Australian Occupational Therapy Journal (2014) 61, 204–207
doi: 10.1111/1440-1630.12125
Viewpoint
Active ageing and occupational therapy align Lindy M. Clemson and Kate E. Laver Ageing, Work & Health Research Unit, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
KEY WORDS aged, aging. As Australia’s population ages, there is an increasing focus within health and social care policy on ‘active ageing’; that is ‘the process of optimising opportunities for physical, social and mental wellbeing throughout the life course, to extend healthy life expectancy, productivity and quality of life in older age’ (World Health Organization, 2002, p. 12). The three pillars of active ageing are health, security and participation although it appears participation is most important to older people. A survey conducted with older Australians found that while they acknowledged the importance of health and security, they overwhelmingly defined active ageing in terms of participation; through social interactions, involvement and personal development (Buys & Miller, 2006). Personal development reflected the importance of having a ‘sense of achievement and a purpose in life’ (Buys & Miller, p. 8). We are ideally placed to be leaders in the field of active ageing and health and aged care reform. These concepts of active ageing are not new to us and the principles, philosophies and terminology associated with active ageing fit perfectly with occupational therapy. The foundation of occupational therapy is based on the understanding that human’s need to be engaged in activity. Now is an exciting time; there are many opportunities and ways that we can develop as a profession. It is a time where we can demonstrate how our unique approach to health and social care can improve outcomes for older people. Yet there are also challenges and aspects of our practice that we must re-consider. This viewpoint article: (i) outlines how far we have come by providing an overview of research trends in
Lindy M. Clemson PhD, MAppSc (Research), BAppSc (OT), DipOT; Professor, Research Fellow. Kate E. Laver PhD, MClinRehab, BAppSc (OT); Research Officer. Correspondence: Lindy M. Clemson, Faculty of Health Sciences, The University of Sydney, East Street, Lidcombe, NSW 1825, Australia. Email: [email protected] Accepted for publication 18 February 2014. © 2014 Occupational Therapy Australia
occupational therapy in this field over the last 20 years; (ii) provides examples of areas where there is strong research supporting interventions that must be implemented in practice; and (iii) identifies some of the actions required in order for our profession to thrive in the field of ageing.
Occupational therapy research in ageing 1993–2013 Although occupational therapists often lament the lack of research literature to support common occupational therapy interventions, there has been a steady increase in occupational therapy literature in the field of ageing over the past 20 years. We searched the CINAHL database for literature published between 1993 and July 2013 using the terms ‘occupational therap*’ AND (aged or ageing or aging or elderly or elder or old or older or senior or geriatr*) in the title, abstract or keywords. We identified a total of 589 relevant papers; the number of papers published per year is displayed in Figure 1. Trends over time are portrayed in Table 1 in which the main areas of research published in the 1993–1997 period and the 2008–2012 period are presented. It can be seen that our focus on occupational engagement has remained constant over time. Falls prevention and the assessment and retraining of activities of daily living have also had a strong presence in the research literature. There are several areas where the amount of research published has increased over time. Drivingrelated publications increased from one in 1993–1997 to 20 in the 2008–2012 period. Dementia is increasingly recognised as an important area for research; both by occupational therapists, with publications increasing from 1 to 13, and policy makers with dementia recently identified as a national health priority (Australian Institute of Health and Welfare, 2012). There has been a relatively recent increase in research into the use of technologies. Despite the number of publications in this area increasing, it is surprising to find so few publications given the capacity of occupational therapists to be involved in technologies such as smart home design and telehealth and our expertise in prescribing and training in the use of assistive devices. Our search revealed that sadly there appears to be a lack of research into mental health in older people; an impor-
205
VIEWPOINT
FIGURE 1: Publications in ageing and occupational therapy by year. TABLE 1: Comparison of the major areas of research in occupational therapy and ageing over time 1993–1997
2008–2012 Number of publications
Areas of research
Number of publications
Occupational engagement/time use Home modification/aids Service delivery/evaluation Cognition Activities of daily living assessment and retraining Exercise and rehabilitation Professional practice
8 8 8 6 6
Occupational engagement/time use Driving Falls Service delivery/evaluation Acute care/discharge planning
27 20 16 15 15
5 4
13 11
Student education Falls Policy
4 4 3
Dementia Activities of daily living assessment and retraining Professional practice Home modification/aids Technology
Areas of research
tant area given the high incidence of depression and social isolation experienced by older people (McDougall et al., 2007). In addition, although one of our core skills is the prescription of home modifications and assistive aids, there were relatively few research papers investigating this process or measuring outcomes for the client.
Translation of evidence based occupational therapy interventions is lacking and should be prioritised Among the body of published clinical trials there is now a strong evidence base for specific occupational therapy interventions with older people. For example, in the area of dementia care there is evidence based on
10 8 8
a high quality systematic review and meta-analyses for non-pharmacological interventions for community dwelling people with dementia and their caregivers (Brodaty & Arasaratnam, 2012). Occupational therapy has a prominent and strong presence in effective and promising programmes. Systematic interventions conducted by occupational therapists have been shown to reduce the frequency of behavioural and psychological problems experienced by the person with dementia. In addition, non-pharmacological interventions can be more effective than pharmacological treatment and do not have the associated side effects (Gitlin, 2012). Structured occupational therapy interventions have also been shown to improve outcomes for caregivers by reducing the upset associated with behavioural symptoms (Bro© 2014 Occupational Therapy Australia
206 daty & Arasaratnam). There are now several different evidence based interventions conducted by occupational therapists for dementia; while there are differences in the characteristics of the interventions, the interventions all involve core occupational therapy skills such as goal setting, caregiver education, modification in the environment and engagement in meaningful activity, for example, the COPE intervention (Gitlin, Winter, Dennis, Hodgson & Hauck, 2010). Although there is an increasing number of clinical trials, there has been limited uptake of evidence-based interventions in clinical practice and there are few examples of translational research; research that determines whether evidence-based treatments can be successfully implemented and achieve the same positive results outside the context of a clinical trial. Translation is possible; a study translating one of the interventions in the United States found that after extensive training therapists did not have difficulty integrating the intervention (Gitlin, Jacobs & Earland, 2010). However, the training was found to be time-consuming and there were difficulties in implementing the number of intervention sessions involved in the programme within the organisational structure necessitating adaptations to the training, usual practice and the original programme (Gitlin, Jacobs, et al., 2010). This project demonstrates that interventions shown to be successful in research trials can be translated into clinical settings. Partnership between occupational therapists, the organisation and researchers, is integral in helping translate this into practice. In the area of falls prevention, we have had evidence now for over a decade that home safety assessments by occupational therapists are effective in reducing both the rate of falls and risk of falling, particularly among at-risk people (Gillespie et al., 2012). We know that it works, we know for whom it works and we know that it is cost saving (Gillespie et al.). Despite this evidence emergent over the past decade, falls prevention services are not always accessible (particularly in rural areas) and interventions are not always evidence based. Why hasn’t widespread adoption of evidence based treatment occurred? A qualitative study to explore the issues underlying the training and implementation of an evidence-based structured home safety falls prevention intervention was conducted via interviews with occupational therapists and stakeholders (Clemson, Donaldson, Hill & Day, in press). Occupational therapists embraced the intervention describing it as ‘bread and butter’ and ‘fundamental occupational therapy’. They reported higher professional development and satisfaction following training. But there were challenges in implementation; it involved working with clients in changing habits and required a high ‘level of thoroughness’. The organisational structure with a focus on assessment did not easily support the implementation and while the therapists believed their intervention was effective they © 2014 Occupational Therapy Australia
L. M. CLEMSON AND K. E. LAVER
were not able to observe the direct outcomes as direct feedback mechanisms were missing. This project demonstrated that implementation of new evidence-based interventions is not only a matter of providing education for the individual therapists, but considering the implementation context from a number of perspectives: the organisation, the individual therapists’ level of skill and therapists’ trust in the evidence (Clemson et al., in press). These examples demonstrate that there is evidence that specific structured occupational therapy interventions can improve outcomes for older people in key areas yet translation is lacking. We must upskill in ways to accelerate translating evidence and find ways to ensure these programmes become part of our practice to achieve the best results for our clients. And as new research is published we need to ensure that we are in a position to take it on board.
Steps we need to take to re-define our role Multiple surveys of occupational therapists have revealed much more time is spent on assessment and little time is dedicated to providing intervention (Bennett, Shand & Liddle, 2011; Fricke & Unsworth, 1998; Kinn & Galloway, 2000; Van’t Leven et al., 2011). Bennett et al. surveyed Australian occupational therapists (n = 134) in regard to their practice with people with dementia. Nearly 40% of respondents spent half their time assessing clients and 12% of respondents spent more than 75% of their time assessing. In contrast, 11% of respondents spent more than half of their time providing intervention. These findings were echoed in another survey where occupational therapists working with people with Alzheimers Disease in Canada reported that only a small portion of time was dedicated to intervention. Furthermore, clinical experience rather than evidence determined decisions about the type of intervention provided (Van’t Leven et al.). Similar findings have been reported in the areas of falls prevention and assessment and retraining of activities of daily living (Fricke & Unsworth; Kinn & Galloway). To play a key role in the field of ageing we need to ensure that we are regarded as interventionists and not just assessors. This may require lobbying to change organisational expectations of our role and investigating ways to better manage our practice. The aforementioned studies reported that occupational therapists wanted more training and lacked confidence in providing evidence-based interventions; these factors need to be addressed. We must ensure that therapists receive adequate training in providing interventions that are evidence based. We must ensure that skills learnt in training are carried over to clinical practice. We must use methods to ensure successful translation. Some of the success associated with successful implementation of interventions is the use of fidelity tools. Implementation fidelity is critical to successful
VIEWPOINT
translation of evidence-based interventions into the real world context. Implementation fidelity (or integrity) is the degree to which the core components of an intervention are delivered as intended by the developers (Carroll et al., 2007). These can include tools for peer review and self reflection. As a profession, we do not have a culture of fidelity checks; however, we must embrace these practices if we are to develop our skills in intervention. In conclusion, there are currently many opportunities for occupational therapists in ageing. The increase in the volume of research literature in the field is positive and this trend needs to continue. There are gaps in both areas of research (such as mental health of older people and technology use) and the type of research (such as translational research and studies of cost-effectiveness). Research findings should be disseminated widely, both within and outside of the profession. We must re-affirm our roles so that we are regarded as leaders in the area of active ageing. Now is the time to re-invent ourselves and stand up for our roles and the emergent strengths of our evidence base. Occupational therapy offers so much yet we must demonstrate our effectiveness in the field of ageing. We have come a long way since the inception of our profession in 1919 and even in the last 20 years but there is still work to be done.
References Australian Institute of Health and Welfare. (2012). Dementia. Retrieved 14 October, 2013, from http://www.aihw. gov.au/dementia/ Bennett, S., Shand, S. & Liddle, J. (2011). Occupational therapy practice in Australia with people with dementia: A profile in need of change. Australian Occupational Therapy Journal, 58, 155–163. Brodaty, H. & Arasaratnam, C. (2012). Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169, 946–953. Buys, L. & Miller, E. (2006). The meaning of ‘active ageing’ to older Australians: Exploring the relative importance of health, participation and security. Paper presented at the Australian Association of Gerontology, Sydney. Retrieved 6 March, 2014, from http://eprints.qut.edu.au/6671/1/ 6671.pdf
207 Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J. & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2007, 40. Clemson, L., Donaldson, A., Hill, K. & Day, L. (in press). Implementing person-environment approaches to prevent falls: A qualitative inquiry in applying the Westmead approach to OT home visits. Australian Occupational Therapy Journal. Fricke, J. & Unsworth, C. (1998). Occupational therapists’ conceptions of instrumental activities of daily living in relation to evaluation and intervention with older clients. Scandinavian Journal of Occupational Therapy, 5, 180–191. Gillespie, L., Robertson, M., Gillespie, W., Sherrington, C., Gates, S., Clemson, L. et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9, CD007146. Gitlin, L. N. (2012). Good news for dementia care: Caregiver interventions reduce behavioural symptoms in people with dementia and family distress. American Journal of Psychiatry, 169, 894–897. Gitlin, L., Jacobs, M. & Earland, T. (2010). Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable medicare service: Outcomes and lessons learned. Gerontologist, 50, 847–854. Gitlin, L. N., Winter, L., Dennis, M., Hodgson, N. & Hauck, W. (2010). A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial. Journal of the American Medical Association, 304, 983–991. Kinn, S. & Galloway, L. (2000). Do Occupational Therapists and Physiotherapists teach elderly people how to rise after a fall. British Journal of Occupational Therapy, 63, 254– 259. McDougall, F., Kvaal, K., Matthews, F., Paykel, E., Jones, P., Dewey, M. et al. (2007). Prevalence of depression in older people in England and Wales: The MRC CFA Study. Psychological Medicine, 37, 1787–1795. Van’t Leven, N., Graff, M., Kaijen, M., de Swart, B., Olde Rikkert, M. G. M. & Vernooij-Dassen, M. J. M. (2011). Barriers to and facilitators for the use of an evidence-based occupational therapy guideline for older people with dementia and their carers. International Journal of Geriatric Psychiatry, 27, 742–748. World Health Organization. (2002). Active ageing: A policy framework. WHO, Geneva, Switzerland.
© 2014 Occupational Therapy Australia
doi: 10.1111/1440-1630.12125
Viewpoint
Active ageing and occupational therapy align Lindy M. Clemson and Kate E. Laver Ageing, Work & Health Research Unit, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
KEY WORDS aged, aging. As Australia’s population ages, there is an increasing focus within health and social care policy on ‘active ageing’; that is ‘the process of optimising opportunities for physical, social and mental wellbeing throughout the life course, to extend healthy life expectancy, productivity and quality of life in older age’ (World Health Organization, 2002, p. 12). The three pillars of active ageing are health, security and participation although it appears participation is most important to older people. A survey conducted with older Australians found that while they acknowledged the importance of health and security, they overwhelmingly defined active ageing in terms of participation; through social interactions, involvement and personal development (Buys & Miller, 2006). Personal development reflected the importance of having a ‘sense of achievement and a purpose in life’ (Buys & Miller, p. 8). We are ideally placed to be leaders in the field of active ageing and health and aged care reform. These concepts of active ageing are not new to us and the principles, philosophies and terminology associated with active ageing fit perfectly with occupational therapy. The foundation of occupational therapy is based on the understanding that human’s need to be engaged in activity. Now is an exciting time; there are many opportunities and ways that we can develop as a profession. It is a time where we can demonstrate how our unique approach to health and social care can improve outcomes for older people. Yet there are also challenges and aspects of our practice that we must re-consider. This viewpoint article: (i) outlines how far we have come by providing an overview of research trends in
Lindy M. Clemson PhD, MAppSc (Research), BAppSc (OT), DipOT; Professor, Research Fellow. Kate E. Laver PhD, MClinRehab, BAppSc (OT); Research Officer. Correspondence: Lindy M. Clemson, Faculty of Health Sciences, The University of Sydney, East Street, Lidcombe, NSW 1825, Australia. Email: [email protected] Accepted for publication 18 February 2014. © 2014 Occupational Therapy Australia
occupational therapy in this field over the last 20 years; (ii) provides examples of areas where there is strong research supporting interventions that must be implemented in practice; and (iii) identifies some of the actions required in order for our profession to thrive in the field of ageing.
Occupational therapy research in ageing 1993–2013 Although occupational therapists often lament the lack of research literature to support common occupational therapy interventions, there has been a steady increase in occupational therapy literature in the field of ageing over the past 20 years. We searched the CINAHL database for literature published between 1993 and July 2013 using the terms ‘occupational therap*’ AND (aged or ageing or aging or elderly or elder or old or older or senior or geriatr*) in the title, abstract or keywords. We identified a total of 589 relevant papers; the number of papers published per year is displayed in Figure 1. Trends over time are portrayed in Table 1 in which the main areas of research published in the 1993–1997 period and the 2008–2012 period are presented. It can be seen that our focus on occupational engagement has remained constant over time. Falls prevention and the assessment and retraining of activities of daily living have also had a strong presence in the research literature. There are several areas where the amount of research published has increased over time. Drivingrelated publications increased from one in 1993–1997 to 20 in the 2008–2012 period. Dementia is increasingly recognised as an important area for research; both by occupational therapists, with publications increasing from 1 to 13, and policy makers with dementia recently identified as a national health priority (Australian Institute of Health and Welfare, 2012). There has been a relatively recent increase in research into the use of technologies. Despite the number of publications in this area increasing, it is surprising to find so few publications given the capacity of occupational therapists to be involved in technologies such as smart home design and telehealth and our expertise in prescribing and training in the use of assistive devices. Our search revealed that sadly there appears to be a lack of research into mental health in older people; an impor-
205
VIEWPOINT
FIGURE 1: Publications in ageing and occupational therapy by year. TABLE 1: Comparison of the major areas of research in occupational therapy and ageing over time 1993–1997
2008–2012 Number of publications
Areas of research
Number of publications
Occupational engagement/time use Home modification/aids Service delivery/evaluation Cognition Activities of daily living assessment and retraining Exercise and rehabilitation Professional practice
8 8 8 6 6
Occupational engagement/time use Driving Falls Service delivery/evaluation Acute care/discharge planning
27 20 16 15 15
5 4
13 11
Student education Falls Policy
4 4 3
Dementia Activities of daily living assessment and retraining Professional practice Home modification/aids Technology
Areas of research
tant area given the high incidence of depression and social isolation experienced by older people (McDougall et al., 2007). In addition, although one of our core skills is the prescription of home modifications and assistive aids, there were relatively few research papers investigating this process or measuring outcomes for the client.
Translation of evidence based occupational therapy interventions is lacking and should be prioritised Among the body of published clinical trials there is now a strong evidence base for specific occupational therapy interventions with older people. For example, in the area of dementia care there is evidence based on
10 8 8
a high quality systematic review and meta-analyses for non-pharmacological interventions for community dwelling people with dementia and their caregivers (Brodaty & Arasaratnam, 2012). Occupational therapy has a prominent and strong presence in effective and promising programmes. Systematic interventions conducted by occupational therapists have been shown to reduce the frequency of behavioural and psychological problems experienced by the person with dementia. In addition, non-pharmacological interventions can be more effective than pharmacological treatment and do not have the associated side effects (Gitlin, 2012). Structured occupational therapy interventions have also been shown to improve outcomes for caregivers by reducing the upset associated with behavioural symptoms (Bro© 2014 Occupational Therapy Australia
206 daty & Arasaratnam). There are now several different evidence based interventions conducted by occupational therapists for dementia; while there are differences in the characteristics of the interventions, the interventions all involve core occupational therapy skills such as goal setting, caregiver education, modification in the environment and engagement in meaningful activity, for example, the COPE intervention (Gitlin, Winter, Dennis, Hodgson & Hauck, 2010). Although there is an increasing number of clinical trials, there has been limited uptake of evidence-based interventions in clinical practice and there are few examples of translational research; research that determines whether evidence-based treatments can be successfully implemented and achieve the same positive results outside the context of a clinical trial. Translation is possible; a study translating one of the interventions in the United States found that after extensive training therapists did not have difficulty integrating the intervention (Gitlin, Jacobs & Earland, 2010). However, the training was found to be time-consuming and there were difficulties in implementing the number of intervention sessions involved in the programme within the organisational structure necessitating adaptations to the training, usual practice and the original programme (Gitlin, Jacobs, et al., 2010). This project demonstrates that interventions shown to be successful in research trials can be translated into clinical settings. Partnership between occupational therapists, the organisation and researchers, is integral in helping translate this into practice. In the area of falls prevention, we have had evidence now for over a decade that home safety assessments by occupational therapists are effective in reducing both the rate of falls and risk of falling, particularly among at-risk people (Gillespie et al., 2012). We know that it works, we know for whom it works and we know that it is cost saving (Gillespie et al.). Despite this evidence emergent over the past decade, falls prevention services are not always accessible (particularly in rural areas) and interventions are not always evidence based. Why hasn’t widespread adoption of evidence based treatment occurred? A qualitative study to explore the issues underlying the training and implementation of an evidence-based structured home safety falls prevention intervention was conducted via interviews with occupational therapists and stakeholders (Clemson, Donaldson, Hill & Day, in press). Occupational therapists embraced the intervention describing it as ‘bread and butter’ and ‘fundamental occupational therapy’. They reported higher professional development and satisfaction following training. But there were challenges in implementation; it involved working with clients in changing habits and required a high ‘level of thoroughness’. The organisational structure with a focus on assessment did not easily support the implementation and while the therapists believed their intervention was effective they © 2014 Occupational Therapy Australia
L. M. CLEMSON AND K. E. LAVER
were not able to observe the direct outcomes as direct feedback mechanisms were missing. This project demonstrated that implementation of new evidence-based interventions is not only a matter of providing education for the individual therapists, but considering the implementation context from a number of perspectives: the organisation, the individual therapists’ level of skill and therapists’ trust in the evidence (Clemson et al., in press). These examples demonstrate that there is evidence that specific structured occupational therapy interventions can improve outcomes for older people in key areas yet translation is lacking. We must upskill in ways to accelerate translating evidence and find ways to ensure these programmes become part of our practice to achieve the best results for our clients. And as new research is published we need to ensure that we are in a position to take it on board.
Steps we need to take to re-define our role Multiple surveys of occupational therapists have revealed much more time is spent on assessment and little time is dedicated to providing intervention (Bennett, Shand & Liddle, 2011; Fricke & Unsworth, 1998; Kinn & Galloway, 2000; Van’t Leven et al., 2011). Bennett et al. surveyed Australian occupational therapists (n = 134) in regard to their practice with people with dementia. Nearly 40% of respondents spent half their time assessing clients and 12% of respondents spent more than 75% of their time assessing. In contrast, 11% of respondents spent more than half of their time providing intervention. These findings were echoed in another survey where occupational therapists working with people with Alzheimers Disease in Canada reported that only a small portion of time was dedicated to intervention. Furthermore, clinical experience rather than evidence determined decisions about the type of intervention provided (Van’t Leven et al.). Similar findings have been reported in the areas of falls prevention and assessment and retraining of activities of daily living (Fricke & Unsworth; Kinn & Galloway). To play a key role in the field of ageing we need to ensure that we are regarded as interventionists and not just assessors. This may require lobbying to change organisational expectations of our role and investigating ways to better manage our practice. The aforementioned studies reported that occupational therapists wanted more training and lacked confidence in providing evidence-based interventions; these factors need to be addressed. We must ensure that therapists receive adequate training in providing interventions that are evidence based. We must ensure that skills learnt in training are carried over to clinical practice. We must use methods to ensure successful translation. Some of the success associated with successful implementation of interventions is the use of fidelity tools. Implementation fidelity is critical to successful
VIEWPOINT
translation of evidence-based interventions into the real world context. Implementation fidelity (or integrity) is the degree to which the core components of an intervention are delivered as intended by the developers (Carroll et al., 2007). These can include tools for peer review and self reflection. As a profession, we do not have a culture of fidelity checks; however, we must embrace these practices if we are to develop our skills in intervention. In conclusion, there are currently many opportunities for occupational therapists in ageing. The increase in the volume of research literature in the field is positive and this trend needs to continue. There are gaps in both areas of research (such as mental health of older people and technology use) and the type of research (such as translational research and studies of cost-effectiveness). Research findings should be disseminated widely, both within and outside of the profession. We must re-affirm our roles so that we are regarded as leaders in the area of active ageing. Now is the time to re-invent ourselves and stand up for our roles and the emergent strengths of our evidence base. Occupational therapy offers so much yet we must demonstrate our effectiveness in the field of ageing. We have come a long way since the inception of our profession in 1919 and even in the last 20 years but there is still work to be done.
References Australian Institute of Health and Welfare. (2012). Dementia. Retrieved 14 October, 2013, from http://www.aihw. gov.au/dementia/ Bennett, S., Shand, S. & Liddle, J. (2011). Occupational therapy practice in Australia with people with dementia: A profile in need of change. Australian Occupational Therapy Journal, 58, 155–163. Brodaty, H. & Arasaratnam, C. (2012). Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169, 946–953. Buys, L. & Miller, E. (2006). The meaning of ‘active ageing’ to older Australians: Exploring the relative importance of health, participation and security. Paper presented at the Australian Association of Gerontology, Sydney. Retrieved 6 March, 2014, from http://eprints.qut.edu.au/6671/1/ 6671.pdf
207 Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J. & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2007, 40. Clemson, L., Donaldson, A., Hill, K. & Day, L. (in press). Implementing person-environment approaches to prevent falls: A qualitative inquiry in applying the Westmead approach to OT home visits. Australian Occupational Therapy Journal. Fricke, J. & Unsworth, C. (1998). Occupational therapists’ conceptions of instrumental activities of daily living in relation to evaluation and intervention with older clients. Scandinavian Journal of Occupational Therapy, 5, 180–191. Gillespie, L., Robertson, M., Gillespie, W., Sherrington, C., Gates, S., Clemson, L. et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 9, CD007146. Gitlin, L. N. (2012). Good news for dementia care: Caregiver interventions reduce behavioural symptoms in people with dementia and family distress. American Journal of Psychiatry, 169, 894–897. Gitlin, L., Jacobs, M. & Earland, T. (2010). Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable medicare service: Outcomes and lessons learned. Gerontologist, 50, 847–854. Gitlin, L. N., Winter, L., Dennis, M., Hodgson, N. & Hauck, W. (2010). A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial. Journal of the American Medical Association, 304, 983–991. Kinn, S. & Galloway, L. (2000). Do Occupational Therapists and Physiotherapists teach elderly people how to rise after a fall. British Journal of Occupational Therapy, 63, 254– 259. McDougall, F., Kvaal, K., Matthews, F., Paykel, E., Jones, P., Dewey, M. et al. (2007). Prevalence of depression in older people in England and Wales: The MRC CFA Study. Psychological Medicine, 37, 1787–1795. Van’t Leven, N., Graff, M., Kaijen, M., de Swart, B., Olde Rikkert, M. G. M. & Vernooij-Dassen, M. J. M. (2011). Barriers to and facilitators for the use of an evidence-based occupational therapy guideline for older people with dementia and their carers. International Journal of Geriatric Psychiatry, 27, 742–748. World Health Organization. (2002). Active ageing: A policy framework. WHO, Geneva, Switzerland.
© 2014 Occupational Therapy Australia
