The diversity of Occupational Therapy Services for older persons in Malta
by Antoinette Laferla Dip Ger Dip OT
Assistant Principal Occupational Therapist
Occupational Therapy Department
St Vincent de Paul Residence
Occupational Therapy has become part of the multidisciplinary rehabilitation team, however, a number of professionals still do not understand the work carried out by the therapist especially in a long-term setting. This article highlights the services which are presently being offered by occupational therapists working at St Vincent de Paul Residence. Still, one should also keep in mind that other services are offered by occupational therapists working with older persons who receive acute care at St Luke’s Hospital, subacute rehabilitation at Zammit Clapp Hospital, psychiatric care at Mount Carmel Hospital and also in Gozo.
An occupational therapist (OT) working with the elderly makes use of purposeful activities in order to maintain the optimal level of functional independence of that person in all areas of life. 1,2
- Residential Services
Persons being admitted to SVPR are assessed by an OT to identify any areas where rehabilitation is needed. Each ward at SVPR has an OT who is responsible for the rehabilitation of the residents. Specific assessments such as bathing, dressing, feeding, toileting and perceptual are carried out when necessary and appropriate techniques are taught and aids given on loan after training sessions. Every client needs a tailor-made package of treatment due to the diversity of needs and interests.3 All services are also given to older persons who are admitted to SVPR as respite. Sessions with relatives of residents are held, especially at the respite ward, when new techniques need to be taught in order to encourage more independence and decrease the amount of anxiety experienced during activities of daily living.4
OTs carry out a number of group activity sessions ranging from high mobility, reminiscence, discussion, creative and cookery groups, to groups for specific conditions such as dementia. During a group therapy session, any physical, cognitive and psychosocial goal may be achieved for different individuals at the same time.5
The activity centre within the occupational therapy department offers therapeutic diversional activities which include cane work, rug wool, fretwork, woodwork, knitting, sewing, crochet and tapestry. There has been a time when these activities have been put aside, even by OTs, since they were not giving the profession a very scientific look! However, through evidence based research it is now proved that diversional activities contribute to optimal rehabilitative care. It is up to the therapist to grade and adapt the activity according to the abilities and needs of each resident. Through these activities, the older person achieves not only hand or arm function, strength and coordination, but also learns how to remain mentally active, how to function socially and maintains a high level of self-esteem.6 It was also proved that participation in activities has a positive influence on variables that contribute to adaptation to ageing.7 One of the present challenges of OTs working at SVPR is to decrease the number of residents (presently 25.8%) who voluntarily choose not to participate in any form of activity.8
OTs try to help elderly persons at SVPR to remain part of society as much as possible by encouraging residents to participate in activities outside the residence such as carnival, horticulture exhibitions and Christmas Festivities.
Through all the above mentioned activities the OT tries to minimize what Goffman has described as ‘the total institution’ i.e. that there is no separation between work, leisure and family and that residents are treated all alike, doing the same things and following a set routine. Through participation in these activities the residents are given an amount of diversity, autonomy and choice.9
A number of older persons are seen as out-patients. Most cases are referred from other hospitals, from the therapist visiting the day centres or directly from general practitioners. Rehabilitation is carried out at SVPR, and home visits are carried out when necessary.
C. Community Services
Government Homes for the Elderly
Occupational Therapy Service is provided to residents in the five different Government homes. An OT visits each home at least once a week and is involved not only in the rehabilitation of residents, but also in giving advice to provide a safer environment within the home.
Normal ageing is not synonymous with disease and disability. 10 For the past four years an emphasis has been made to educate older persons who are still living in the community and who attend the church and government day centres for the elderly. A health promotion programme has been drawn up in which different issues concerning the elderly population are discussed. Advice is given on how a person may adapt his/her lifestyle and everyday routine in order to combat any limitations which might set in.
Home visits are arranged for out-patients or for older persons using the respite facility prior to returning home. Sometimes this service is also offered to persons residing at SVPR who visit relatives during weekends and who are finding some difficulty in the other setting. The OT gives advice on adaptations or any structural changes needed in the home in order to maintain independence and promote safety. Furthermore,
OTs are involved in presenting reports to the Housing Department Board, when persons apply for funding of particular projects such as stair lifts, lifts or structural changes in bathrooms and showers.
All the above mentioned services are offered by the OTs at SVPR as part of the ongoing rehabilitation provided by a multidisciplinary team. The collaboration of every person within this team will lead to a better quality of life for the residents. Also, the community services help to provide a more independent lifestyle which will delay the need for older persons to apply for residential care.
1. College of Occupational Therapists website. Available
2. American Occupational Therapy Association, Inc website. Available from: http://www.aota.org/featured/area6/index.asp.
3. Reynolds PJ, Allen SC. Rehabilitation of the elderly – an overview. In: Shukla RB, Brooks D, editors. A guide to care of the elderly. London: HMSO, 1996.
4. Boone A, Rodrigues BJ. Working with families and caregivers of elders. In: Lohman H, Padilla RL, Byers-Connon S, editors. Occupational Therapy with elders: strategies for the COTA. USA: Mosby, 1998.
5. Byers-Connon S, Hoff S. Group treatment with elders. In: Lohman H, Padilla RL, Byers-Connon S, editors. Occupational Therapy with elders: strategies for the COTA. USA: Mosby, 1998.
6. Drake M. Crafts in therapy and rehabilitation. 2nd ed. USA: Slack Incorporated, 1999.
7. García-Martin MA, Gómez-Jacinto L, Martimportugués – Goyenechea C. A structural model of the effects of organized leisure activities on the well-being of elder adults in Spain. Activities, Adaptation and Aging 2004; 28(3):19-34.
8. Occupational Therapy Department Report – Audit of SVPR residents re: activities. 2006. (reproduced with permission).
9. Bond J. Living Arrangements of Elderly People. In: Bond J, Coleman P, Peace S, editors. Ageing in society: an introduction to social gerontology. 2nd ed. London: Sage Publication, 1993.
10. Swift CG. Disease and disability in older people – prospects for intervention. In: Squires AJ, editor. Rehabilitation of Older People – a handbook for the multidisciplinary team. 2nd ed. London: Chapman and Hall, 1996.