Introduction to the Fourth Edition

In the 2 decades since the first edition of this book was published, the aging of the global population has continued apace. Although some realities about aging remain constant, the experience has changed in important ways. Many of these changes are very positive: good health until later in life, continuing engagement with important occupations, improved societal perceptions about aging and older adults. However, these positive changes do not represent universal realities. In some places, older adults continue to be marginalized and devalued. Good health is not a certainty, particularly in the developing world and among lower socioeconomic groups. Ensuring adequate financial and instrumental resources can be a struggle for many.

Yet all of us are, if we're lucky, headed toward old age. Many of us have loved ones who are already there—or perhaps we're there ourselves. Much can be done to promote positive aging for everyone, and much is already being done; physical and occupational therapists are actively engaged in these efforts and have tremendous contributions to make in ensuring the best possible experience of later life for everyone.

This volume is greatly expanded from previous versions: an acknowledgment of the complexity of the aging experience, the science that contributes to positive aging, and the specific considerations that therapists must bring to their efforts to support older adults.

The major organizing principle for this edition is the International Classification of Function (ICF; World Health Organization, 2001/2008). This structure reflects a framework often used by physical therapists and is closely aligned with the related Occupational Therapy Practice Framework (3rd ed.; American Occupational Therapy Association, 2014). The choice to use the ICF to organize the material reflects our wish to promote professional collaboration, acknowledging the close relationship between occupational therapy (OT) and physical therapy (PT) and the increasing emphasis in health care on interprofessional practice.

Incorporating the perspectives of two health professions in a single book has been surprisingly challenging. We, and our reviewers, had lively discussions about professional roles, boundaries, and interactions. You may disagree with some of our assertions about the roles of the two disciplines. These disagreements may depend not only on your field, but also on where you practice. Some countries (Canada, for example) are more likely to be comfortable with some crossing of professional boundaries. In some settings in the United States (especially rural and inner city), boundary crossing may be essential because there may be limited access to any care at all. We have also incorporated consideration of how PT and OT interact with other disciplines. The "Interprofessional Practice" boxes throughout the book provide insights about the health-care team as a whole. Effective practice in working with older adults requires that team: something to keep in mind as you make use of the material presented here.

Using This Book

Each chapter begins and ends with a clinical case, some briefly presented, others more fully developed. These are designed to help readers apply the facts on a given topic. Most cases focus on individuals, but some emphasize population-based interventions. PT and OT both work increasingly in these more global kinds of care, helping to adapt environments, for example, or addressing public policy. In a few instances, cases appear more than once, with a different focus related to new material in a given chapter, or they appear at the start and end of a chapter to encourage more in-depth consideration of a situation.

Each chapter also includes a number of feature boxes in addition to "Interprofessional Practice." "Around the Globe" boxes are designed to promote understanding of what is universal and what is culturally and societally mediated about aging. They also provide interesting ideas that may be trans-ferrable from one location to another. The "Promoting Best Practice" boxes highlight research that can inform practice. Keep in mind that most of the material in the book is based on evidence. Evidence-based practice is not simply about reading the occasional study; it requires exploring what is known about any condition, situation, or intervention that is part of your work and applying that knowledge to treatment planning and delivery.

Although we tried to avoid excessive overlap, some is unavoidable. Both the normal changes associated with aging and the many possible illnesses and disabilities that can develop reflect complicated factors, with many interacting dynamics. To ensure adequate coverage, some linked material appears in several chapters. For example, cardiovascular accident (CVA/stroke) is a vascular event, so it fits the discussion of cardiopulmonary conditions of later life, but it also has significant cognitive, musculoskeletal, and sensory consequences, so some material fit those chapters. In the end, we included relevant content in several places where it made sense to do so.

Likewise, material focused on evaluation and intervention had relevance for many topics. So the chapters on how systems age have a primary focus on the probable and potential changes that occur, but where it seemed logical, discussion of evaluating cardiovascular function, vision, pulmonary capacity, and so on has been included. Relevant information about exercise, one of the most vital interventions for both well and impaired older adults, is included in several chapters, each with a somewhat different emphasis. You will want to refer back and forth to build a comprehensive perspective, recognizing that it is simply not feasible to provide every piece of information simultaneously.

This edition also has a robust online supplement where a wealth of information can be found: websites, video links, lists of assessments, news articles, case studies, video lectures, and more. We hope you will use these liberally and that the online materials will serve as a good resource for practice.

Understanding later life and focusing on enhancing positive aging can benefit not just older adults but their families, friends, communities, and society at large. We hope that as you read and as you move from learning to application, you will consider the ways in which this material can help you make a difference in your communities, your work, and in your own lives.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. http://dx.doi.org/10-5014/ajot.2014.682006

World Health Organization. (2001). International classification of function. Geneva: Author. Retrieved from www3.who.int/icf

World Health Organization (2008). ICF: International classification of functioning, disability, and health. Geneva: Author.