In the next 25 years, longer life spans and aging baby boomers will effectively double the population of Americans aged 65 years or older to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population (“The State of Aging and Health in America 2013,” Centers for Disease Control and Prevention). With people living longer and longer, the importance of occupational therapy (OT) in relation to healthy aging is coming to the forefront of primary care.
Lisa Carson, OTD, OTR/L, is an occupational therapist in the Program’s Community Practice. She also works with Stanley Birge, MD, in the geriatric clinic at the Center for Advanced Medicine, which is located on the Washington University Medical Center campus. There she is part of a health-care team that conducts comprehensive assessments of clients aged 65 or older that address both the medical and occupational needs of the individual.
“When clients come in for their initial appointment, they are asked to bring a family member or friend who has a role in their daily life. Our nurse will take the client to another room for cognitive testing. Meanwhile, Dr. Birge, the medical residents and I talk to the family member or friend to hear their concerns and what changes they have noticed in the client. You don’t always get an accurate report from the clients with cognitive impairments, so the input from family and friends can be vital to seeing the whole picture,” Carson says. “When the client returns, we ask them about their daily activities and goals. When the appointment is over, the team meets to come up with a plan of care. The patient and their family or friend return the following week to receive a plan incorporating our recommendations. If a follow-up OT session is needed, we schedule it.”
Carson’s interest in older adults started when she was a third-year doctoral student at the Program as she completed her practice model on healthy aging. “At that time, several people in my life were approaching retirement, and they would tell me how stressed and anxious they were about it because they didn’t know what their daily routine would look like. People think about their financial planning prior to retirement, but they don’t think about what their occupations are going to be since their primary occupation—working—is over. My practice model focused on the various aspects of a healthy life and what the necessary components are to think about as we age.”
Healthy behaviors can include staying socially, mentally and physically active; a healthy diet; medication management; home safety and establishing a daily routine. Some of these behaviors can be hard to maintain when a client has lost the ability to drive or has difficulty forming new relationships.
“For clients who can’t drive, they have to rely a lot on family members for transportation and can easily become socially isolated. Another challenge they face is just simply having people to do things with because their friends have passed away. With their social activity limited, they don’t always have the opportunity to make new friends at this point in life,” Carson explains. “I can help clients find resources in their community so that they can stay socially, mentally and physically active.”
Many of Carson’s clients are concerned about their cognition and memory. Justine Crawford, 73, came to Dr. Birge’s clinic with these concerns. She was also interested in learning about preventative care for herself and her husband as they age in place.
“Children see a pediatrician, and older adults should see a geriatrician to know where you are as far as your age, how you are doing and everything. I’ve never encountered anything like this team before,” Crawford says. “I really enjoyed the challenge of the cognitive assessments. It was a neat experience.”
Looking at the whole picture of a person’s health is what makes a geriatrician different from the various specialists clients often see to address specific problems. Having multiple providers can lead to overmedication in older adults, which can increase the risk of adverse reactions and side effects. A home visit from an occupational therapist can help to assess how and how often clients are taking their medications.
“One of my clients had a physician who was considering raising her blood pressure medication because it wasn't being effective. After a couple of home visits, we discovered that she was not taking her medicine correctly,” Carson says. “That's the kind of situation a physician doesn't have the chance to see because they spend a limited time with the person in a clinical setting. There is a lot of knowledge that can be gained from going into someone’s home, and that information can alter the plan of care.”
That environment lens is why Birge values having Carson on his team.
“OT is not just about looking at the home environment and the function of an individual. It's an intervention because Lisa can implement strategies to improve their function, and a lot of times that means that we have to modify the environment,” Birge says. “We can't do that here in the clinic, so there's just no substitute for being able to go into the home and see what the conditions are, what that environment really looks like and what are the barriers to that person's safety.”
Expanding people’s awareness of what OT can do for aging populations is one of the goals Carson is hoping the clinic and her practice will be able to accomplish moving forward.
“OT for older adults isn’t just about falls or home safety. It can also be about re-forming their lifestyle and establishing healthy habits so that they can live more independent and productive lives no matter what their health conditions, disabilities or risk factors are,” Carson says.