Florence Clark

Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial

Background Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people. Methods A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <

Cost‐Effectiveness of Preventive Occupational Therapy for Independent‐Living Older Adults

12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area. Results Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US

Confronting challenges in intervention research with ethnically diverse older adults: the USC Well Elderly II Trial

41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures. Conclusions A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people. Trial Registration clinicaltrials.gov identifier: NCT0078634.

Practical contributions of occupational science to the art of successful ageing: How to sculpt a meaningful life in older adulthood

OBJECTIVES: To evaluate the cost‐effectiveness of a 9‐month preventive occupational therapy (OT) program in the Well‐Elderly Study: a randomized trial in independent‐living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.

The Meaningful Activity Participation Assessment: A Measure of Engagement in Personally Valued Activities.

Background Community-dwelling older adults are at risk for declines in physical health, cognition, and psychosocial well-being. However, their enactment of active and health-promoting lifestyles can reduce such declines. Purpose The purpose of this article is to describe the USC Well Elderly II study, a randomized clinical trial designed to test the effectiveness of a healthy lifestyle program for elders, and document how various methodological challenges were addressed during the course of the trial. Methods In the study, 460 ethnically diverse elders recruited from a variety of sites in the urban Los Angeles area were enrolled in a randomized experiment involving a crossover design component. Within either the first or second 6-month phase of their study involvement, each elder received a lifestyle intervention designed to improve a variety of aging outcomes. At 4—5 time points over an 18—24 month interval, the research participants were assessed on measures of healthy activity, coping, social support, perceived control, stress-related biomarkers, perceived physical health, psychosocial well-being, and cognitive functioning to test the effectiveness of the intervention and document the process mechanisms responsible for its effects. Results The study protocol was successfully implemented, including the enrollment of study sites, the recruitment of 460 older adults, administration of the intervention, adherence to the plan for assessment, and establishment of a large computerized data base. Limitations: Methodological challenges were encountered in the areas of site recruitment, participant recruitment, testing, and intervention delivery. Conclusions The completion of clinical trials involving elders from numerous local sites requires careful oversight and anticipation of threats to the study design that stem from: (a) social situations that are particular to specific study sites; and (b) physical, functional, and social challenges pertaining to the elder population. Clinical Trials 2009; 6: 90—101. http://ctj.sagepub.com

Reflections on the human as an occupational being: Biological need, tempo and temporality

Abstract Given that the longevity revolution has already arrived and will continue to flourish in the upcoming decades, Western societies are confronted with the urgent challenge of promoting the goal of successful ageing for untold millions of citizens. With regard to this goal, current thinking points to the optimistic conclusion that potentially controllable lifestyle factors play a crucial role in enabling people to experience health and satisfying lives well into older adulthood. In this paper, the importance of occupation as providing a fundamental, personally relevant context for the enactment of sustainable lifestyle choices that foster successful ageing is described. This stress on the significance of occupation is supported by the successful outcome of an experimental test of a preventive occupational therapy intervention designed to promote health and psychosocial well‐being in community dwelling elders. Based on the theory and research that is discussed, a practically oriented synthetic overvi...

The Concepts of Habit and Routine: A Preliminary Theoretical Synthesis

The Meaningful Activity Participation Assessment (MAPA), a recently developed 28-item tool designed to measure the meaningfulness of activity, was tested in a sample of 154 older adults. The MAPA evidenced a sufficient level of internal consistency and test-retest reliability and correlated as theoretically predicted with the Life Satisfaction Index-Z, the Satisfaction with Life Scale, the Engagement in Meaningful Activities Survey, the Purpose in Life Test, the Center for Epidemiologic Studies Depression Inventory and the Rand SF-36v2 Health Survey subscales. Zero-order correlations consistently demonstrated meaningful relationships between the MAPA and scales of psychosocial well-being and health-related quality of life. Results from multiple regression analyses further substantiated these findings, as greater meaningful activity participation was associated with better psychological well-being and health-related quality of life. The MAPA appears to be a reliable and valid measure of meaningful activity, incorporating both subjective and objective indicators of activity engagement.

Predictors of Computer Use in Community-Dwelling, Ethnically Diverse Older Adults

Abstract Global health through occupation is contingent upon our understanding of the human as an occupational being. In this paper, I reflect upon two aspects of the human as an occupational being: 1) the biological need for occupation, and 2) tempo and temporality as a way of beginning to generate a blueprint for global health. Wilcocks theory on the human need for occupation proposes that people living in post industrial nations are diverted from engagement in occupations that function to meet biological needs. The theory largely addresses the issue of what kinds of occupations are likely to be health promoting, given a set of assumptions about the history of humans as occupational beings. On the surface it would appear that occupations that resemble those of prehistoric men and women would be optimal for promoting health and well‐being, but these kinds of occupations are largely unsuitable for incorporation into contemporary lifestyles. Yet, there are elements of prehistoric occupations that can be r...

Autonomic and Behavioral Responses of Children With Autism to Auditory Stimuli

Although a number of diverse research areas underscore the importance of habit and routine, there has been little theoretical coherence to this work considered as a whole. Varying definitions of habit and routine, as well as the extremely broad range of phenomena to which they apply, have hampered the ability to develop any overarching synthesis. In connection with a recent conference sponsored by the American Occupational Therapy Foundation, this article offers a preliminary theoretical synthesis of habit and routine with respect to definitional issues, relation to quality of life, and potential benefits to consumers with disabilities.

Psychometric Properties of Reverse-Scored Items on the CES-D in a Sample of Ethnically Diverse Older Adults.

Objective: In this study, we analyzed self-reported computer use, demographic variables, psychosocial variables, and health and well-being variables collected from 460 ethnically diverse, community-dwelling elders to investigate the relationship computer use has with demographics, well-being, and other key psychosocial variables in older adults. Background: Although younger elders with more education, those who employ active coping strategies, or those who are low in anxiety levels are thought to use computers at higher rates than do others, previous research has produced mixed or inconclusive results regarding ethnic, gender, and psychological factors or has concentrated on computer-specific psychological factors only (e.g., computer anxiety). Few such studies have employed large sample sizes or have focused on ethnically diverse populations of community-dwelling elders. Method: With a large number of overlapping predictors, zero-order analysis alone is poorly equipped to identify variables that are independently associated with computer use. Accordingly, both zero-order and stepwise logistic regression analyses were conducted to determine the correlates of two types of computer use: e-mail and general computer use. Results: Results indicate that younger age, greater level of education, non-Hispanic ethnicity, behaviorally active coping style, general physical health, and role-related emotional health each independently predicted computer usage. Conclusion: Study findings highlight differences in computer usage, especially in regard to Hispanic ethnicity and specific health and well-being factors. Application: Potential applications of this research include future intervention studies, individualized computer-based activity programming, or customizable software and user interface design for older adults responsive to a variety of personal characteristics and capabilities.