Supporting Aging in Place

Occupational therapy practitioners have unique training and knowledge to meet the needs of the aging population.

The United States Census Bureau reports that Baby Boomers (which generally refers to people born between years 1946-1964) should reach at least 65 years of age by the year 2030. Not only is the number of older adults in the United States increasing at a rapid rate, but they are also living longer.

Recommended course: Supporting Aging in Place: An Occupational Therapist’s Toolkit

Due to advances in medicine, chronic disease management etc., Americans reaching the age of 65 are currently expected to live an additional 19.3 years on average, according to the Administration on Aging.

Another recent study by the American Association of Retired Persons (AARP) identified that 77% of adults 50 years and older want to remain living in their home long-term as they age. Additional research demonstrates that quality of life is higher among older adults who live at home and are active in their community, compared to older adults who are institutionalized (Castillo et al. 2020). This provides further support to the role of occupational therapy within this practice area and population.

What is aging in place?

Staying in your own home as a community-dwelling older adult compared to moving or relocating to an institutional setting (such as assistive living facilities, long-term care centers etc.) is described as aging in place. The U.S. Centers for Disease Control and Prevention defines aging in place as “the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level.”

Due to their unique training and skill sets, aging in place offers a prominent niche for the occupational therapy profession, according to The American Occupational Therapy Association (AOTA).

Coinciding with another term, productive aging, emphasizes positive attributes of getting older via the promotion of activities and opportunities that enhance life satisfaction, quality of life and self-esteem as one ages.

The role of occupational therapists

Occupational therapy practitioners have unique training and knowledge to meet the needs of this population. They can consider ‘fit’ and interaction between the person, environment and occupation to encourage safe, meaningful performance in desired occupations and roles. These include activities of daily living, home management, work/volunteerism, leisure, etc.

Aligned with the Occupational Therapy Practice Framework: Domain and Process, 4th Edition, occupational therapy practitioners have content knowledge about various body structures and functions. These include those structures known to naturally decline due to age, such as cognition, sensory functions (such as vision and hearing) and musculoskeletal functioning. Each of these can impact mobility, balance, and strength.

Supporting aging in place

To support aging in place, occupational therapy practitioners can conduct home safety evaluations to inform home safety recommendations. Some assessments that can be administered include but are not limited to:

• Cougar Home Safety Assessment (CHSA) 5.0
• Home Falls and Accident Screening Tool (HOME FAST)
• Home Environment Assessment Protocol (HEAP)
• Home Safety Self-Assessment Tool
• In-Home Occupational Performance Evaluation (I-HOPE)
• Safety Assessment of Function and the Environment for Rehabilitation – Health Outcome Measurement and Evaluation (SAFER HOME) version 3

In 2001, the AOTA initiated a partnership with Rebuilding Together, a national home repair nonprofit, to promote the distinct value of occupational therapy within the realm of home modifications. As a result, the Rebuilding Together Safe at Home Checklist was originated which is another helpful, easy-to-use, screening tool that can be used to identify fall hazards, home safety, and accessibility issues.

Interventions and home modifications

Based upon their evaluations, occupational therapy practitioners can develop and implement interventions to help older adults. These may include recommending home modifications, training on adaptive equipment, and education on fall prevention to support aging in place.

• Home modifications focus on increasing accessibility within the home (such as installing ramps or hand-railings) or minimizing barriers that may be unsafe such as fixing electrical hazards or improving lighting.
• Adaptive equipment can promote independence and increase safety in the home. Occupational therapists can provide training on how to use a reacher or other devices. These devices compensate for poor balance or limited range of motion.
• Fall prevention education is another essential component to support aging in place. Did you know that the majority of falls in older adults happen within the home? In conjunction with home modifications, occupational therapy practitioners can design and recommend therapeutic exercise programs. These programs promote physical activity, encourage proper footwear use, and train in the use of assistive devices. The goal is to encourage safe, functional mobility within the home.

The importance of occupational therapy

Due to the holistic focus of the profession, occupational therapy practitioners can also help develop coping strategies to combat the fear of falling. Per a descriptive longitudinal study, over 40% of community-dwelling older adults report a fear of falling (Lavedan et al., 2018). This is a known psychosocial component that can serve as a predictor of falls. It may also cause social isolation and be a hindrance to those that desire to age in place.

To further develop specific content knowledge, occupational therapy practitioners can seek out evidence-based resources (such as this scoping review by Carnemolla and Bridge, 2020).

They might also pursue advanced training such as Specialty Certification in Environmental Medications (SCEM), Certified Aging in Place Specialists (CAPS), Certified Living in Place Specialist (CLIPP) or Executive Certification in Home Modifications.