Occupational Therapy


Article Author:
Sclinda Janssen


Article Editor:
Julie Grabanski


Editors In Chief:
Sherri Murrell
Joshua Ambrosio


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Frank Smeeks
Kristina Soman-Faulkner
Radia Jamil
Patrick Le
Sobhan Daneshfar
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
6/18/2019 2:52:31 AM

Definition/Introduction

Occupational therapy is a service provided in long-term care (LTC) facilities to promote quality of life through participation in meaningful occupations.  Occupational therapy practitioners are skilled in physical and psychological evaluation of residents living in LTC.  The psychological wellbeing of residents in LTC facilities is a major concern; 49% of the residents have a diagnosis of depression.[1]This aspect of occupational therapy rehabilitation service in LTC is often overlooked; therefore, it is essential for occupational therapy practitioners to include psychological assessments in their overall evaluation of residents to create interventions that facilitate participation in meaningful occupations.

Issues of Concern

Participation and Psychological Well-being

Lack of participation in meaningful occupations, called occupational deprivation [2], leads to depression among LTC residents, which compromises overall psychological wellbeing.   The risk for occupational deprivation increases in LTC because many residents experience age- and illness-related decline in capabilities. Helping residents to compensate for age-related changes promotes occupational justice, which is a term used to describe humans' right to engage in valued occupations[3].  This engagement promotes health, well-being, and quality of life.  Leisure participation, a specific occupational engagement, enhances motivation and physical and psychological abilities [4].  It is, therefore, important to include leisure in the overall assessment of participation in meaningful activities.

Cognition Ability and Psychological Well-being

Researchers associated poor quality of life and psychological well-being with impaired cognitive abilities ([5]).  Other researchers found a clear association between cognitive decline and lower well-being on almost all measures (five out of six)[6].  It is, therefore, important to assess cognition as a component of psychological well-being.

Emotional Health and Psychological Well-being

With depression rates escalating after admission to LTC facilities, it becomes even more important to assess emotional well-being of residents.  Emotional well-being affects motivation to engage in once meaningful activities; depression may appear as a lack of interest, loneliness, and a decline in cognitive capabilities[7], which further compromises overall well-being. 

Psychological Assessment

Psychological well-being encompasses participation in meaningful occupations, cognitive ability, and emotional health. Occupational therapy practitioners are proficient in performance of evaluations for psychological well-being in residents living in LTC.  Comprehensive assessments for psychological well-being should target participation in meaningful activities (including leisure), cognitive abilities, and emotional well-being.  Because there are limited guides for psychological assessment available for occupational therapy practitioners in LTC, I list evidence-based assessment resources below.  Due to productivity demands in LTC settings, practitioners can complete most of these selected assessments within a reasonable amount of time.

Assessments of Occupational Participation

  • Activity Card Sort [8]: Assessment of participation in meaningful occupations; 30-45 min
  • Canadian Occupational Performance Measure (Law, Baptiste, Carswell, McColl, Polatajko, Pollock, & Opzoomer, 1990)[9]: Identify, prioritize occupations and assess occupational performance; 30-45 minutes
  • Barthel Index[10]:  Standardized assessment of ADL performance on a numerical scale; 15 minutes
  • Functional Independence Measure [11]:  Frequently used observation tool to assess performance level of ability; 15 minutes

Assessments of Cognitive Health

  • Montreal Cognitive Assessment [MoCA][12]: Screening for mild cognitive dysfunction; 10 minutes
  • Short Blessed Test (Katzman, Brown, Fuld, Peck, Schechter, & Herbert Schimmel, 1983)[13]: Screening for mild cognitive dysfunction; 10-20 minutes
  • Global Deterioration Scale [14]: Screening that summarizes cognitive function to caregivers; Time Varies
  • Louis University Mental Status (SLUMS) exam[15]: Screening for detecting mild cognitive impairment and dementia; 15 minutes
  • Mini Kingston Standardized Cognitive Assessment Revised [16]: Screening for cognitive dysfunction.  Bridge between cognitive screens and evaluations; 30 minutes
  • Ross Information Processing Assessment-Geriatric:2 [RIPA-G:2][17]: Assessment of memory, spatial orientation, recall of general information, temporal orientation, organization, problem-solving, and abstract reasoning; 45-60 minutes

Assessments of Emotional Well-being

  • Geriatric Depression Scale[18][19]: Screening to rate level of depression; 5-7 minutes
  • Beck Depression Inventory-II [20]: Simple assessment to quantify depressive symptoms; 15 minutes
  • Cornell Scale of Depression in Dementia [21]: 19-item interview; 15 minutes

Clinical Significance

Psychological assessments for residents living in LTC should examine residents’ participation in meaningful activities, cognitive abilities, and emotional well-being because of the interconnectedness between each of them as they impact health, well-being, and quality of life.  Occupational therapy practitioners should incorporate these assessments into the traditional rehabilitation evaluations they already conduct. 

Occupational therapy practitioners should use psychological assessment results to further promote participation in meaningful activities, especially leisure-type because of the strong correlations with health, well-being, and quality of life[4].  Use of leisure participation as an intervention, or therapeutic activity, which is a Medicare current procedural terminology billing code, is invaluable to the therapy process.  Leisure-type interventions promote motivation and enjoyment in the therapeutic process and are also highly gradable and adaptable, such as doing the activity in standing, increasing speed, raising the work surface, adding wrist weights to the resident.  Leisure-type interventions are also more therapeutic than rote exercise because they offer the ability to recruit multiple body systems and skills, such as proprioception, vestibular, vision, cognition, emotion, muscle tone, range-of-motion, endurance, motor planning, and gross and fine motor coordination.

Practitioners can also integrate leisure activities into functional maintenance programs (FMP) with restorative aide staff or activity personnel who continue helping the residents to do the leisure-type interventions/therapeutic activities after practitioners discontinue occupational therapy services.  Traditionally, the FMPs have been rote exercised-based; however, leisure-based FMPs will offer greater outcomes because these types of activities are often more meaningful and engaging to the residents, which prompts residents to exert more effort in the therapeutic process.

An occupational therapy practitioner can also share psychological assessment results with the LTC team to guide care planning.  Medical doctors can then use results for the Annual Wellness Visit (a Medicare benefit under the Patient Protection and Affordable Care Act) to address medical areas of concern and make referrals to other healthcare team members to further promote health, well-being, and quality of life.

Psychological assessments should include an analysis of participation in meaningful occupations, cognitive health, and emotional well-being.  Results are useful to further enhance participation, health, well-being, and quality of life among residents in LTC facilities.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Occupational Therapy - Questions

Take a quiz of the questions on this article.

Take Quiz
When consulting for a community center an occupational therapist is asked to assist in planning a youth club. The purpose of the club is to find occupations for youths at risk for violence and to build and to protect the community. Select the best activity to achieve this goal.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient in a partial hospitalization program has difficulty making decisions. The OT has decided on a baking activity but the patient is noncommittal. Select the best response.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient was asked to try to achieve the goal of initiating 2 requests to other members of the group to share material over 1 week but failed. What would be the next step?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient has progressive weakness and the long term goal is that the family will carry out a feeding program. Select the best short term goal.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A medical school asks an occupational therapist (OT) to give a lecture to third-year medical students. The therapist is concerned due to a lack of resources. Which of the following would be best?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is evaluated by an occupational therapist before discharge. The patient had surgical removal of a malignancy and is still weak. She is considered medically stable according to the discharging provider's documentation. She requires assistance with ambulation and is scheduled to receive chemotherapy given by a home health nurse. She has family members at home who can assist her with her activities of daily living. What is the best recommendation for this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An OT is working with a depressed patient to formulate long term goals but the patient is general and vague about them. Which of the following is most important to include in the treatment goals?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An OT group for patients with major depressive disorder plans on using a sensorimotor intervention. Select the best starting activity.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
When developing relevant objectives and goals for OT for a child, which of the following should be the focus?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A nursing home OT is asked by the director of the nursing home to assist in writing a job description for a second OT. What should this contain?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with a peripheral nerve injury working on an assembly line is having sensory problems. During therapy, which issue would be addressed last?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the major purpose for occupational therapy for the elderly?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following would not be an appropriate intervention goal?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the true statement about the World Federation of Occupational Therapists.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following best describes occupational therapy interventions that promote health and wellness in a client with dementia living in a long-term care facility?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An occupational therapist is doing a full evaluation of a new client who has recently been admitted to a long-term care facility. Which of the following screening tools should be included in the evaluation to assess emotional well-being?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In an occupational therapy client, which of the following conditions may develop because of how depression affects motivation to engage in activity?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An occupational therapy client with mild dementia is suddenly striking out at other residents. Which of the following is the best approach to decrease the patient's aggressive behavior?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Occupational Therapy - References

References

Harris-Kojetin L,Sengupta M,Park-Lee E,Valverde R,Caffrey C,Rome V,Lendon J, Long-Term Care Providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014. Vital & health statistics. Series 3, Analytical and epidemiological studies. 2016 Feb     [PubMed]
Townsend E,Wilcock AA, Occupational justice and client-centred practice: a dialogue in progress. Canadian journal of occupational therapy. Revue canadienne d'ergotherapie. 2004 Apr     [PubMed]
Nilsson I,Townsend E, Occupational justice--bridging theory and practice. Previously published in Scandinavian Journal of Occupational Therapy 2010; 17: 57-63. Scandinavian journal of occupational therapy. 2014     [PubMed]
Jung JY,Park SY,Kim JK, The effects of a client-centered leisure activity program on satisfaction, self-esteem, and depression in elderly residents of a long-term care facility. Journal of physical therapy science. 2018 Jan     [PubMed]
Gates N,Valenzuela M,Sachdev PS,Singh MA, Psychological well-being in individuals with mild cognitive impairment. Clinical interventions in aging. 2014     [PubMed]
Wilson RS,Boyle PA,Segawa E,Yu L,Begeny CT,Anagnos SE,Bennett DA, The influence of cognitive decline on well-being in old age. Psychology and aging. 2013 Jun     [PubMed]
Melrose S, Late life depression: nursing actions that can help. Perspectives in psychiatric care. 2018 Nov 30     [PubMed]
Tucker FM,Edwards DF,Mathews LK,Baum CM,Connor LT, Modifying health outcome measures for people with aphasia. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2012 Jan-Feb     [PubMed]
Colquhoun HL,Letts LJ,Law MC,MacDermid JC,Missiuna CA, Administration of the Canadian Occupational Performance Measure: effect on practice. Canadian journal of occupational therapy. Revue canadienne d'ergotherapie. 2012 Apr     [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Elder Adult Care. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Elder Adult Care, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Elder Adult Care, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Elder Adult Care. When it is time for the Nurse-Elder Adult Care board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Elder Adult Care.