OT827 Lectures (1) PDF: Ageism and Social Participation in Older Adults

Lecture 3: Ageism Ageism: Stereotyping or discriminating against people based on their age Older adults: Might think they can't do anything Think that they always need help Can't do occupations they did when they are young Sources of Age Discrimination Younger People Employers...

Lecture 3: Ageism Ageism: Stereotyping or discriminating against people based on their age Older adults: Might think they can't do anything Think that they always need help Can't do occupations they did when they are young Sources of Age Discrimination Younger People Employers Government Healthcare system/healthcare professionals (e.g., not accepted as a patient by a family physician) ○ Older adults come in more to family physician ○ More comorbidity ○ Cost more money for family doctor Local businesses Family members Peers How might older adults experience ageism? Agism types Personal ○ Some cultures help older adults by respect Institutional ○ older people get paid more and cost more in institutions ○ technology and older people intentional (explicit) ○ Younger people might think that older adults had their own resources and time ○ Young people getting promoted to job and older people encourage to retire already unintentional (implicit) ○ Offering help to older adults who doesn't need help Two types of Ageism in younger people against Older People Succession Consumption Three Common Forms of Age Discrimination Being ignored or treated as they are invisible Being treated like they have nothing to contribute Assumption that they are incapable At what age do workers start to experience ageism? 40 yrs old Signs of Age Discrimination at Work 1. Hearing Age related comments or Insults.... 2. Seeing a Pattern of Hiring Only Younger Employees.... 3. Getting Turned Down for a Promotion.... 4. Being Overlooked for Challenging Work Assignments.... 5. Becoming Isolated or Left Out.... 6. Being Encouraged or Forced to Retire.... 7. Experiencing Layoffs. Older adults are encourage to retire and let younger people do the work Appearances of older people get commented by younger people Older people wanting to go back to education while working might get discriminated What Older Adults Say About Discrimination People assume....... I have nothing to contribute....... I’m incompetent....... I have memory loss....... I am slow....... I am hard of hearing People treat me like a child How older people deal with age shaming? Speak up Engage in the world Positive attitude Being independent Being with young people Empowerment Education on independence of older adults Remind caregivers about ageism stereotypes and encourage older people to maintain occupations Intergenerational activities with youth Video: Language use Younger people are more associated with "healthy, active, social, modern" words Managing agism in practice Awareness of ageism stereotypes, attitudes, actions towards older adults, own ageist attitudes of clients Sensitive to language use when talking to older adults, cultural differences, volume when speaking Avoid making assumptions, underestimating, helping without consent Promote independence, achieving goals and occupations, autonomy and choice, confidence, advocacy, community engagement, quality of life Importance of social participation: Social support to prevent isolation in older people Promote independence and belonging Helped with physical and mental health What factors associated with aging might impact social participation? Older people lose friends and connection with others - grief Self grief from loss of own capabilities Transportation becomes harder Having hearing loss and vision impairment can affect connecting with others Ageist stereotypes preventing social participation Cognitive load might be too much for older people Being caregivers to their partners - older adults Lack of finances and resources Lack of opportunities to promote community engagement Social participation Decreases/increases with age - but only after 75 yrs old People aged 85 yrs old and over report lowest participation in recreation/social activities/physical activities compared to other areas of participation People living at home with family/spouse have a higher level of social participation Health problems such as osteoarthritis, respiratory problems, and hypertension are negatively/positively associated with participation Active participation in leisure activities/physical activities is associated with successful aging What are the effects of availability of social support? Crisis management Social participation engagement Transportation General positive attitudes Better self-esteem Belonging Social network is highly correlated to well-being Types of social support: Emotional (family, peers, caregiver) Informational (COVID info, bus sched, fall prevention) Instrumenta/Practical support (IADLs, grocery, etc.) What are sources of social support? Local family dependent ○ Living close to family members (within 8-10 km) ○ Regular contact ○ Older adults who live in their own house, have comorbidities ○ Family dynamics might prevent older adults from living with families Local integrated ○ Friends and neighbours  ○ Church and voluntary bodies, social network, developed over a long period, may be larger ○ When older adults move, they lose social connection Local self–contained ○ A few relatives ○ Geographically distant ○ Reliant on neighbours in time of emergency ○ Risk of falls, might not have someone to check on them Wider community-focused ○ Large ties with the local community ○ Little needs for assistance Private restricted ○ Minimal contacts with a few friends ○ Why? A life-long pattern of extreme independence or, lack of seeking out friends Facts about support networks type No association with depression or dementia People living in: ○ Local integrated networks (friends, church, etc) have greater level of happiness ○ Sheltered with locally integrated networks are more active and less lonely Formal Social Support Includes social and health care professionals Advantages: ○ Gives older adults resources ○ Prevent isolation ○ Relationship is continuing ○ HCP are trained to collaboration with decision making Disadvantages: ○ Monetize ○ Waiting times ○ Stigma due to power imbalance ○ Discomfort Having Pets for older adults Psychological health benefits Pet’s loyalty and affection Benefits of having a pet (dog or cat) for older adults ○ Engagement in activities of daily living ○ Contribute to sense of identity ○ Health promoting (going for walks) ○ Improve social context (increase social circle) What are the disadvantages?? ○ Not same as socializing as people ○ Cost expensive ○ Hard to train sometimes ○ Can be hard to take care of (stress)  ○ Falls risk, messy house ○ Grieving of pets Dysfunctional Social Contexts Harmful effects on physical and psychological wellbeing Impairing when support networks are shrinking or are under heavy stress Private networks with minimal outside contact are capable of hiding abuse Have you heard of abuse stories?? Older adults being abused in nursing home, LTC, etc. Loneliness and Social Isolation Living alone is not social isolation, if regular contact with variety of relatives and friends is maintained Loneliness is: fewer social ties than a person expects, desires, or feels Consequences of Social isolation: diminished quality, type, frequency, and emotional satisfaction of social network and social participation Loneliness and Social Isolation among older adults Risk of all social networks shrinking through: Retirement, illness and relocation Difficulty in maintaining networks Death of people close to them Can you guess?? 60 and over are at risk of social isolation- 50% Experience some degree of loneliness later in life- 33% Older adults living in long-term care Moderately lonely- 61% Severely lonely- 35% Social Isolation associated with: Physical and mental health Hospitalization and mortality ○ More socially isolated, more likely to be hospitalized Neighbourhood variables Income, living situation, information access ○ Low income affects social connection, not going to grocery, restaurants, etc. ○ Older adults who don't speak English - won't go to some public places since it is hard to communicate Social Context & Occupations Social context influence quality and quantity of life Leisure occupations Life satisfaction Well-being Engaging in more social activities provides: Safeguard against stress Opportunities to stay active and engaged Longer life expectancy What to consider for improving social networks for older adults? Practical implications: Client's approach and lifestyle Family-centered Social network to improve community integration Group based therapy or support groups Meaningful and desirable social activity Intergenerational project Characteristics of interventions with positive impact on social isolation Adaptability Involvement of older people in the planning, developing and execution of activities Productivity focus ○ Common goal ○ Creativity ○ Active vs. passive approach ○ Activities that present a challenge Social Prescribing Connecting clients with non-medical services to improve their health and well-being Process usually involves: screening for social needs (such as social isolation or access to food), referring to community-based services (such as welfare advice or housing support), supporting people to access relevant services (often using a care coordinator or link worker). Potential benefits: Improved: Mental health Social connections Connection to culture Physical and behavioral health Reduced: Stress Isolation, loneliness Primary and secondary care use Emotional Well-Being From 50 to 70 yrs, positive emotions increase and negative emotions decrease Before and after those ages, patterns differ across specific emotions Overall, older adults have a higher positive– relative-to-negative emotional experience than the younger adults Emotion and physiology - Stress  With high levels of sustained emotional arousal, older adults have greater difficulties returning to homeostasis than young adults Stressful situations for older adults: Social isolation Neurological dysfunction Exposure to chronic and unpredictable stressors Overload of predictable stressor Depression Rate of depression in older adults is lower than younger adults Older adults’ symptoms of depression is more harmful than younger adults ○ Decreased cognitive, physical, and social functioning ○ Increased risk of morbidity (e.g. cardiac events), risk of suicide, self neglect, mortality Depression may present as lifetime illness or as late-life condition Older adults tend to present physical symptoms vs emotional ones: ○ Sleep problems ○ Fatigue ○ Psychomotor slowing ○ Impaired cognition ○ Loss of interest in living ○ Hopelessness about future Rate of depression in older adults is lower than younger adults Older adults’ symptoms of depression is more harmful than younger adults Risk of depression in older adults is increased With sudden events in later life including: ○ Financial difficulties/ socioeconomic disadvantages ○ A new illness or disability/a family member with a new illness or disability, ○ Retirement/ change in living situation Anxiety Feeling of worry, nervousness, or unease More common than depression in older adults (mixture is common) ○ Similar risk profiles Frequently relates to fear of falling and/or is comorbid to other illnesses ○ Reduced activity level ○ Older adults might not engage in other activities due to anxiety Occupational Therapy Role Screening ○ Interview ○ Standardized tools: e.g. Geriatric Depression Scale (GDS), Patient Health Questionnaire (PHQ-9), Geriatric Anxiety Inventory (GAI) Referral Intervention ○ Psychotherapy ○ Mindfulness-based interventions ○ Enhance support  ○ Increase participation Lecture 4: Culture Considering culture, context, and diversity 1. Practice Active Listening 2. Show Respect and Curiosity 3. Be Open to Learning 4. Remain Calm and Patient 5. Recognize and Challenge Your Biases 6. Practice Non-Verbal Communication 7. Seek Common Ground 8. Apologize if Necessary 9. Adapt to the Situation 10. Educate Yourself 11. Seek Feedback Islamic faith perspective for elders Quran: respect elders Arrange time with prayer accommodation Cultural considerations: ○ Touching without consent is inappropriate Meet with greetings and leave with goodbyes ○ Halal dietary controls Some pets not considered clean Case 4: Understanding family dynamics and relationship with partner and daughter Setting boundaries Process with abusive relationship Talk to mentor, find resources for abuse prevention Bring up tension on family and how it might be the source of the problems Trauma-informed approach Duty to inform, imminent risk Need consent from client to talk to family, Risa LGBTQ+ stigma in workplace Understand feelings of guilt and mental health concerns/mood, which affect her managing the house Medication management ○ Lack of routine because of retirement ○ Find new routine to take medications ○ Engage with leisure and selfcare ○ Understanding finances ○ Find the sources of missing medication Lecture 5: Physical and sexuality Part 1 - Physical Changes Aging is characterized by changes in anatomical structures and physiological functions of the body Change occurs in all systems: Integumentary – skin Cardiovascular, Respiratory and Immune systems Neuromusculoskeletal Digestive, Metabolic and Endocrine Genitourinary and Reproductive Skin Less elasticity with wrinkles, sags, dryness and extra folds Loss of underlying subcutaneous fat tissue Reduction in oil production Slower wound healing Hard time doing self-care, need to dress wound Pain stopping occupations Might need bed positioning strategies Frustration Decreased thermal regulation Become more sensitive to environment Become isolated if not wanting to go out Cardiovascular System Increased Heart rate & longer to get back to baseline Decreased Number of pacer cells in the heart Increased Stiffening of cardiac valves, arteries, and veins Decreased Heart efficiency Respiratory System A moderate decline in respiratory function Decrease in vital capacity Chest wall stiffness Weakening of muscles breathing Increased diaphragm breathing Increasing risk of respiratory system infection Changes to the Digestive, Metabolic and Endocrine Systems Growth hormone Estrogen production with menopause Pancreas function Function of gastrointestinal system Appetite and diet changes Nutrient uptake slows, have to buy supplements ○ Medications are hard to swallow sometimes ○ Constipation  Leads to pain, delirium, not sleeping well All affects occupation Drug metabolism Medications dose might be increased Have side effects Takes a handful of pills everyday Changes to the Central Nervous System Cerebral atrophy ○ Increase size of lateral ventricles- frontal & pre-frontal ○ Loss of neurons and white matter- Hippocampus Amyloid (Senile) plaques and neurofibrillary tangles Decrease in neurotransmitters ○ Decrease in dopamine ○ Related to mood, reward ○ Older adults are slower, higher risk of falls CNS still capable of plasticity Changes to the Peripheral Nervous System Decrease in: Number of lower motor neurons Speed of nerve impulses Ability of peripheral nerves to regenerate ○ Muscles are not working as well ○ Pain and temperature ○ At risk of skin breakdown Bone density decrease Bones become more fragile Bone loss and osteoporosis especially in women Note: Regular progressive exercise can increase bone mineral density into the 8 th decade Important to continue exercise to increase bone density Physical activities can be gardening, walking, etc Joint Structures and Tissues Joint capsules stiffness, ligaments, and lose elasticity Less synovial production Cartilage thins Attention: Over 70 years >> osteoarthritis Muscles Less skeletal muscle mass: ○ Less number and size of muscle fibers ○ More connective tissue and fat within the muscles What are the consequences of less skeletal muscle mass? ○ Impacts strength, endurance, flexibility, reaction time Muscle can reproduce itself despite of age, can increase strength Posture Increased postural sway Changes in spine Rounded shoulders Slightly flexed elbow, hips and knees Valgus or varus deformities of the hips knees and ankles Key threats related to changes with age: Physical inactivity Physical exercise and activity Lack of physical activity: ○ Muscle atrophy ○ Joint stiffness and instability ○ Less efficient venous return ○ Decreased cardiac output ○ Bone loss Key threats related to changes with age: Frailty Frailty: Declines in physiologic reserve and function across multiple systems. Frailty syndrome in older adults meeting 3 of 5 criteria: ○ low grip strength ○ low energy ○ slowed walking speed ○ low physical activity ○ unintentional weight loss Fragility Increased risk for poor health outcomes Speed of walking related to length of life ○ Slower speed with older age Results in: ○ Muscle breakdown and limited physical activity ○ Higher risk of conditions ○ Self-perception and mood changes ○ Heart problems might arise Key threats related to changes with age: Undernutrition, malnutrition and obesity Unbalanced food intake Malnutrition Risk factors: ○ Dysphagia, slow eating, low protein intake, poor appetite, need for using a feeding tube ○ Living in long-term care or with long-standing illness Increased risk of other illnesses Affects energy levels Social activity might be limited Mood changes with appetite changes Feeding tube leads to isolation How can OT address these threats? Physical activities Encourage and build routine with physical activities Socialize with other people with different programs Dancing, walking, gardening, shopping Frailty Fall prevention Nutritional deficits Education on food, diet, etc. Supplements added to diet Culture affects all of these things Common Conditions Affecting the Hand Osteoarthritis Rheumatoid arthritis Osteoporosis Skin changes Factors Affecting Function in Aging Hands Intrinsic factors ○ Genetic factors ○ Diseases ○ Soft tissue changes ○ Changes to bones, cartilage and fingernails Extrinsic factors ○ Environmental factors ○ Physical activities ○ Traumatic injury Changes in Hand Function Age-related declines in the CNS and PNS A large area of the CNS specifically is devoted to controlling the hands and particularly the thumb Changes in Hand Function: Changes due to normal aging Sensation Skin Muscle Bone Hand pain prevalence in older adults ranges from 12 to 21% Affects opening bottles for medications, supplements, food packages Pain affects leisure, self-care Pain impacts mood, limited physical activity Skin Changes Less skin elasticity  Slowed repair processes Feel cold in their hands Reduced sensitivity to local heat sources Slower skin reflexes Fingernails Important tools for fine grip and manipulation Nail changes include: ○ Discoloration ○ Changes in contour ○ Changes in thickness and roughness ○ Decreased fingernail growth Toenails grow in leads to pain ○ Discomfort with walking, putting on shoes ○ Sympathetic system affected (happens mostly with SCI) Muscle Strength After 60 years of age: Decline in grip strength, by as much as 20– 25% loss/decrease of number and length of muscle fibers, particularly in the Thenar muscle group Bone and Joints Decline in ROM ○ Wrist flexion(12%), wrist extension (41%), and ulnar deviation (22%) Decreased bone density Osteoarthritis Consequences of osteoarthritis of the fingers include: Pain, swelling, joint deformities Bone spur formation such as Heel spur Restricted range of motion of wrist and fingers Difficulty in performing manual activities that require grip and pinch Functional Concerns of OA Fine dexterity Bilateral coordination Fine-grip tasks Hand-force control Speed of hand-arm movements Gait and Balance Disorders in Older Adults Difficulty in walking Require a mobility aid to ambulate Prevalence of difficulty walking in hospital settings and LTC homes is higher Common and a major cause of falls Associated with increased morbidity and mortality Related with reduced level of function Gait and Balance Change in skeletal and muscular system = change in posture Relationships between balance and Postural changes Personal factors Medications Changes associated with aging: Reduction gait velocity and step length Increased stance width Increased time with both feet on the ground Bent posture Less force at the moment of push off Medical Conditions & Risk Factors Associated with Gait and Balance Disorders Affective disorders and psychiatric conditions Cardiovascular diseases Infectious and metabolic diseases Musculoskeletal disorders Neurologic disorders Sensory abnormalities Other factors (e.g. other medical conditions Evaluation of Gait and Balance 1. History 2. Current medication review 3. Physical examination 4. Gait and balance performance testing 5. Presence of environmental hazards Ask questions about gait and balance Older adults forget things so it is important to always ask Look at bruises, cuts, etc.  Look at their environment Who are they living with? Is their house full of clutter, falls risk Interventions for Gait and Balance Fall prevention Early identification of gait and balance disorders Identifying appropriate intervention prevent dysfunction and loss of independence A multifactorial evaluation followed by targeted interventions OT, PT, and exercise therapy Sexuality in Older Adults Importance of Sexual intimacy Enjoyable sex into age 80s and beyond. Sexual satisfaction correlates with: Relationship satisfaction Medical health Fewer prescription medications Traditional vs a more creative approach to intimacy Society thinks older people are not having sex anymore Different cultures have different perspectives on sexuality When people lose their partner and get married again, there are attitudes from others Taboo in middle eastern culture Age and Medical-Related Changes in sexuality - Men Lower levels of testosterone ○ 70-75 yo testosterone levels still high compared to women hormone changes happen on 50s Vascular changes Changes in the smooth muscle Health related: Depression, anxiety, medication side effects, alcohol consumption ○ Men less likely seek mental health services - More depression, anxiety Age and Medical-Related Changes in Sexuality - Women Lower levels of estrogen ○ Happens around 45-55 years old Vaginal dryness Fragile mucous membranes – risk of infection ○ Bladder infection (UTIs) that stops them from having sex Other issues: Body image, relationship and family issues, and medical conditions ○ Some women gain weight as they old (changes in metabolism) and they also gain more chronic conditions Feel worse about themselves which affects their sexuality Consider same-sex relationships Common Causes of Sexual Concerns Arthritis Chronic Pain Heart disease Dementia Depression Neurological conditions Surgery e.g. hip replacement Medications and alcohol Sleep problems Stroke affects sexuality - limited movement and sensation Barriers to sexuality and intimacy Body image, beliefs, and values Lack of knowledge Lack of opportunity Lack of privacy - Caregivers and others might be around Attitudes of adult children - big factor Lack of comfort View of healthcare provider Implications to sexuality and intimacy Clients need opportunities to discuss sexual concerns Suggested conversation starters: “Are you sexually active?” If yes, then “Do you have any questions regarding your sexuality that you’d like to discuss?” “Oftentimes aged people experience changes in their bodies that impact sexual function. Is there anything happening with your body, or your partner’s body, that is making you uncomfortable? Do you want to be sexually active? Are you comfortable talking about your sexuality? Would you like to talk to another provider (same sex) Potential OT role: Referral Education Advocacy Positioning for pain or function Energy conservation Advocate for clients referral can take a while Open conversation, do not push Send info and refer to family doctor Education Talk about attitudes on sexuality  Talk about traditional and modern sexual practices ○ Sex toys ○ Consider cultural practices Talk about health conditions and sexual concerns Talk about sex as ADLs part of basic living Consider history of sexual experiences Energy conservation Less energy as we get older Conserve energy to have sex Lecture 6: Sensory and cognitive Touch, vibration, pressure Decreased structure and number of touch receptors Decreased speed of processing Changes to circulation Affects hand function, balance, safety (burns, wounds) ○ Consider diabetes and wounds (less likely to heal) ○ Prevent pressure ulcers and educate about positioning ○ Consider burns and wounds that might be caused by cooking, etc. Pain: Not well understood May go unreported Hard to older adults to explain pain Muscles are stiff but not saying if they are in pain Cultural differences and how they feel comfortable talking about pain ○ Language barriers ○ Attitude on older adult and having pain always Not sleeping well, which might be causing pressure wounds Taste and Smell Complain of changes in taste and smell Decreased Discriminate between sweet, salty, bitter and sour Decreased Smell identification What are the possible functional effects of taste and smell changes on older adults lifestyle? Putting too much salt, sugar, etc. since taste sensation is affected Vision Reduced lens accommodation – presbyopia and retinal illumination Common eye conditions with age: ○ cataracts, glaucoma, macular degeneration, diabetic retinopathy In your time, use the vision simulator through the following link and consider the activities that would be affected by each eye condition https://www.myeyedr.com/eye-health/vision-simulator Presbyopia affects Working Social participation Reminder to have glasses Reading small fonts on prescriptions, menu, prices Hard to see molds, etc. Eye impairments Affects safety can't see surroundings Social interaction with others Leisure sports Driving Eating Macular degeneration Driving, safety, cooking, social interaction, writing Glaucoma Driving, walking on streets Cataracts Reading, driving, etc. Easy to fix Hearing Hearing loss- most marked at higher frequencies Intrinsic factors - cell loss in nervous system and stereocilia, thickening of ear drum, decreased elasticity of the ossicular chains and atrophy of the cochlea What are the extrinsic factors for hearing change? Less socially active Hard to hear other people Sometimes everything becomes noise Vertigo and balance problems - fall risk Turning head might lose their balance and fall Educate how to move around slowly Slowly get up from bed or doing transfer Implications of sensory loss? Communication Social interaction Safety Occupational Performance Interventions for sensory loss Setting up cues Sensory prevention Adaption of task and tools ○ Font size, magnifying glasses  Education on safety for client and family Advocacy System navigation and resources Older adults living together might not communicate properly, risk of falls Social participation Age-related Cognitive Changes Cognitive change: A major threat to participation and quality of life All cognitive abilities do not decline with age Life experience may compensate decline associated with memory impairment Understanding patterns of preserved & impaired cognitive functions > understanding the impact on OP Not all cognitive abilities decline, some stay intact OT’s Goals: Promote cognitive health Assist understand changes Develop strategies to enhance functioning Cognitive Changes: Arousal and Sleep Changes to frontal lobe changes in arousal and sleep patterns Increase in sleep Sleep disturbances associated with depression, Alzheimer's disease, cardiac, respiratory and musculoskeletal conditions Sleep disturbances impact cognitive functioning Cognitive Changes: Intellectual changes Crystalized intelligence remains intact Fluid intelligence is impacted Note: Significant intellectual changes in adults > correcting them might reduce their self-esteem Cognitive Changes: Speed of processing Decreased speed at which information is processed in working memory Slowing in the peripheral and central nervous systems + Slowed sensory processing -> increased reaction time and increased time to process and retrieve new information Scores may be influenced by test relevancy Doctors don't spend time enough for appointments ○ Older adults takes time to understand and process things ○ Advocate for clients to have longer appointments Cognitive Changes: Executive function Reduced: Planning, abstract thoughts, decision-making, cognitive flexibility, and use of appropriate behaviours Speed and efficiency of problem solving: ○ Abstract reasoning Mental flexibility and set shifting in reasoning tasks Intervention strategies to promote learning and occupational engagement Intervention Strategies: Assist the client... 1) Understand mechanisms of memory and issues 2) Develop strategies related to attention and working memory 3) Use direct attention to what is to be learned 4) Minimize distractions 5) Increase attention specially for more than one modality/task 6) Allow time for processing, reduce content presented, slow speech rate/pause, increase exposure time 7) Reduce stress and anxiety 8) Allow self-pacing 9) Encourage active verbalization (talk aloud) and elaboration of new information vs just rehearsal 10) Provide clear instructions for organizing a complex task - Logically group information and focus on essential aspects 11) Build on what the client already knows 12) Encourage organisational strategies 13) Mnemonic/Reminder strategies Note: Cognitive training reduces cognitive and functional decline ACTIVE Study Advanced cognitive training for independent and vital elderly 1. Memory training: focused on verbal episodic memory Teaching of mnemonic strategies for remembering: ○ Instruction in strategy or mnemonic rules ○ Word lists and sequences of items, grocery list ○ Text material ○ Main ideas and story details Individual and group feedback on performance 2. Reasoning training: focused on the ability to solve problems that follow a serial pattern identifying patterns in a letter or number series or in everyday activities abstract reasoning tasks as well as reasoning problems related to activities of daily living individual and group exercises 3.Speed of processing training: focused on visual search skills Gradually complex speed tasks on a computer: ○ decreasing stimuli duration ○ adding a distraction ○ increasing the number of concurrent tasks or ○ presenting targets over a wider spatial expanse. ACTIVE study: Results 2 Years: Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years 10 Years: Participants in each intervention group reported less difficulty with IADLs, memory, reasoning 60% of trained participants (versus 50% of controls) were at or above their baseline level of self-reported IADL function Reasoning and speed-of-processing interventions: maintained the effects on the targeted cognitive abilities Implications for OT Assessment and Intervention Factors Less energy with older age, so it is harder to keep up with learning songs for choir and results to being easily exhausted Her family routines of caring for grandchildren and dog, including doing laundry can cause her caregiver stress from family expectations/culture Ageist attitudes on self Intervention Education about self attitudes Energy conservation techniques Involving family in planning routines and understanding their culture