Occupational Therapy Led Health Promotion for Older People: Feasibility of the Lifestyle Matters Programme

Article excerpt

The aim of this feasibility study was to see if an occupation-based health-promoting intervention for community-living older people could be delivered successfully and also to provide some information to guide a future trial of clinical effectiveness. The participants' ages ranged from 60 to 92 years. Twenty-eight participants commenced the 8-month programme and 26 completed it; they have continued to meet independently following facilitator withdrawal.

The participants were interviewed qualitatively before and after the 8-month programme. Additionally, pre-programme and post-programme measurements of cognition, depression, functional dependency and quality of life were conducted with each participant before and after the intervention.

The post-intervention interviews illustrated the individualised benefits experienced by the participants, with greater self-efficacy being a significant theme. A comparison of the pre-intervention and post-intervention scores on the quantitative measures showed an upward trend on all dimensions of quality of life. The measurement of cognition, depression and dependency proved useful for screening purposes and for identifying individuals at risk, but not as an outcome measure.

The delivery of the programme was feasible and its benefit to participants was observed, but there is a need for further research to test the intervention rigorously and to explore applicability in a range of settings.

Key words: Health promotion, wellbeing, occupation, self-efficacy, outcomes.

Introduction

This paper reports a feasibility study of health-promoting interventions for community-living older people, conducted during 2004/5 in one city in the North of England. The Lifestyle Matters project was inspired by the United States (US) Well Elderly study (Mandel et al 1999), which involved the delivery of a health-promoting intervention called Lifestyle Redesign[R]. Based on an occupational approach to healthy ageing, Lifestyle Redesign[R] helps older people to improve their quality of life and to avoid the negative spiral of decline (Mandel et al 1999). Participants meet in a weekly group over several months and have monthly individual sessions with one of the facilitators. The emphasis throughout is on the identification of participants' own goals and their empowerment through sharing the strengths and skills possessed by group members.

Lifestyle Redesign[R] was found to be effective in enhancing the physical and mental health, occupational functioning and life satisfaction of community-living older adults in Los Angeles (Clark et al 1997, 2001, Hay et al 2002). Given the prevailing policy focus upon the provision of health-promoting interventions for older people (World Health Organisation 2002, Godfrey et al 2004, Social Exclusion Unit 2005, Age Concern 2006, Windle et al 2007, National Institute for Health and Clinical Excellence [NICE], in press), it was considered to be an opportune time to test a similar approach in the United Kingdom (UK). It was realised that an intervention developed for use in a US context would not necessarily transfer to a UK population of older people, so the feasibility study sought to establish:

* Whether older people living in the UK would wish to participate in a programme of this nature and, if so, how they might be recruited

* What the preferred structure and content of the intervention programme would be

* Whether, given the national shortage of positions for occupational therapists in the UK, other facilitators could deliver the intervention with occupational therapy supervision

* How health outcomes and other potential outcomes can be most appropriately measured in this population.

Literature review

Occupation, defined as activity that is meaningful for individuals and for groups of people, is essential for the maintenance of quality of life at all stages of the life course (Clark et al 1991, Law et al 1998, Yerxa 1998). …