Occupational Participation at 85 Plus: A Review of the Literature
Haslam, Laura, New Zealand Journal of Occupational Therapy
In affluent societies worldwide, the populations of older people are increasing and older people are living longer than at any previous time in human history. Compared to the Organisation for Economic Co-operation and Development (OECD) countries, New Zealand has a young population, with 11.5 percent of people aged 65 plus. However, this percentage is projected to grow steadily to around 13 percent by 2010 and then much more rapidly to 22 percent by 2031 and 25 percent by 2051 (Ministry of Health, 2002). In effect, this means that over this period, the number of people 65 and over will double, while the number of people aged 85 plus is expected to increase six fold, reaching over a quarter of a million by 2051. At this time, people over 85 will make up 22 percent of all New Zealanders aged 65 years and over, compared with 9 percent in 1996 (Ministry of Statistics, 2000).
This paper focuses on the occupations of people over 85 for two reasons. Firstly, as shown above, this age group will have the highest growth rate. Secondly, it is important to differentiate within the population aged 65 and over. This population covers at least two generations--the oldest people alive today were born in the first decade of the 20th century, whereas those in their 60s were born in the 1940s, and could well be the children of the oldest. It is generally assumed that from around the age of 85, health and capacity for independent living will decline, and that disability and the need for care will increase. If this is the case, then the occupations of this age group will be different to those of people aged 65 to 85. Due to variable use of age bands in the literature, articles were included in this review which referred to people younger than 85 if they also dealt with people 85 plus.
Current policy as outlined in the New Zealand Positive Ageing Strategy (Minister for Senior Citizens, 2001) reinforces the Government's commitment to promote the value and participation of older people in communities. The Health of Older People Strategy (Ministry of Health, NZ, 2002) has identified the need for research into the development and evaluation of interventions to promote the health and well-being of older people as a priority area. Occupational science has demonstrated that engagement in occupation is based on a biological need and contributes to health and survival throughout the life span (Wilcock, 1995; Wood, 1998). In order to promote the health and well-being of people 85 plus through occupational participation, occupational therapists need to be aware of current theories of ageing which relate to occupation, know what the occupations of this age group are, and understand the factors which shape occupational participation.
Theories of occupation and ageing
Broad understandings of the occupations of older people are contained in theories of ageing. Cummings and Henry (1961) argued for a theory of disengagement in which the main task of old age was defined as letting go and withdrawal from work and strenuous recreation. Since then results from a ten year programme of interdisciplinary research which began in the USA in the late 1960s, led to a paradigm shift away from disengagement theory to "successful ageing" (Rowe & Kahn, 1998). Rowe and Kahn defined the task of successful ageing as discovering or rediscovering relationships and activities that provide closeness and meaningfulness for the older person. They identified three characteristics of successful ageing: low risk of disease and disease related disability; high mental and physical functioning; and active engagement with life.
Closely related to successful ageing is "productive ageing" which refers to "behaviours that are inner-directed, personally meaningful and satisfying to the older person, whether or not they can be categorised as paid or volunteer service and regardless of whether others benefit directly from them" (Kaye, Butler, & Webster, 2003, p. …