IADL interventions for the Elderly

The Paper
Hunter, E. G., & Kearney, P. J. (2018). Occupational therapy interventions to improve performance of instrumental activities of daily living for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72(4).

The Problem
Up to 40% of older adults live with some kind of disability that makes engaging in IADLs difficult.  IADL intervention is an integral part of OT practice, so clarifying what works is essential.

Study Details

Researchers (supported by the AOTA) set out to complete a systematic review to answer the question: “What is the evidence for the effect of interventions within the scope of occupational therapy on the performance of selected IADLs for community-dwelling older adults?”

Thirteen Level I studies were used, along with one level III study (so the evidence quality was high).  Like in other reviews we’ve seen, the inclusion criteria was wide and included interventions that fit within the scope of OT practice.  But, OTs didn’t have to be the ones delivering the intervention.

Key Takeaways
Four major areas of intervention were identified:

Cognitive: 

  • Interventions using IADL activities to target cognitive skills has a favourable effect on IADL performance - compared with computerized cognitive exercises.  

  • Treatments that target memory, reasoning, and processing speed (even computerized ones) have a supportive effect on maintaining IADL performance.  

  • In a nutshell: cognitive stimulation and adding novel demands to everyday tasks improves IADL performance durably.

Self-management:

  • Using a Chronic Disease Self Management (CDSM) model to address health issues for older adults appears to help preserve and improve IADL function.

  • Components of effective self management treatments included goal setting,  communication skills, physical active, stress management, medication management, and healthy eating.

Prevention:

  • Similar to findings in fall prevention, physical activity is probably the number one most important intervention to prevent functional decline.

  • Physical activity not only helps maintain mobility and prevent falls, but improves mood and cognition too.

Home-based multidisciplinary rehabilitation interventions:

  • Transitional care programs (helping people get home after hospital) work to improve IADL performance and prevent further decline.

  • Attention at home by OT, PTs or other care workers can have a positive effect on IADLs if treatments involve performing real activity, physical activity or include aspects of the other intervention areas above.

  • Basic check in visits 1-2 times per year aren’t sufficient to improve IADLs


In Summary
Evidence supports what we feel to be true: OTs can help enhance IADL performance.

  1. Cognitive stimulation (through functional activity or other structured tasks) can improve IADLs

  2. Physical activity remains the most important thing to focus on for preventing general functional decline

  3. Interventions need to be tailored to the specific person, and should be focused on activity participation and performance.