Special issue: The ageing population – challenges and opportunities (I)

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This is the first of a two-part special issue addressing the ageing population and the opportunities and challenges for occupational therapy research and practice. Traditionally, and as has been well developed in many countries around the world, occupational therapy targeting older people delivers qualified programmes for preventive home visits, community-based rehabilitation, fall prevention, lifestyle redesign, assistive technology provision, and so forth. Research findings are increasingly transferred to practice contexts and serve to strengthen the quality of occupational therapy practices (Iwarsson, 2013). With population ageing already identified as a grand challenge at the international policy level a decade ago (European Commission, 2009), this special issue is timely and not only serves to highlight the potential of occupational therapy to contribute to much-required knowledge development, but also identifies demands facing our profession and discipline.

This issue comprises five interesting papers that exemplify the contributions of occupational therapy studies to research targeting the ageing population. The papers represent both well-known and novel intervention approaches and target groups, and display a variety of research designs and methodologies.

The first paper is a well-performed scoping review (Turcotte et al., 2018) summarising occupational therapy’s contribution to fostering older adults’ social participation. This review provides a comprehensive overview, which is very useful for both occupational research and practice. The results show that promising practices improve older adults’ participation in social activities and seem to be cost-effective, but also highlight some organisational and systemic barriers. Thus, an important observation is that there is a clear gap between promising practices and current occupational therapy services, speaking to a need for more efficient knowledge translation between research and practice.

Following this, two papers relating to occupational therapy interventions suggest how services could be developed and optimised. In their research article, based on a qualitative study from Denmark, Nielsen et al. (2018) interviewed 11 older adults. They describe how two explanatory syntheses were derived: ‘achieving and maintaining independence’ and ‘strategies used to improve and maintain occupational performance’. Their findings describe participants having a strong desire for independence and striving to improve and maintain their occupational performance through various strategies. The authors provide suggestions as to how current practices supporting older adults living in the community might be improved, and propose that it might be efficient to use ways of achieving a satisfying occupational performance that do not necessarily entail becoming fully independent, concluding that testing is required to ensure applicability in practice. Moreover, they recommend that occupational therapists focus on the use and transfer of problem-solving strategies. Highlighting a new area of practice for occupational therapists, an opinion piece by Du Toit and McGrath (2018) argues that there is a need for occupational therapy to support people ageing with dementia in prisons. The authors draw our attention to those vulnerable groups in society that previously may not have had access to occupational therapy. They point out that the potential of such services for this particular group remains to be studied.

Turning to a specific area of intervention that is well known and firmly established in occupational therapy, the last two research papers in this special issue focus on falls prevention. A study by Mackenzie et al. (2018) targets community-based occupational therapists in Australia and is relevant to the topic in examining their practices in preventing falls among older people before and after attending a home safety workshop. The study explores the outcomes and self-reported changes in practice after attending, concluding that although the study provides some support for the benefit of such educational endeavours, it clearly demonstrates that more is required to facilitate actual change in occupational therapy service delivery. Finally, the last paper in this special issue is a rigorously performed pilot study of a multi-factorial falls-prevention programme, implemented by occupational therapists and physiotherapists in primary healthcare in Sweden (Johansson et al., 2018). Involving 131 community-living older adults, the results show a significant decrease of fear of falling after the intervention. The authors propose that using a small-group learning environment in combination with learning-by-doing could be an effective approach to prevention of falls and fear of falling among community-living people over 65 years of age.

The call for this special issue on challenges and opportunities for occupational therapy in relation to the ageing population received many high-quality submissions, and more than enough for a two-part issue. The second part will be published in October this year and, in addition, other contributions will be published in regular issues of the journal. Colleagues worldwide submitted reports of their research, demonstrating a diversity of perspectives exemplifying the current state of occupational therapy addressing older people.

Increased life expectancy brings challenges not only at the individual level, but also for healthcare (Newbold and Hyrkäs, 2010) and social services, and occupational therapy research is developing to address such demands, a topic I will pursue at more length in my editorial for part two.