Elsa Orellano, Wanda I. Colón, Marian Arbesman; Effect of Occupation- and Activity-Based Interventions on Instrumental Activities of Daily Living Performance Among Community-Dwelling Older Adults: A Systematic Review. Am J Occup Ther 2012;66(3):292–300. https://doi.org/10.5014/ajot.2012.003053
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© 2019 American Occupational Therapy Association
This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults’ performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.
Occupation-based and client-centered interventions (interventions that are community based and delivered by occupational therapists or a team of providers, i.e., multicomponent interventions, Lifestyle Redesign® programs [Clark et al., 1997, 2011 ], and occupational therapy interventions)
Functional activities interventions (i.e., functional task exercise programs and simulated IADL programs)
Performance skills interventions (interventions that target specific performance skills, e.g., physical activity, cognitive skills, and vision rehabilitation)
Home modifications and assistive technology.
Occupational therapy practitioners, educators, and researchers need to use and develop comprehensive and sensitive measures that capture and report the whole scope of IADL outcomes in older adults living in the community.
Strong evidence indicates that client-centered and activity-specific interventions in collaboration with other disciplines must be designed to improve IADL outcomes in older adults living in the community.
Because improvement in physical performance does not always translate to improvement in IADL performance, occupational therapy researchers and practitioners must always assess how the impact of any intervention translates to meaningful occupational performance of older adults.
There is a need to develop evidence for the use of assistive technologies, environmental modifications, and occupation-based and client-centered occupational therapy interventions to improve IADL outcomes in older adults with different functional abilities.
Future research efforts must address the effects of occupation- and activity-based interventions on unexplored IADLs, such as financial management, caregiving, care of pets, child rearing, communication management, and safety and emergency maintenance.
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