April 1, 2009 |

Strategies for infusing well-being

What do you think of when you hear the term “well-being”? Does it imply happiness? Do we need perfect health to obtain it? The concept of well-being is certainly not new; however, increased use of the term to define health and measure quality of life has perpetuated a new focus on well-being in healthcare service delivery. The World Health Organization (WHO) defines well-being as a general term that encompasses physical, mental, and social aspects. WHO further suggests that in order to reach a state of complete well-being, “…an individual or group must be able to identify and realize aspirations, to satisfy needs, and to change or cope with the environment.” Well-being is recognized as a direct strategy to promote health.

But it is not a starry-eyed concept. It can be real for anyone of any age. A strong body of research supports that persons of all ages can benefit from activities targeted to help meet well-being needs. Key elements are:

The need for sufficient daily physical activity to promote physical well-being
A balance in the number and types of daily activity to sustain mental well-being
Opportunities to engage in meaningful interaction with others to facilitate social well-being

For older adults who experience chronic health conditions, need daily assistance with care, and reside in a long-term care setting, achieving well-being may seem to be an impossible task. In addition to cognitive and/or physical factors that may limit participation, residents in these settings are generally dependent on the formal resources available within the facility and the people who care for them. How can these resources be maximized?

Strategies to Promote Physical Well-Being	Strategies to Promote Mental Well-Being	Strategies to Promote Social Well-Being
Encourage residents to walk to the dining room and use regular chairs during meals Allow residents to assist with self-care transfers, dressing, grooming, and bathing Have residents help with simple chores (e.g., putting away their laundry, making their beds, and straightening up their rooms) Develop specific exercise programs targeting strength, balance, and flexibility as well as sessions for those who must sit and for those who can stand Start an afternoon walking club and encourage residents to join Use the Wii or Wii Fit	Offer a wide range of activity programming that includes card games, like bridge or even simpler ones, or brain teasers, such as Sudoku or crossword puzzles Identify residents willing to lead sharing seminars or tutor other residents on subjects related to their own careers or interests (e.g., watercolor painting, Internet surfing, and political science) Set up daily newspaper groups where the residents share information about a specific section to the rest of the group Have activity items available on the unit for residents to “borrow” (e.g., craft or scrapbooking supplies, playing cards, lending library, sewing materials, model building supplies)	Establish a welcoming committee of residents who mentor new arrivals for their first month by answering questions, encouraging participation in activity groups, and making introductions to other residents Encourage the formation of clubs (e.g., poker, book, drama, politics, and debate) Hold contests that promote interaction (e.g., scavenger hunts, team competitions, and dance contests) Schedule “open mic” events for residents to share poetry, comedy, and musical talents with each other Organize residents to complete volunteer activities together for the local community

Occupational therapy practitioners are key partners in promoting well-being in the long-term care setting. With science, research, and evidence-based background that places equal importance on the physical, mental, social, and environmental factors that impact participation in meaningful daily activities, occupational therapy practitioners can expertly identify and eliminate barriers to wellness for this specific population of older adults. For example, occupational therapy practitioners can:

assess a resident’s physical and cognitive capacity to engage in various facility activities (e.g., confirming a resident has the motor skills and attention to safely assist in assembling lottery calendars for a facility fund-raiser);
modify the environment to promote participation (e.g., installation of wheelchair-height flower boxes in the garden to allow residents to do their own spring planting);
adapt activities to facilitate engagement (e.g., introducing one-handed stabilizing devices and one-handed typing skills to allow a resident with a recent stroke to be able to return to publishing the monthly facility newsletter); and
assist residents in identifying and engaging in those activities of greatest importance to them (e.g., working with staff to develop a morning routine that enables a resident to get up and be ready in time for daily church services).

“The Well Elderly Study,” landmark research published in 1997,1 was the feature article in the Journal of the American Medical Association. This study, conducted by occupational therapists at the University of Southern California, examined the effectiveness of occupational therapy in health promotion efforts for low-income, community-dwelling older adults. Results of this study demonstrated that occupational therapy was more effective than a control group that either received social activity services or no interventions in maintaining a healthy and more independent lifestyle. Subsequent follow-along studies proved the economic value of this preventive approach.

Wellness may seem to be an easily achievable goal if your facility has the programming and tools to address resident needs in a traditional format, but there are steps you can take to promote wellness in your setting even without specific resources.

The evidence for improving the well-being of those living in long-term care settings through occupational therapy and occupation-based interventions is significant. Such interventions can be integrated into daily programming by all staff and at minimal cost through identifying activities that are physically, mentally, and socially meaningful to residents and providing opportunities for engaging in them. If you are having difficulty getting started, ask your occupational therapy professionals to help you make the first step.

Pamela E. Toto, MS, OTR/L, BCG, FAOTA, is an adjunct faculty member and researcher at the University of Pittsburgh, where she holds degrees in occupational therapy and healthcare supervision and management. She is currently completing doctoral studies in rehabilitation science. Ms. Toto is board certified in occupational therapy gerontological practice and is chairperson of the American Occupational Therapy Association Special Interest Section Council. Laurel Cargill Radley, MS, OTR/L, is the former Associate Director of Professional Affairs for American Occupational Therapy Association, and has worked closely with the International Council on Active Aging on partnership activities between the two associations. She holds undergraduate and post professional master’s degrees in occupational therapy from the University of New Hampshire and Boston University.

To send your comments to the authors and editors, e-mail toto0409@iadvanceseniorcare.com.

Reference

Clark F, Azen S, Zemke R, et al. Occupational therapy for independent-living older adults: A random controlled trial. Journal of the American Medical Association 1997; 278:1321-6.

Sidebar

Brain exercises yield ‘significant improvement’ in memory, attention

Study shows cognitive decline no longer inevitable

A study being hailed as a breakthrough from researchers at the University of Southern California and the Mayo Clinic shows definitively that computerized brain exercises can improve memory and attention in older adults. Results of the study are published in the April 4, 2009 edition of the Journal of the American Geriatrics Society.

A total of 487 healthy adults over the age of 65 participated in the randomized controlled trial, called the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) Study. Half were assigned to a group that trained on a brain fitness software program for a total of 40 hours over the course of eight weeks. The other half spent an equal amount of time learning from educational lectures on the computer followed by quizzes. The IMPACT study is the largest study ever of a brain fitness program that is available to the public and the first published in a medical journal to show improvements in memory and attention.

The study found that participants who trained on the software, the Brain Fitness Program from Posit Science®, more than doubled their processing speed, with an average increase of 131%. They also saw gains on standard measures of memory and attention of 10 years, on average. These changes were big enough that participants reported significant improvements in everyday activities (such as remembering names or understanding conversations in noisy restaurants). The gains of the brain exercise group were clinically significant; the gains of the lecture group were significantly smaller and not clinically significant.

The Brain Fitness Program was developed by a global team of neuroscientists for Posit Science. It consists of six exercises done on a computer. The product is based on the science of brain plasticity-the ability of the brain to change and form new pathways in response to the right stimulation delivered in the right way.

While some earlier studies have shown older adults get better at exercises that they practice, this study goes two steps further. The improvements at the exercises resulted in gains in standard measures of memory and attention and people noticed improvements in their everyday activities.

“The changes we saw in the experimental group were remarkable-and significantly larger than the gains in the control group,” said Liz Zelinski, PhD, a principal investigator for the study from the University of Southern California. “From a researcher’s point of view, this was very impressive because people got better at the tasks trained, those improvements generalized to standardized measures of memory and people noticed improvements in their lives. What this means is that cognitive decline is no longer an inevitable part of aging. Doing properly designed cognitive activities can enhance our abilities as we age.”

“We saw gains of 4% in memory scores in the brain exercise group,” said Glenn Smith, PhD, the study’s principal investigator from the Mayo Clinic. “That may not sound like much, but it is about what an older person normally loses in a 10-year period. The lectures group saw about a 2% gain, which may sound like they did half as well; however, we look at memory on a curve, not a straight line, and a 2% gain is not something you are apt to notice in your life.”

“This study has profound personal and public implications for aging baby boomers and their parents,” said Joe Coughlin, PhD, director of the AgeLab at the Massachusetts Institute of Technology. “This means boomers may now have tools for a future that is not their grandfather’s old age. It also impacts most aspects of independent living-from aging-in-place to transportation to all the great and little things that we call life. This is big news for aging and for all of us.”

Long-Term Living 2009 April;58(4):18-22