Introduction
Dr. Ann Wilcock and Dr. Elizabeth Townsend coined the term occupational justice. “Occupational justice can be described as an equitable opportunity and resources to enable people’s engagement in meaningful occupations” (Wilcock & Townsend, 2000, p. 85). Conversely, occupational injustice can be considered whenever services are not provided and needs are not met. Occupational justice and occupational therapy can help such elders reduce their dependency on others and improve their quality of life.
Occupational justice
The topic of occupational justice and aging in nursing facilities has been discussed in a few books written by occupational therapists. The idea of occupational justice is based on two basic concepts: people have the potential to achieve the highest level of personal development through the things they do, and that they have rights about the occupation (Van Bruggen, 2008).
Townsend and Wilcock summarize this as “the right to experience occupation as meaningful and enriching, participate in occupations for health and social inclusion, exert autonomy through the choice of occupations, and benefit from diverse participation in occupations” (Van Bruggen, 2008).
In our society, social discrimination or unjust social conditions exist based on age, sex, race, sexual orientation, social class, ethnicity, etc. This puts such groups of people at a disadvantage when compared to others (Wilcock & Townsend, 2000). “Occupational equity calls humans to match meaning with competence, value with capacity and opportunity” (Wilcock & Townsend, 2000).
Although many people do find occupations, which are meaningful and fulfilling, there are others who for various reasons are not able to fulfill or develop their occupational potential. Therefore, finding a meaningful occupation is a practical way of transforming a person and the community. In addition, such a transformation “could be politically and organizationally directed towards health, well-being, happiness, and even the survival of humans” (Wilcock & Townsend, 2000).
Elderly in nursing facilities
Statistical reports in 1995 revealed that at least 4% of the population aged 65 years and above stayed in nursing facilities (Meiner & Lueckenotte, 2005). However, the quality of life of the elderly in nursing homes varies widely. While accounts of a kind, compassionate care are common, there are also reports of inhumane, insensitive treatment of inmates, as well as incidents of physical and mental abuse. Paradoxically, the kind of environment in nursing homes where everything is taken care of for the elderly inmates can be counterproductive. The elderly inmates tend to lose control of their lives and their activity level and psychological well-being decreases (Hess & Markson, 1990).
Occupational Therapy
Occupational Therapy does discuss this topic, including theoretical insights, the aging process, current interventional strategies, etc. Occupational therapy needs to understand this topic in greater detail because with improving life expectancy, there is a need to ensure that the elderly be able to lead a fulfilling and independent life.
According to the American Occupational Therapy Association, occupational therapy is defined as the “use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability, and which develop, improve, sustain or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, physical disability, or other disorder or condition” (Brown, 1999).
The Well Elderly Study was conducted by the Agency for Healthcare Research and Quality (AHRQ) along with the National Institute on Aging and the National Center for Medical Rehabilitation Research. Conducted for 9 months, in people aged 60 years and above, this study evaluated the effectiveness of preventive occupational therapy as a way to avoid functional disability. Group and individual occupational therapy was given to one group of patients over a week, which focused on home and community safety, shopping, mastering the public transportation system, joint protection, adaptive equipment, energy conservation, exercise, and nutrition. The second group of patients participated in a program that relied on social activities, such as community outings, craft projects, films, games, and dances (AHRQ, 2002).
Findings at the end of the study showed that those who were in the occupational therapy group had a better quality of interaction with others, better health, more satisfactory life, better mental health, physical functioning, role functioning, vitality, and social functioning, less pain, and lesser emotional problems (AHRQ, 2002). A reassessment was done six months later on the occupational therapy group of patients. It was found that these patients continued to have the same improvements as noted above (AHRQ, 2002).
Traditionally, occupational therapists have worked with marginalized groups of people in society like the elderly and those with physical, intellectual, or emotional disabilities (Van Bruggen, 2008). As far as the elderly are concerned, the occupational therapist should holistically approach their treatment because the elderly are more likely to have more than one physical or psychological disorder. Occupational therapists working with elderly patients must be able to deal with independent living needs, physical limitations, cognitive changes, and psychological adjustment. Some common disorders include arthritis, hypertension, diabetes, and visual and hearing problems. Occupational therapists will need to carefully assess the elderly client’s status in all three functional areas. Care must be taken to consider any secondary conditions that may affect the client’s total function; prevention of further disability is an additional consideration (Punwar & Peloquin, 2000).
Occupational therapists should encourage the client to identify personal goals and priorities so that the treatment program can be individually tailored to the client’s needs. Group activities are particularly successful with older people because they promote socialization as well as maintain physical and mental abilities. Safety is always a concern with the impaired elderly and assessment of functional performance is critical to judgments about a client’s ability to live safely at home. Therapy is also aimed at improving cognitive awareness and psychological adjustment (Punwar & Peloquin, 2000).
Occupational therapy can help the elderly to remain independent and healthy for a longer period, reduce the morbidity and effects of disability as well health costs (Lewis, 2003).
Conclusion
Occupational justice can be defined as giving equal opportunities and resources to enable people to pursue meaningful occupations. Finding a meaningful occupation is a practical way of transforming a person and the community. The quality of life of the elderly in nursing homes varies widely from compassionate care to inhumane, insensitive treatment of inmates, as well as physical and mental abuse. Ironically, even though everything is taken care of for the elderly inmates, this can lead to a loss of control of their lives, and a decrease in their activity level and psychological well-being. This can be overcome or prevented by occupational therapy.
Occupational therapy can be defined as purposeful activity or interventions that promote health, prevent injury or disability, and develop, improve, sustain or restore the highest possible level of independence.
The Well Elderly Study conducted over 9 months, in people aged 60 years and above, evaluated the effectiveness of preventive occupational therapy as a way to avoid functional disability. This study showed that the elderly assigned to the occupational therapy group had a better quality of interaction with others, better health, more satisfactory life, better mental health, physical functioning, role functioning, vitality, and social functioning, less pain, and lesser emotional problems.
Occupational therapists who work with marginalized groups of people in society like the elderly should holistically approach treatment because the elderly are more likely to have multiple physical or psychological disorders. Occupational therapy can help the elderly to remain independent and healthy for a longer period, reducing the morbidity and effects of disability as well as health costs.
References
- AHRQ (2002). Managing Osteoarthritis.
- Brown, J.B (1999). Physical and occupational therapy in nursing homes: medical necessity and quality of care.
- Hess, B.B. & Markson, E.W (1990). Growing old in America. Transaction Publishers.
- Lewis, S.C (2003). Elder care in occupational therapy. SLACK Incorporated
- Meiner, S & Lueckenotte, A.G (2005). Gerontologic nursing. Edition: 3 Elsevier Health Sciences.
- Punwar, A.J. & Peloquin, S.M (2000). Occupational therapy: principles and practice. Lippincott Williams & Wilkins.
- Van Bruggen, H (2008). Occupational Therapy and Mental Health. Elsevier Health Sciences.
- Wilcock, A.A. & Townsend, E. (2000). Occupational terminology interactive dialogue: Occupational justice. Journal of Occupational Science, 7(2), 84-86.