Examining the benefit of occupational therapy with older adults: Measuring functional ability and costs of practice

Abstract

Introduction: Measurement is a key aspect of healthcare, it allows the assessment of patients, monitoring of effectiveness, and the calculation of expenditure. Inconsistencies in measurement practice has led to difficulties in bench marking and promoting the value of occupational therapy. Objective: Recommendations regarding the measurement of older adults’ functional ability from an occupational therapy perspective will be provided, and the cost of an occupational therapy led health intervention for older adults explored. Methods: Study one is a systematic review of the quality of measurement properties of functional assessments used with older adults, study two provides validation of assessments used in the transition from hospital to home, and study three analyses the cost of two occupational therapy led discharge planning interventions. Results: Study one identified 28 assessments have been used in older adult populations in randomised controlled trials to measure function. A number had been modified over time (e.g. Barthel Index) and others not been evaluated for measurement quality in this population. The functional autonomy measurement system (SMAF) was identified as being a promising assessment for use with older adults. Study two provided further validation of assessments. The Groningen activity restriction scale (GARS) and modified reintegration to normal living index (mRNLI) were valid and sensitive to change in this population. Study three confirmed the value of cost analysis in randomised controlled trials identifying that with two discharge planning interventions that had similar effectiveness an enhanced program was not recommended for routine care for medical/acute patients. Conclusion: Measurement is complicated by a mix of assessments that vary in purpose and quality. Strategic and planned selection of assessments is required so informed decisions of use are made that benefit practice and allow for the monitoring of cost and benefits.