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Three decades have passed since the first edition of this book was published in 1994. Since then, occupational therapy practice with older adults has grown significantly as the global population of older adults has surged. Health care systems have changed, society has changed, but occupational therapy’s commitment to supporting occupationally enriched lives for older adults remains steadfast.
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In western societies, health care for older adults provides an array of services for those who can afford care. In these same societies and across the globe, older adults may not have adequate health care, or even safe and stable living environments. Many continue to be marginalized and devalued. Good health is not a certainty, particularly in economically developing nations and among lower socioeconomic groups. Ensuring adequate financial and instrumental resources can be a struggle for many. There is much work for occupational therapists to do to support older adults’ physical, social, emotional, and spiritual wellbeing. Part of the occupational therapist’s role is to affirm the many ways in which older adults live meaningful lives and make important contributions to their families, communities, and societies.
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Many readers will recognize a subtle, but important change in the title of this textbook – Functional and Occupational Performance in Older Adults. This edition is written solely for occupational therapy students and clinicians. There is an increased emphasis on meaning and occupation and occupational performance in context. The holistic lens of occupation is paramount.
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The major organizing framework continues to be the International Classification of Function (ICF; World Health Organization, n.d.). The ICF provides structure to health care services globally as is reflected in international occupational therapy practice and it emphasizes the importance of wholistic care that integrates disciplines in tending to the needs of their clients. Beyond the title, this edition has other significant changes.
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Part I has new and reorganized chapters on culture, identity, relationships, and ethics. It puts meaning and occupation at the forefront, threaded through every chapter.
Part II, with a focus on body structures and body functions, has the most significant change as it provides a continuum perspective on health conditions – from typical aging to illness and/or dysfunction that may emerge in later life. New to this section is a chapter on special issues, including comorbidities and falls; and a chapter on metabolic conditions. Other material has been reorganized into a chapter on neuromotor conditions and a chapter on neurocognitive conditions, both reflecting up to date understandings of neuroscience.
Part III provides a deep dive into a range of occupations with new chapters on homemaking, sleep and self-management, and caregiving. Community mobility and driving are one chapter, also in recognition of the continuum of transportation needs and options. Rather than a separate chapter on technology, environmental modifications and assistive technologies are embedded in each chapter’s exemplar interventions.
Lastly, Part IV offers a continuum of care review, starting with an important chapter focused on evaluation with older adults, and adding a new chapter on acute care. Each chapter has an emphasis on interprofessional partners and advocating for both clients and services. The future of aging chapter bookends the early chapters in forecasting advances in healthcare, social changes, and technology.
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Our intention in these changes is to address the complexity of the aging experience in the current environment and enhance occupational therapy services for older adults.
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The changes in this fifth edition are designed to help students and instructors engage fully with the book as a whole. There are intentional areas where content is introduced and later addressed in a different context. To help readers follow these overlapping concepts, content is referenced to other chapters. The content has been significantly updated with best evidence for practice.
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Each chapter begins with a mini-case study and questions intended to provoke thought while reading the materials. These same questions can be used to guide students’ professional reasoning. Threaded case studies are incorporated within the chapters to encourage in-the-moment reflections on the content being read. Students and faculty are encouraged to think beyond the answers provided to additional responses to the question prompts. The reader will find that Part II case studies continue into Part IV – with the intention of helping students appreciate how occupational therapists provide services to older adults with conditions (as introduced in Part II) in different care contexts (found in Part IV).
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Embedded in the chapters are boxes, figures, tables, and promoting best practice resources, designed to offer helpful strategies and insights on specific topics. Each chapter ends with critical thinking questions to help readers explore their new understandings. The author’s responses to these questions are in Appendix A, thus providing the students and instructors ample space to create their own answers before considering the author’s perspectives. Appendix B is an assessment table, organized by ICF factors. While the textbook chapters reference literally hundreds of assessments, the table provides information about those most relevant to older adult practice, occupation, and psychometrically best practice. This same attention is paid to the glossary terms, where terms specific to understanding the chapter content are highlighted. Additional terms are clearly defined in the chapters themselves.
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For the instructors, online resources include chapter PowerPoint presentations, learning activities, a test bank, and instructor’s guide. We hope that the online materials will serve as strong resources for practice and instruction.
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Understanding later life and focusing on enhancing positive aging benefits not just older adults but their families, friends, communities, and society. 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.