Activity pacing for deconditioned older adults in sub-acute care

Older adults who are admitted to an acute hospital with a medical condition often recover, but during hospitalisation can develop functional decline termed deconditioning. This deconditioning not only effects physical fitness but can also reduce levels of confidence and the capacity of an older adult to complete everyday tasks. When this level of hospital associated deconditioning impacts significantly on the older adult’s ability to return home, a period of rehabilitation is often recommended. Multidisciplinary health professionals work with the older adult to minimise the impact of the deconditioning that has occurred and facilitate a return to usual activities of daily living. Occupational therapists are one of these health professionals. Occupational therapists aim to enable deconditioned older adults to participate in their meaningful every day occupations. However, there is currently limited evidence for occupational therapists on how to best achieve this goal. The research program presented in this thesis was undertaken in response to a lack of knowledge to guide occupational therapists working with deconditioned older adults in a rehabilitation setting. The research program included a systematic review to establish current evidence. It concluded that while there was limited evidence supporting multidisciplinary rehabilitation for deconditioned older adults, there was almost no evidence regarding the duration of rehabilitation, types of interventions and the intensity of these interventions for the different disciplines, including occupational therapy, when working with this population. A Delphi study established a consensus expert opinion to guide occupational therapists regarding the type of treatment interventions that should be included in rehabilitation with deconditioned older adults and how these interventions should be delivered. One of the rehabilitation interventions identified in the consensus process, activity pacing, was then further defined within a framework of occupation and deconditioning. Eleven outcome measures to evaluate the possible changes in older adults when receiving this activity pacing intervention were identified. The research then assessed the impact of this intervention in a randomised controlled trial and found a small effect that older adults receiving activity pacing were more likely to better manage their daily routines on returning to their home environment (F (1,96)=4.125, p=.045, partial eta squared=.041). A major limitation of this study was achieving an independent control group in a rehabilitation setting, where all participants are involved in some degree of training and practice of new knowledge in activity pacing to improve independence and achieve their goals. Implications of the findings in this thesis were discussed for different stakeholders and suggestions for future research were identified. Hospital associated deconditioning continues to occur in the acute hospital setting with older adults. The research included in this thesis has contributed to the evidence base for occupational therapy interventions for older adults undergoing rehabilitation following the development of this deconditioning. As a result of this research program, occupational therapists working with this group of people have guidance in what an activity pacing intervention can include, how this treatment can be delivered and suitable tools to measure the change that occurs from participating in an activity pacing program. Finally this research has laid a foundation of evidence upon which further investigations into the use of an activity pacing intervention with deconditioned older adults, can be built.