Table 1.
Dimension | Target area : goal | Treatment Approach |
---|---|---|
Extrinsic: | Housing safety: Modify and repair built environment to decrease fall risk and increase mobility | 1) OT assesses house for safety risks. Creates prioritized list for HM examples of which are: fill in holes in floors, stabilize shaky banisters, caulk holes, control pests, lower microwave to reachable height, install tailored bathroom safety equipment. |
Intrinsic: Individual Factors | Self-care: ↑ ability to independently conduct ADLs and IADLs | 1) For each participant-identified area of concern, the OT a. observes performance; b. with participant, identifies solutions for priority concerns, c. orders, installs, and trains participant in the use of the adaptive devices. 2) The HM installs adaptive devices such as raised toilet seats and shower chairs. |
Communication with PCP: Enhance patient activation to facilitate safe management | 1) RN provides Health passport; 2) medication simplification; 3) letters from RN to PCP on medication issues; 4) RN refers participants to new PCP if have none or Housecalls PCP if unable/unwilling to leave home; 5) Patient activation training by RN | |
Medication Management: ↑ ability to adhere to medication regime | RN helps participant identify medication management problems and solutions such as 1) patient education on medication need; 2) dose timing; 3) physical reminders; 4) medications with fall implications | |
Intrinsic: Physiologic factors | Strength/balance: ↑ ability to stand, balance, and recover from falls, near-falls | 1) RN implements NIA exercise with participant; 2) RN assesses interest in DVD’s of TaiChi and tailored home visits from Tai Chi instructors; 3) RN assesses interest in exercise bands; 4) OT trains in fall recovery; 5) OT and RN reinforce strength and balance strategies at each visit. |
Depression: Enhance skills for mood management | RN implements an evidence-based depression intervention if necessary. 1) The participant identifies problems such as social isolation, health care needs, and housing-related issues that feel overwhelming; 2) participant and RN generate multiple solutions, evaluate and compare solutions;3)participant implements the chosen solution; 4) participant and RN evaluate the outcome. | |
Pain: To decrease pain to facilitate function | 1) RN does thorough pain assessment 2) RN advocates on behalf of participant with PCP re pain medication 3) RN educates participant on timing and dosing of pain medication; 4) RN provides other pain management techniques such as topical NSAIDs, distraction, mobility, heat |
OT = Occupational Therapist
RN = Registered Nurse
HM = Handyman
PCP = Primary Care Provider
ADL = Activity of Daily Living
IADL = Instrumental Activity of Daily Living
NIA = National Institute on Aging
DVD = Digital Video Disk
NSAIDs = Non-steroidal anti-inflammatory medications