Time for Reflection...A Sum Up So Far

Over the course of writing this blog, I have covered areas of the aging population phenomenon that will impact on occupational therapy practice in New Zealand. As a result, I have come to realise that occupational therapy has a lot to offer the aging population. I think we can rest assured that our profession is safe for a few years yet.

It has been an interesting experience writing this blog. Re-affirming myself with the technology and sourcing pictures and videos as well as the substance of my posts has been immensely enjoyable.

I feel attached to this subject because as a third year occupational therapy student, I will see the evolution of occupational therapy in years to come as it adapts to the aging population. I may even be involved in this adaptation, an exciting prospect.

I have learnt that occupational therapy needs to assert its role with the aging population. This has been acknowledged by Pete Hodgson, a former minister of health, in 2006 at the annual New Zealand Association of Occupational Therapy conference. Pete Hodgson, stated the need for occupational therapists to move towards defining and implementing their future role in population based health, especially with older citizens (Wilcock, 2007).

That means adjusting to working at population and community levels by adopting an upstream, 'health promotion' approach. It also means accommodating the rising number of people that will need intervention for a condition such as dementia by being innovative and holistic in our approach.

Occupational therapy will also need to embrace 'active aging' and become more culturally competent with the wide range of cultures that are becoming more prevalent in New Zealand.

I did not realise how significant the aging population phenomenon was until this year. I also did not have much interest in elder care. That has all changed; as I have learnt more I realise that the aging population will herald significant changes, particularly in healthcare. However, not all are negative and occupational therapy will play a key role in ensuring the ongoing health and wellbeing of older people in New Zealand.

Thank you for taking the time to read my blog. I hope it has been informative and provoked some thought.

Jamie

Guitar Man

One thing we must try to remember is that older people have a lifetime of skills and wisdom to impart. They are the window to our past and the mirror of our future.

Look at how proficient this elder gentleman is on the guitar. It is all accomplished with such ease and leisure.

As a guitar player myself, I hope I am half that good by the time I get to his age!

Jamie

Active Aging and Occupational Therapy

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Wilcock, (2007) has proposed the concept of 'active aging' as a means of older people staying healthy, active and satisfied. Looking at this with an occupational perspective; it is well established within occupational therapy literature that occupations contribute to individual health and well being (Borell, 2008 & Kielhofner, 2004). Therefore, active aging is a proactive means of maintaining mental, physical, social and emotional health through engagement in occupation rather than adhering to the commonly accepted social norm in western society, which is to quieten down as one ages (Wilcock, 2007).

Incorporating active aging in occupational therapy practice with older people could ensure higher therapeutic outcomes. Encouraging older people to be more active and not feel constrained by their age will ensure that older people are challenged, stimulated and fulfilled as they age. This will have a positive benefit on health. Wilcock, (2007, pg 15), argues in her article that active agers have to fight against ‘conventions, bureaucracy, families and health professionals’ in order to be able to age actively.

Wilcock, (2007) also asserts that occupational therapists should look past only addressing the needs of people with medically defined illness or disability and focus on the full spectrum of the aging population, including healthy individuals. This is in line with working at a population level; the 'upstream' approach that I discussed in a previous post about working at community and population levels. Remember, if active aging is one of the fences that stop people falling off the metaphorical cliff, then there are not as many people to rescue at the bottom.

I believe that Occupational therapy could narrow the barriers that hinder active aging by bringing it into the public consciousness. This could be done through advertising and awareness campaigns to the masses at a population level right down to regional and local involvement through district health boards, local councils, general practitioners and primary health organisations. Of course this approach would include the three principles of the Treaty of Waitangi; partnership, protection and participation.

Jamie

Retiring in an Aging New Zealand

It is very likely that in a few years, the age of retirement in New Zealand will rise as a result of the government evaluating its pension scheme that provides New Zealanders with superannuation from the age of 65. Older people will be expected to work longer when the aging population wheel starts turning faster.
You could argue both sides of the coins here...

On the positive side: Nowadays, older people in New Zealand enjoy the benefits of a high life expectancy due to our high standard of living and advances in medical science. We live longer, therefore we should work longer. Already in Australia the age at which citizens qualify for a pension is gradually rising 6 months every two years until it reaches 67 (Centre Link, 2009). Not only will older people remaining in the work force be good for our economy, new retirees such as baby boomers may not be able to support there desired lifestyle on a government pension. This may be an incentive to stay working.

And for the negative team: Citizens who reach 65 are entitled to retire and receive a government pension. They deserve this in return for the years of taxes they have contributed to New Zealand and for the children they have raised that have taken their place in the workforce. Having worked for so many years, time to oneself is that much more precious. Retirees are by no means unproductive members of society, many devote their time and money to charity, volunteering and community groups.

When the inevitable retirement age arises, occupational therapy could find a niche in this area of the aging population. By implementing return to work programmes or stay in work programmes occupational therapists would be instrumental in ensuring older people who remain in work longer are safe and not working outside their means.

It is my belief that a rise in the retirement age is inevitable. In order to accomodate the aging population, New Zealanders will need to work for longer. However, the government should take some responsibilty and give options for a 32 hour or less working week for people over the age of 65. This will help ensure that burnout does not occur and older people remain satisfied in the workforce.

I would be interested to know the opinions of others in this area.

Jamie

Occupational Therapy and Demetia

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At present there are approximately 41,000 New Zealanders living with dementia, this is expected to increase to 77,000 in 2026 (Ryall, 2010 ¶ 12). What can be done to cope with this huge increase? Ryall, 2010 has acknowledged that it is becoming increasingly harder to find suitable care for people with dementia. $5 million dollars a year for the next 5 years has been invested in respite beds for older people with dementia.

Is this enough? Respite care is only a few weeks, not a lifetime of care for someone as vulnerable as a dementia sufferer.

Occupational therapists have a lot to offer with elder dementia care. Not only could we be involved in the educating, role modelling and supporting of carers we are a proven resource in dementia units.

Gitlin, Corcoran & Leinmiller-Eckhardt (1995) as cited in Chung, (1997) state that occupational therapists often do not consider the needs of carers and the unique way they care for their stricken family member when intervening with older people with dementia. This leads to disillusionment and ultimately a lack of compliance with interventions on the carers part. Maybe this is an area that a framework could be established to ensure collaborative and proacvtive relationships are formed with carers?

What are your thoughts? If anybody has experience with dementia, I would be interested to hear from you.

Jamie

'The Art of Aging'

This is an interesting video about an older couple who confronted their fears of aging by incorporating it into their art. It is a good example of meaningful occupation helping 'baby boomers' come to terms with their mortality. Painting and sculpting older people helped them confront their beliefs and self perception as well as realise the beauty in aging.

I recommend this video as it aptly shows the transition from a negative to positive view about aging.

Cultural Change with the Aging Population

Over the last few decades, a wide number of varying ethnicities have settled in New Zealand, all of whom bring different cultures, values systems and ways of life. As a result of this, the face of older people is changing in New Zealand. This will result in occupational therapists needing to be more culturally aware and sensitive towards citizens of New Zealand as they age and hold onto their unique cultures (Wright St. Clair, 2008). This could possibly clash with currently held 'European' social norms (Wright St. Clair, 2008).

Already, occupational therapy is very aware and sensitive to tangata whaiora values in its competencies and clinical practice reflects these high standards. In the future, it will be essential to move from being culturally safe, to being culturally competent with a wide range of cultures as diversity of clients will be an integral part of New Zealand occupational therapy practice in the future.

Occupational therapists will need to be ever more tactful, sensitive and aware of their own beliefs and prejudices. An understanding of what 'meaningful occupation' to older people of other cultures encompasses will also be essential (Wright St. Clair, 2008). Linking back to working at a community and population level, the profession will need to ensure its messages can somehow relate to a wide range of cultures.

Jamie

Aging Population Video

Professor John Piggot talks about the aging population in relation to pensions and health expenditure. Although this is an Australian video, there are a lot of crossover issues in New Zealand.

The Future? OT at a Community and Population Level

What does working at a community and population level mean? I asked people I know and many didn't have a clue; I had to do some research to find out.

The research I did outlined to me the fact that all around us there are influences at community and population levels, mainly put out by the government, but we treat them as part of the wallpaper.

Who hasn't seen the hard hitting, clever adverts that show gruesome drink driving accidents, or friends intervening with binge drinkers and family abusers. Not to mention the oldest of them all, the quit smoking advertisements. Working at population and community levels is nothing new. It involves reaching, educating and influencing a wide audience as opposed to just one or two individuals at a time (Dyson, 2002). It would seem the New Zealand government is mastering this art.

Occupational therapy is moving towards working at these levels. In the future, it is going to become unfeasible for occupational therapists to work in the community seeing clients 1:1. In this role, they are acting as the ambulance at the bottom of the cliff, picking up the pieces. A better alternative is a fence at the top stopping people going over the edge.* This is referred to as an 'upstream approach' (Scriven & Atwal, 2004). Something has to give as the government will not keep supporting this type of intervention without measures in place to help prevent it.

A move to population based healthcare or 'health promotion' (Scriven & Atwal, 2004) is aimed at countering the strain the aging population will put on the healthcare system. To put this in perspective; Healthcare expenditure is set to rise 3.6% each year for the next fifty years (Dyson, 2002).

The government has already started. Objective 5 of the Health of Older People Strategy (2002) is aimed at promoting; ‘population-based health initiatives and programmes’, these initiatives will; ‘promote health and wellbeing in older age’ (Dyson, 2002, pg 38-45). The aims of this objective are; increasing physical activity, improving nutrition, reducing social isolation, decreasing depression and curtailing the number and frequency of falls in older people (Dyson, 2002).

Occupational therapists have a proven record of being of value in these areas. They just have to define their role within the changing face of New Zealand healthcare.

Jamie

*This analogy is used in class by one of our lecturers, it can be found in Scriven & Atwal (2004). Thanks Fiona!

Occupational Therapy Paradigm Change?

As the population ages and the government focuses on cost-effective ways to treat older people, new systems will be put in place by the Ministry of Health.

The onus will then be on the occupational therapy professions to adopt and adapt to these changes.

Therefore, it is my belief that a paradigm change may be inevitable as a result of this.

Occupational therapy (OT) is a very malleable profession. According to Kielhofner, (2004), OT has gone through five paradigms to arrive at the contemporary paradigm we follow today. Who is to say that this paradigm will not evolve again to encompass the changing face of older person’s healthcare as a result of the aging population?

I believe this is very real possibility as the aging population phenomenon is not only being experienced in New Zealand, but in most 'western' countries around the world (Gavrilov & Heuveline, 2003). These countries will also need to adapt the way they deliver healthcare, contributing to a paradigm change.

The occupational therapy profession is in a prime position to evolve and adapt its paradigm alongside the complicated factors that contribute to an aging population. To do this in line with the likely political developments that will take place in New Zealand, OT will need to change from working with clients at a 1:1 level to working at population and community levels.

This reality is being acknowledged at a higher level: In 2006, at the annual New Zealand Association of Occupational Therapy conference, the Minister of Health, Pete Hodgson, stated the need for occupational therapists to move towards defining and implementing their future role in population based health, especially with older citizens (Wilcock, 2007).

Working at community and population levels will be explored in my next post.

Jamie

Where We Stand

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It is a firm reality that New Zealand's population is aging. The challenge is not in changing this, but adapting to it, as it is already happening as a natural result of changing population demographics. Factors such as declining fertility rates (McDonald & Kippen, 2000), rising life expectancy and the follow on effect of the post war ‘baby boom’ from 1945 – 1963 (Daniels, 1988) all contribute to this change.

The challenge is managing and accommodating the aging population. The New Zealand government has already begun this process, through initiatives such as; the Health of older people strategy, kiwisaver and the recruitment and retention of qualified health workers - including occupational therapists. The aim of these changes enacted by the government is to have a positive and stimulatory effect on New Zealand as a nation, even as the proportion of younger people declines.

To put the aging population in perspective, the New Zealand government has predicted that by the late 2030’s, over 25% of all New Zealanders will be 65 years of age and over, compared with 12% in 2005 (Statistics New Zealand, 2006).

What are the challenges and implications of this for occupational therapy?
Is the profession safe with this change in population demographics?
What will have to change in the profession to adapt to the aging population?

These questions will be explored in further posts.

Jamie

Introduction

Greetings,

My name is Jamie Collier; I am a third year occupational therapy student at Otago Polytechnic in the South Island of New Zealand. I have created this blog to specifically explore the aging population phenomenon and what impact it will have on occupational therapy practice in New Zealand.

Some key areas I plan to discuss in my blog posts (always in regard to occupational therapy) include:

• Cultural safety with the Aging Population
• A possible paradigm change due to the aging population
• Occupational therapy at a community level
• Occupational therapy’s future within New Zealand as the population ages
• The Concept of ‘active aging’

And much more...

So stay tuned and feel free to comment on any posts that strike a chord with you, I welcome and value any opinions or thoughts.

Jamie