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"The capacity to do something useful for yourself or others is key to personhood, whether it involves the ability to earn a living, cook a meal, put on shoes in the morning, or whatever other skill needs to be mastered at the moment."
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—M.C. Bateson (1996, p. 11)
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
Define self-care activities within the domains of everyday occupations.
Distinguish between activities of daily living (ADL) and instrumental ADL (IADL) activities and describe their relevance in health, wellness, and quality of life.
Identify the symbolic and practical meanings of self-care activities.
Understand the performance of self-care activities as a function of the individual and the environment.
Understand the relationship between self-care performance and perceptions of competence and control.
Summarize research findings on limitations in self-care.
Identify common assessments of ADL and IADL used for older adults.
Identify intervention strategies for enabling self-care performance.
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Clinical Vignette
Robert Macarthur is a 75-year-old man recently diagnosed with Parkinson's disease and mild dementia. He lives alone in his three-story home and until recently was able to manage with occasional help from friends. Over the past few months, Robert has developed tremors and difficulty with gross and fine motor movement. He is able to walk but is slow and unsteady. Stairs have been difficult as have showering and dressing.
Mr. Macarthur is a retired high school French teacher with a moderate pension, but recently his funds have diminished due to various medical costs and need for home adaptation. Historically he was very active, loved to play tournament tennis, and traveled the world with his ex-wife and various friends. He has expressed frustration at his decreased motor abilities and increased forgetfulness. He has one son who lives in the same city but no other family nearby for support. Mr. Macarthur's physician has recommended he consider moving, but he fears leaving his community and friends he values.
What are some of the psychological implications of Robert's situation, and how might an occupational therapist (OT) address them?
What might a physical therapist (PT) focus on in concert with the OT?
What are the current and potential effects of Robert's diagnoses on self-care?
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Acomplete understanding of the functional performance of older adults includes recognizing the importance of daily activities and how they contribute to overall health and well-being. Self-care skills are affected by declining function, including sensory limitations, cognitive declines, reduced strength and agility, and restricted mobility. These often accompany chronic disease and expected physiological changes that occur through the aging process. Emphasis is placed on preserving function and developing strategies to maximize quality of life throughout the performance of activities of daily living. This chapter considers self-care, a special category of the domain of everyday human activity that has important implications for the health and well-being of elderly persons.
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