Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials H. Nagayama, K. Tomori, K. Ohno, K. Takahashi and K. Yamauchi (2015)
How can you best help aging populations as an OT?
Older adults now account for 40-50% of the total healthcare costs many countries around the world. With growing costs, cost effective interventions are needed to address functional ability, social participation, and quality of life (QOL).
One possible cost effective support could be OT. If this is the case then it's likely that your future work as an OT will be to support this growing demographic.
But is occupational therapy a cost effective solution for older adults in today’s healthcare system?
The researchers hypothesized that: “occupational therapy may increase functional ability and QOL while reducing healthcare costs through improved independence in the older people when compared with other types of therapy (standard care or no intervention)”
This study was a Systematic Review (using PRISMA guidelines), and data for the study was taken from several search databases: MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library and OT seeker databases, and unpublished study data. Dated up to 2014.
The researchers included the following areas of OT intervention: Individual and group types of occupational therapy interventions which targeted physical, sensory, psychological and cognitive function, ADL, environment, use of assistive devices and primary caregiver counselling. A bit of everything really!
From 437 possible studies, 5 met the study criteria.
The Bottom Line
2 studies conclusively showed OT is cost-effective for issues including dementia, frailty and falls.
OT showed promise in being a cost effective approach to wide variety of additional issues for older adults, but this paper (as with many level I evidence research studies) provides limited specific input for OTs on what interventions are best for addressing medically based outcomes and/or specific issues within this demographic.
In other words, yes, there's a good chance your future work as an OT may be in the form of support for aging populations, but it's still unclear from this paper which specific OT interventions (other than falls, dementia and frailty) are going to best support your practice skills in this area.
A key take-away for your practice: Cost-effectiveness is probably not because of direct changes from intervention - but due to enhancing older adults problem solving or self management skills.
P.S This review highlights a challenge for OTs using Level I evidence (like RCTs, meta-analyses, and systematic reviews): Even though they’re high on the evidence hierarchy, these kinds of studies are often challenging to implement in day-to-day clinical work as their outcomes and suggestions can be quite broad.
One solution for OTs is to remember that it's often more helpful to search for smaller scale studies with single interventions and well controlled patient groups than the big meta-analysis; these smaller studies can provide practical, evidence based approaches to help to inform your day-to-day OT work!