Telehealth Delivery of Evidence-Based Intervention within Older Adult Populations: A Scoping Review

Introduction

Telehealth service delivery is increasingly used to facilitate older adults’ participation and engagement in meaningful and necessary occupational activity. Telehealth service delivery is an overarching term for the delivery of occupational therapy services using some form of audio-visual technology or teleconferencing as a modality (American Occupational Therapy Association, 2013; Scott et al., 2020; Tilstra et al., 2019). Recognized on the international level as well, the World Federation of Occupational Therapists (WFOT) defines telehealth as “the use of information and communication technologies (ICT) to deliver health-related services when the provider and client are in different physical locations” (p.1). Within the scope of telehealth service delivery, sessions can be held through (a) electronic visits/e-visits: internet platforms (e.g., Google), Apple iPad applications (e.g., Facetime), and video web-based platforms (e.g., Zoom and WebEx) and (b) teleconference visits/service (e.g., via phone use and/or text use). Research on evidence-based (EB) interventions among older adults varies based on delivery methods. The current literature extensively documents the following EB interventions and/or programs traditionally implemented in person, such as: Aging Well by Design (Cassidy et al., 2017); Community Occupational Therapy in Dementia (Döpp et al., 2013); Community Aging in Place-Advancing Better Living for Elders (CAPABLE; Szanton et al., 2011); Environmental skills-building program (Chee et al., 2007); Home Hazard Removal Program (HARP; Stark et al., 2017); and Lifestyle Redesign (Clark et al., 1997). Occupational therapy researchers and practitioners are responsible for the implementation of effective EB interventions to meet the needs of the growing older adult population. An understanding of how to best use EB practice and telehealth service delivery is warranted to offset the delay in integrating EB intervention and meet the needs of older clients who may not be able to attend in person therapy (Juckett & Robinson, 2018; Lam et al., 2013). In 2020 during the COVID-19 pandemic, the American Occupational Therapy Foundation (AOTF) Planning Grant Collective meeting focused on telehealth and how technology is used in the assessment and intervention in the everyday context. Researchers began exploring the type of technology being used to deliver telehealth services and even how data are collected via telehealth (Proffitt et al., 2021). Based on the call to expand the research in telehealth service delivery by AOTF, this scoping review will investigate EB interventions via telehealth within older adult populations (Lam et al., 2020). The purpose of this scoping review is to synthesize the evidence regarding EB interventions via telehealth services; and the technology medium used to deliver EB interventions in older adult populations within occupational therapy and/or by occupational therapists.

Methods

We followed the five-step process outlined by Arksey and O’Malley (2005) and the Preferred Items for Systematic Reviews for Scoping Reviews (PRISMA-ScR) reporting guidelines (Tricco et al., 2018) to ensure this scoping review was standardized and comprehensive. The PRISMA-ScR process provides a replicable model and involves a “systematic search of a body of literature to identify knowledge gaps, with a visual representation of results” (Tricco et al., 2018, p. 467). A prospective study protocol was developed based on our research questions and registered on the Center for Open Science electronic platform (Washington, 2022).

Step 1. Identifying the Research Question

We developed the following research questions utilizing the Participants, Concept, and Context framework (Aromataris, 2020): 1. In older adult populations (participants), what EB interventions (concept 1) are delivered through telehealth (concept 2) in occupational therapy and/or by occupational therapists (context); and 2. what modes of telehealth were used to deliver the EB interventions?

Step 2. Identifying Relevant Studies

We conducted a systematic search of the literature in July 2022 using six databases: APA PsycInfo, Academic Search Complete, CINAHL, COCHRANE library, MEDLINE, and PubMed with full text. The Medical Subject Headings (MeSH) search terms used were occupational therapy OR occupational therapists, and older adults OR aging OR seniors; and the general term: telehealth. The initial search terms were kept broad to collect an extensive list of records.

Step 3: Selecting the Studies

Study Eligibility.

The inclusion criteria for the studies were (a) written in English in a peer-reviewed journal; (b) directly used occupational therapy services and/or an occupational therapist; (c) used specific EB interventions through telehealth or virtual delivery; (d) included older adults aged ≥65 years; and (e) published between January 2012 and June 2022. The exclusion criteria were studies that (a) investigated assessment and evaluation only/did not include any intervention; (b) investigated caregivers; therapists, health professionals, and/or students only (without older adult participants); and (c) were existing meta-analyses, conference abstracts, and scoping or systematic reviews (however, the reference lists from these articles were screened for study eligibility). Screening and Reviewing Process. An extraction/data chart was developed by two authors (SW, EE) based on the Briggs Institute format (Joanna Briggs Institute, 2015) which included: participants’ demographics, study design, telehealth mode of delivery, the evaluation and/or assessment administered, the theoretical framework and/or model used, the EB intervention, and study outcomes/themes (Aromataris, 2020). Each study was screened in two phases per the PRISMA-ScR guidelines (Tricco et al., 2018): (a) title and abstract review (SW, EE, LM, SS) by the inclusion and exclusion criteria, and if applicable, (b) full-text review (SW,EE, LM, SS).

Step 4. Charting the Data

The full-text review was completed which included: (a) reviewing selected publication to ascertain inclusion/exclusion per the study protocol (SW, EE, LM, SS); and (b) discussing discrepancies to come to a final consensus on each article (SW, EE, LM, SS). The extracted data were placed into this shared spreadsheet through an encrypted electronic data drive and reviewed by each study member (SW, EE, LM, SS). Two reviewers completed the abstract review independently (LM, SS), after this was completed and an additional two authors (SW, EE) completed the abstract review as a quality check. All four reviewed the 21 full-text articles independently and agreed upon the final 10 articles through the shared electronic data drive. No discrepancies were noted.

Step 5. Summarizing and Reporting the Results

The team used the extraction table to summarize findings. The table identified similarities among population demographics, theoretical framework/models used, EB intervention, telehealth delivery, and study outcomes/themes discussed in the literature (Table 1). The themes of the selected articles were developed by the study team based on the aforementioned factors (SW, EE, LM, SS) and summarized through a descriptive thematic analysis (Braun & Clarke, 2006). The thematic narrative analysis emphasizes the identification, analysis, and interpretation pattern of meaning (e.g., themes) within data and outcomes presented (Braun & Clarke, 2006); this narrative method was also used to summarize findings to address each research question.

Table 1.

Summary of Evidence from the Scoping Review on Virtual Delivery of Evidence-Based Intervention Within Older Adult Populations

Author/Year	Participants and Age, Health Condition/Service	Study Design	Telehealth Mode of Delivery	Evaluation/Assessment	Theoretical Model and Intervention	Key Findings
Beit et al. (2022)	N=16; Median Age: 65.5 (Range: 56–69.3 yrs); Acquired brain injury (ABI)	Randomized Controlled Trial	Videoconference; Skype™	COPMa, Performance Quality Rating Scale (PQRS), Mayo-Portland Adaptability Inventory-4 (MPAI-4)	Cognitive Orientation to Daily Occupational Performance approach (tele-CO-OP) with a tele-CO-OP group and a control waitlist group Weekly videoconferencing sessions over 14 weeks	No significant improvements in the control group at the end of the 3-month wait period. Improvements in COPM scores for trained and untrained goals for both groups following intervention Improvements in the PQRS and MPAI-4 scores.
Boehm et al. (2015)	N=1; Age: 70 yrs.; Post-stroke	Case Study	Teleconference; Standardized Phone	Fatigue Impact Scale (FIS) COPM	The Managing Fatigue Course Discussions focused on rest, communication and body mechanics, activity application of ergonomics and activity modification, prioritizing and planning. 6 sessions over 6 weeks	Improved Occupational Performance and Satisfaction as evidenced by COPM Decreased fatigue impact as evidenced by FIS
Breeden (2016)	N=6; Age ≥ 65 yrs.; Home Modification	Narrative Study Design	Telehealth; VSee software program	SAFER-HOME Assessment	Developmental research sequence (Spradley, 1979); Constructivist learning theory Participants’ photos of home safety concerns to discussed during the telehealth sessions 1 session/week for 3 weeks	No evidence was found supporting the use of photography Some Improvement in SAFER-HOME v.3 scores for 5 out of 6 participants Indicators that older adults were comfortable with technology
Lafaro et al. (2020)	N=34 ; Median Age: 73 (Range: 66–84 yrs); Cancer	Experimental Design	Videoconference; Zoom	Pedometer 6-minute walk test, TUG Testb,Short Physical Performance Battery	Chronic Care Self-Management Model (CCM), SMART goal setting, to identify functional barriers Client/Caregiver dyadic intervention 2 in-person sessions; 3 video conference sessions 2 sessions pre surgery and 3 sessions post discharge	Improvement in 6-minute walk test Significant improvements in SPPB Outcome patterns declined after surgery followed by gradual improvements in function
Laver et al. (2020)	N=63 participants; Median Age of Home Visit Group: 80.47 yrs.; Median Age of Telehealth Group: 79.45 yrs.; Dementia	Randomized Controlled Trial; Care of Persons with Dementia in their Environments (COPE) Intervention	Video Telehealth; Cisco WebEx via laptop, cell phone,	Caregiving Mastery Index, Caregiver’s Perceptions of Change, Activities of Daily Living Function, Type and Frequency of behavioral symptoms of persons living with dementia	Adapted version of the COPE dyadic intervention; 60 minute sessions; 8 sessions over ≤ 16 weeks	Caregiving Mastery Index showed improvements, but were not statistically significant Both groups reported significant improvements in caregiver’s perceptions of change Intervention delivered via telehealth significantly reduced travel time Offering dyadic interventions via telehealth is feasible
Murphy et al. (2021)	N=32 participants) Mean age: 52 (Range: 20–73 yrs.); Scleroderma	Randomized Controlled Trial	Web based App-delivered home exercise; PT Pal	QuickDASHc, Modified Rodnan Skin Score, Handgrip Strength, R/L Tip pinch strength test, R/L 9-hole peg test, PROMIS physical function, PROMIS satisfaction with participation, R/L hand total active motion	App Alone group were instructed to perform exercises daily PT Pal Intensive group weekly therapy visits while and PT Pal All were given a separate survey to ascertain treatment satisfaction 45–60 minute sessions weekly over 7 weeks	No significant between-group differences on QuickDASH App Alone has some improvements at 8 weeks, but continued to improve over the following 18 weeks Intensive Group had more improvement noted at 8 weeks, but lost some after sessions ended, as seen at 18 weeks Both groups improved in 9-hole peg test Handgrip improved in App Alone but not in the intensive group
Perkins et al. (2022)	N=10 groups of older adults; Age 65 yrs.; Dementia	Experimental	Video Telehealth; Zoom	MMSEd, Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-COG)	Cognitive Stimulation Therapy Framework vCST Two sessions weekly, 45–60 minutes, for 7 weeks	vCST is a feasible online intervention Effective sessions involved physical objects, structured activities, and those with visual stimuli Discussion-based activities that were less structured and had more complicated instructions were less effective.
Plow et al. (2019)	N=208 adults; Age Range: 18–65 years; Multiple Sclerosis	Randomized Controlled Trial	Telephone	Fatigue Impact Scale, Godin Leisure-Time Exercise Questionnaire, Multiple Sclerosis Impact Scale, Accelerometer	Participants were randomized into contact-control intervention (CC), physical activity only intervention (PA-only), and physical activity plus fatigue self-management intervention (FM+) 3 or 6 group teleconferences followed by 4 individual phone calls; 12 weeks total	FM+ improved self-reported fatigue and physical activity compared with CC at posttest PA-only had improvements compared with CC on moderate-to-vigorous exercise and step count Small change in promoting physical activity and reducing fatigue impact in people with MS through the use of phone calls
Sclarsky & Kumar (2021)	N= 1; Age: 89 years; Alzheimer’s Disease	Case report	Video Telehealth; Telephone and Web-based video call	OTPFe COPM Occupational Profile used to guide intervention	Person–Environment–Occupational Performance (PEOP) Model used to guide approach Client/Caregiver dyadic intervention 2–3 60-minute visits over 30 days	COPM performance and satisfaction scores improved by ≥2 points in participation during mealtime, ADL routines, fall prevention, and cooking. Reported Greater understanding of the COVID-19 disease process due to their telehealth experience
Scriven et al. (2019)	N=21 participants. Mean age: 57.95 (Range=29–83 yrs.); Chronic Pain	Formative evaluation using a mixed-method analysis	Multisite telehealth group model--hub-and-spoke model videoconferencing; Cisco C20/SX20	CPAQ 20f, Brief Pain Inventory (BPI), DASS 21g, Patient Impression of Change Scale (PICS), Pain Self Efficacy Questionnaire (PSEQ), PROMISh	The Manage Your Pain--South West (MYP-SW) program Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Consolidated Criteria for Reporting Qualitative Research (COREQ-32) 2 hour sessions per week, over 4 weeks	95% of participants were positive about using telehealth in the future and 2/3 preferred Improvement in CPAQ No significant change in PSE, PROMIS, EQ-5D, and DASS Stress levels remained moderate pre and post-program and anxiety and depression remained moderate

^aCOPM=Canadian Occupational Performance Measure

^bTUG=Timed-Up-and-Go Test

^cQuickDASH=Quick Disabilities of the Arm, Shoulder, and Hand (DASH)

^dMMSE=Mini-Mental State Examination

^eOTPF=Occupational Therapy Practice Framework: Domain and Process

^fChronic Pain Acceptance Questionnaire 20

^gDepression Anxiety Stress Scale 21

^hPatient Reported Outcomes Measurement Information System

Results

The initial search yielded 536 publications. inclusion and exclusion criteria. Twenty-one full-text reviews were completed and yielded 10 articles that included EB interventions for older adults within the scope of practice for occupational therapy or delivered by occupational therapists (see Figure 1). The study types were as follows: case study (n = 2), experimental (n = 2), formative evaluation (n = 1), narrative (n = 1), randomized controlled trial (RCT: n = 4). The review team (SW, EE, LM, SS) organized and identified the themes of the 10 articles: Cognition (Perkins et al., 2022); Environment/Home Modifications (Breeden, 2016); Health Management (Scriven et al., 2019); Occupational Engagement (Laver et al., 2020); and Performance-Based intervention (Boehm et al., 2015; Lafaro et al., 2020; Murphy et al., 2021; Perkins et al., 2022; Plow et al., 2019; Sclarsky & Kumar, 2021). Two of the studies were published in the American Journal of Occupational Therapy (Boehm et al., 2015; Sclarsky & Kumar, 2021), and one in a rehabilitative journal (Plow et al., 2019); two within aging-specific journals (Laver et al., 2020; Perkins et al., 2022); four within health-specific journals (Beit Yosef et al., 2022; Lafaro et al., 2020; Murphy et al., 2021; Scriven et al., 2019), and one in a technology-specific journal (Breeden, 2016). Eight studies used an electronic audio-visual telehealth delivery method, and two studies used a teleconference (telephone/cell phone) delivery method.

Figure 1.

PRISMA 2009 Flow of information through the phases of the scoping review

Note. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Source. Adapted from Moher et al. (2009).

Theoretical Framework/Models

The selected studies used different theoretical models to inform the design and implementation of the EB interventions (see Table 1). The Perkins et al.’s (2022) study used the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) domains of: intervention characteristics, setting, individual characteristics, and process to develop the cognitive stimulation therapy (CST) model (Spector et al., 2003). CST is an EB intervention for older adults living with dementia to engage in meaningful and stimulating activities, with the goal of maintaining memory and mental functioning. The Breeden (2016) study used constructivist learning theory (Clark & Rossiter, 2008) to guide clients through how they can discover meaning in the intervention within their home environment by organizing the clients’ thought process and building a narrative. The study also included Spradley’s (1979) Developmental Research Sequence to guide the therapists’ qualitative inquiry with open-ended, broad descriptive, structural-based, and contrasting questions to facilitate self-directed change. Finally, Laver and colleagues (2020) used an adapted version of the Care of Persons with dementia in their Environments (Gitlin et al., 2010) dyadic program to employ nonpharmacologic approaches and best clinical practices to support physical function of those with dementia using behavioral strategies. Three studies used client centered practice where the preferences and needs of the individual were considered, supported, and respected; and the strengths and expertise of the client are acknowledged (Whalley Hammell, 2013). First, the Beit Yosef et al. (2022) study focused on participation as outlined in the International Classification of Functioning, Disability, and Health (World Health Organization, 2001), and the Cognitive Orientation to Daily Occupational Performance (CO-OP; Dawson et al., 2009) approach to systematically promote holistic participation among the older adults. Second, Lafaro and colleagues (2020) used the Chronic Care Self-Management (CCM; McCorkle et al., 2011) model to encourage skill-building through planning and building self-efficacy through one-on-one coaching. Finally, the Sclarsky and Kumar (2021) study used the Person-Environmental-Occupational-Performance (PEOP; Baum & Christiansen, 2015) model to examine the personal and dynamic factors of service delivery (e.g., client, physical context, desired occupation, and level of performance).

Intervention and Key Findings

Study Theme: Cognition

Perkins and colleagues (2022) used CST (Spector et al., 2003; Streater et al., 2012), a psychological intervention for those aging with cognitive impairment (N = 10 groups of 3–4 older adults, specified number of participants not provided by the field study). The original CST protocol was adapted to a virtual format, vCST, over the Zoom technology platform. Participants completed two weekly 45 to 60 minute telehealth sessions for 7 weeks. The sessions involving physical objects or show and tell sparked participant engagement, but the sessions that involved the Zoom shared screen feature, multi-step instruction, and activities out of the camera’s view were more difficult for the participants to engage in. Overall, the virtual delivery of CST was feasible and promising but required modifications such as a greater reliance on caregivers and clients for accessing the electronic devices, and digital literacy and use of virtual platforms to carry out the intervention (Perkins et al., 2022).

Study Theme: Environment/Home Modification.

The Breeden (2016) case study used the VSee (2013) software program to facilitate client reflective activity by answering open-ended, descriptive, and contrasting questions to promote discussion of prior safety issues, fall incidents, and environmental hazards/conditions with older adults (N = 6) (Spradley, 1979). Participants completed one telehealth session per week for 3 weeks. The participants sent photos of their home prior to the session, which were used for discussion and training on home safety, recommendations, use of adaptive equipment, fall risks in the home, and fall prevention. Older adults were comfortable with the use of the technology platform for the sessions, and their cell phone to capture the pictures. The participants’ home modification scores, as measured by the SAFER-HOME version 3 assessment (Chiu & Oliver, 2006), demonstrated improvement from pre–post intervention.

Study Theme: Health Management

The Scriven et al. (2019) study used the Manage Your Pain–South West (MYP-SW) program, which used an Acceptance and Commitment Therapy (ACT)-based approach focused on education and the neurophysiology of persistent pain and the development of active self-management strategies (Vowles et al., 2009). The participants (N = 21) from rural areas with chronic pain accessed and participated in the program using a hub-and-spoke model telehealth system. Within this model, specialists and occupational therapists led the pain management service and delivered the program to participants at multiple rural/remote spoke sites simultaneously for one, 2-hour session per week for 4 weeks. Approximately 95% of participants indicated they would use telehealth in the future, and ⅔ of the participants preferred telehealth as an alternative to in person sessions. Participants reported a higher level of pain acceptance, with a positive change in functional capacity, after the intervention.

Study Theme: Occupation Engagement

The Laver et al. (2020) study used the Care of Persons with Dementia in their Environments (COPE) dyadic intervention (Gitlin et al., 2010) which involves assessment of the person with dementia, the care partner and their environment followed by identification of key care challenges. This study examined the delivery method (telehealth vs. in home) of a dyadic dementia care program in relation to older adults’ (N = 63) activities of daily living, and type and frequency of behavioral symptoms. The intervention was adapted in this study and delivered through the Cisco WebEx software for eight, 60-minute sessions over 16 weeks. Both groups reported significant improvements in the caregiver’s perception of change. While the amount of time spent delivering the program was similar for the in person versus telehealth sessions, the telehealth delivery method significantly reduced travel time for the therapist and clients. The study concluded dyadic intervention via telehealth is feasible and results in similar benefits regardless of the type of service delivery.

Study Theme: Performance-Based

Five studies used a performance-based EB intervention (Boop et al., 2020), three of which were RCTs. First, the Beit Yosef et al. (2022) study used the Cognitive Orientation to Daily Occupational Performance approach (CO-OP; Dawson et al., 2009), with an adapted tele-CO-OP group versus a control waitlist group for individuals with Multiple Sclerosis (N = 16). Participants received videoconferencing/Skype sessions for 14 weeks. The tele-CO–OP group showed greater improvement in their Canadian Occupational Performance Measure (COPM; Law et al., 1990) performance and satisfaction scores than the waitlist control group participants (Beit Yosef et al., 2022). Second, the Murphy et al. (2021) study investigated the Rehabilitation for Arm Coordination and Hand (REACH; Murphy et al., 2018) EB upper extremity intervention with App-delivered home exercises (intensive group) and occupational therapy sessions, compared to App-delivered home exercise only (telehealth group) for individuals with scleroderma (N = 32). Participants completed weekly 45- to 60-minute sessions over 7 weeks. While the intensive group had more improvements over the first 8 weeks of the study, after follow-up at 18 weeks, both groups experienced clinically meaningful improvements in the QuickDASH hand disability. Third, the Plow et al. (2019) RCT physical activity and fatigue self-management intervention was delivered over the telephone with individuals with multiple sclerosis (N = 208). Participants were randomized to three separate intervention groups (a contact–control, physical activity only, and physical activity with fatigue management). Participants received three to six group teleconference calls followed by four tailored phone calls with each individual over 12 weeks. All participants experienced a small yet statistically significant impact on increasing physical activity and managing fatigue. However, there were no significant differences among the three groups pre–post intervention in terms of falls, orthopedic injuries, and health and wellness services suggesting the mode of delivery did not impact the health outcomes of participants in any of the groups. The two case control studies within this group provided nuanced experiences of intervention through telehealth delivery.

The Sclarsky and Kumar (2021) study focused on engagement during meals, participation in activities of daily living, and leisure participation for the client living with dementia. Participants completed 2 to 3, 60-minute telehealth sessions over 30 days. Participants’ performance and satisfaction scores on the COPM showed significant improvements for specific task outcomes including fall prevention from pre–post intervention. The Boehm et al. (2015) study investigated the effectiveness of the EB intervention, managing fatigue: A 6-Week Course for Energy Conservation, via telehealth for individuals with poststroke fatigue. The intervention focused on energy conservation techniques, specifically pacing and balancing rest with activity, client education, and wellness and self-management strategies via one telehealth session per week for 3 weeks. Participants’ scores on the COPM showed improvement in self-rated performance in activities of daily living and satisfaction from pre–post intervention. The final study under this theme, Lafaro et al. (2020) used an experimental design to implement the CCM Model (McCorkle et al., 2011) EB intervention strategies with older adults undergoing cancer surgery (N = 34). The intervention included a personalized walking program, using SMART goal setting, including reviewing and revising SMART goals to identify, define, and overcome functional barriers. Participants completed four telehealth sessions: (a) before surgery via Zoom; (b) in-person before discharge; (c) 1–2 visits via Zoom post discharge; and (d) 2–4 weeks after discharge via Zoom. The intervention resulted in improved postoperative outcomes by promoting perioperative physical activity, behavioral change, and self-monitoring approaches; with a 70% retention rate.

Discussion

We conducted a scoping review to synthesize the evidence regarding EB intervention via telehealth services; and the method used to deliver EB intervention with older adults within occupational therapy or by occupational therapists. There is an increasing interest in the use of electronic/technology devices and intervention options among older adult populations. A recent American Association of Retired Persons (AARP) survey noted over half of adults age ≥70 years owns one or more electronic device with daily use; and spends on average $1,144 on technology, an increase from $394 in 2019 (Kakulla, 2021). It is optimal to implement EB interventions to meet the needs of a growing tech savvy older adult population, especially those who are not able or do not want to attend in-person therapy sessions due to extenuating factors (e.g., chronic illness or disability). EB intervention is a key component of older adults/participants’ self-efficacy and self-directed change (Juckett & Robinson, 2018), as highlighted within the methodology used within the EB intervention examples.

Similar to the Ninnis et al.’s (2019) scoping review, this review was inclusive of different study designs to present a comprehensive body of literature. It is important to acknowledge this review examines what is published in the literature and may not be a comprehensive representation of the telehealth delivery occurring in clinical and community practice. In response to research question 1: In older adult populations, what EB interventions are delivered through telehealth in occupational therapy and/or by occupational therapist? Occupational therapists are using other telehealth modes of delivery and EB in their current practice but have not disseminated this information within the profession or general public (Hwang & Shim, 2021; Ninnis et al., 2019). As the demand for telehealth service grows and technology becomes even more prevalent within older adult populations, the profession (OT) will need definitive information about the efficacy and limitations of EB intervention and telehealth delivery.

Overall, the studies noted it was feasible to administer the interventions and accompanying assessments via telehealth and, in some cases, proved to be more efficient than in person administration. However, the aforementioned AARP study noted 44% of older adults are not confident in the privacy of the information shared over technology platforms and devices (Kakulla, 2021). Thus, ongoing workshops and standardized training modules are warranted to ensure the consistency and the confidentiality of the services delivered through telehealth platforms are met (Ninnis et al., 2019).

In response to research question 2: What modes of telehealth were used to deliver the EB interventions? The consideration of older adults’ age-related risk and equitable access to telehealth services and supports (e.g., access to Wi-Fi service, electronic tablets, and cellphones) were vital to the implementation of telehealth services provided. Significant findings from this review were: (a) eight studies used an electronic audio-visual delivery method (e.g., Zoom, Skype, Web Ex) and (b) two studies used a teleconference (telephone/cell phone) delivery method. The studies within this scoping review acknowledged how barriers such as digital literacy and accessibility to electronic devices and Wi-Fi, and caregiver support influenced the implementation of telehealth services. The studies within this review addressed these barriers in real time by providing: educational resources to clients and caregivers, electronic devices, and research team/staff support to remediate limitations.

Limitations and Future Directions

One limitation is that we conducted our search using six databases and may have missed other relevant studies only available in other databases not accessed, or in studies not published in English. The sample sizes varied greatly within the selected studies, with 70% of the studies containing less than 25 participants; the small sample sizes may decrease the generalizability of the studies. In addition, the studies may not be transferable to the global south dependent on the availability of technology resources and telehealth accessibility (Doraiswamy et al., 2021). The case report studies used a qualitative method of data collection which limits the generalizability of the studies. Future research is needed to (a) assess the impact of EB intervention and the accessibility of telehealth delivery for older adults on a local and federal policy level; (b) develop multifaceted studies with varying sample sizes to examine older adults’ lived experiences and technology needs; and (c) evaluate the effectiveness of intervention through telehealth delivery (Centers for Disease Control and Prevention, 2022).

Conclusion

This scoping review highlighted EB interventions delivered via telehealth, and older adults’ overall experiences, perceptions, and satisfaction with the delivery method. The findings demonstrated the positive experiences the older adults and their caregivers had with the telehealth delivery methods; and acknowledged the benefits of the technology due to the limited in-person therapy services available due to the COVID19 pandemic restrictions, limited transportation options, and/or geographical location. In conclusion, telehealth and EB intervention has demonstrated its effectiveness within older adult populations, it is vital for occupational therapy to continue to show professional leadership in this area to foster best practice and utilization among practitioners.