Outcomes of protocol-based and adaptation-based occupational therapy interventions for low-income elderly persons on a transitional unit.
OBJECTIVE
The study objectives were to describe (a) adaptation trajectories of elderly persons treated on a transitional unit for deconditioning and tracked after their return to the community, (b) an individualized adaptation-based intervention provided to selected elderly persons in addition to protocol-based treatment for deconditioning, (c) goals and outcomes of these two interventions, and (d) contrasting perceptions of outcomes by elderly persons, their family members, and their therapists.


METHODS
A longitudinal qualitative design was used to track 8 participants from transitional unit to community. Data on the protocol-based intervention were obtained from chart review and therapist interviews. Data on the adaptation-based intervention were obtained from the Client-Centered Evaluation and Community Adaptive Planning Assessment, which were used for goal setting and problem solving. In the community, contrasting perspectives on outcomes were obtained from the participants, their family members, and their therapists through semistructured interviews.


RESULTS
Participants' adaptation trajectories revealed that half relocated to new living arrangements after discharge from the transitional unit. At the time of follow-up, 91% of the protocol-based goals and 100% of the adaptation-based goals had been met in some fashion, with modification in the goal or development of new solutions in some cases. Outcomes valued by the participants were returning to former occupations and relationships; family members valued getting quality care for the participant; and therapists valued improvement in strength, endurance, and increased independence in activities of daily living (ADL).


CONCLUSIONS
Findings support use of an individualized consultative intervention that addresses occupational performance areas and performance contexts combined with a protocol-based, hands-on intervention that addresses performance components and basic ADL for elderly persons with multiple chronic illnesses.
Spencer
J
J
School of Occupational Therapy, Texas Woman's University, Houston Center 77030, USA.
Hersch
G
G
Eschenfelder
V
V
Fournet
J
J
Murray-Gerzik
M
M
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008173:Lung Diseases, Obstructive / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D009788:Occupational Therapy / Q000379:methods* / Q000523:psychology; D011203:Poverty; D012047:Rehabilitation Centers; D013781:Texas; D016896:Treatment Outcome