therapy, PLLC, providing occupational therapy to the homes of seniors in the Wilmington, NC region.