Demographic data reveal that the number of elderly Americans has risen dramatically in recent years and will continue to rise. Because older individuals are at risk for numerous chronic health and psychological conditions that threaten their ability to live independently and experience a satisfying life, they stand to benefit significantly from the provision of occupational therapy services. However, despite the growing demand for such services, the occupational therapy profession is currently experiencing a severe manpower shortage. Given this situation, research is urgently needed to identify the cost effectiveness of geriatric occupational therapy service delivery, as rigorous studies on the effectiveness of occupational therapy in treating the elderly are largely absent in the literature. The goal of this 3-year grant project is to conduct the first intensive effectiveness study of occupational therapy service provision to the low-income well elderly.To accomplish this purpose,an interdisciplinary research team featuring an occupational therapist, a physician with extensive experience in gerontology, and a biostatistician as Co-Principal Investigators are conducting a randomized field experiment in which 345 low-income elderly residents of a large, federally subsidized housing project have been or will be assigned to either: (a) a group-centered occupational therapy intervention condition; (b) a social program control group; or (c) a no-treatment control condition. For each subject, the treatment phase of the study will last 9 months. In order to evaluate the effectiveness of therapy, all subjects will receive pretreatment, posttreatment, and 6-month follow-up testing on measures of physical and social functional capacity, life satisfaction, depression, self-rated and physician-rated health status, and nutritional intake. For each of these effectiveness indicators, the significance of mean differences in change-from- baseline scores between the therapy and control conditions will be tested for both the posttest and follow-up assessments. Further, a censored variable corresponding to the elapsed time prior to transfer to a step-up facility will be included and will be assessed via survival analysis. In addition, correlational analyses will be undertaken to determine the client characteristics that are predictive of response to treatment; the outcome of these correlational analyses will be utilized to delineate the type of client who is likely to benefit most from therapy in achieving a specified outcome goal. Finally, cost effectiveness analyses will be undertaken by an economist and will include estimates of the medical costs avoided as a result of undergoing occupational therapy.
