Improving Healthy Daily Activity in Older Adults with Multimorbidity: Efficacy and Acceptability of ActiveOT

TL;DR

A new therapy called ActiveOT helps older adults with multiple health conditions improve their daily healthy activities and is well accepted by participants.

Contribution

ActiveOT, combining behavioral activation and occupational therapy, is shown to effectively improve health-promoting daily activities in older adults with multimorbidity.

Findings

ActiveOT participants showed significantly higher COPM scores at 10 and 22 weeks compared to controls.

89% of ActiveOT participants experienced clinically meaningful improvements in daily activity performance.

Participants reported high satisfaction with the person-centered and flexible nature of the ActiveOT intervention.

Abstract

Nearly half of U.S. older adults have multimorbidity (≥2 chronic conditions) in addition to functional limitations that restrict engagement in health-promoting daily activity (e.g., sleep, medication-taking, physical activity). We tested a combination of behavioral activation and occupational therapy (n = 21) compared to brief education (n = 20) on performance of health-promoting daily activity, measured by the Canadian Occupational Performance Measure (COPM) at baseline, 10 weeks, and 22 weeks. “ActiveOT” was delivered by occupational therapists in 10 once-weekly sessions in participant homes. On average, the 41 participants were 73 years old, female, and identified as White. They averaged 4.0 chronic conditions (SD = 1.3), and 1.6 functional limitations (SD = 1.5). Baseline scores were not different between groups. At 10-weeks, the ActiveOT group had higher COPM scores (M = 7.3, SD = 1.7) compared to controls (M = 4.9, SD = 1.8; t(35)= 4.32, p < 0.001). This trend continued at the 22-week follow-up where the ActiveOT group had higher COPM scores (M = 7.8, SD = 1.2) than controls (M = 5.3, SD = 1.8; t (33) =4.81, p < 0.001). Between-group COPM scores reflected large effect sizes at 10 weeks (Cohen’s d = 1.42) and 22 weeks (Cohen’s d = 1.63), and 89% of ActiveOT participants experienced clinically meaningful improvements (MCID=3). We conducted semi-structured follow-up interviews with ActiveOT participants (n = 15) to understand the acceptability and satisfaction with the intervention and study processes. ActiveOT participants reported overall satisfaction with the intervention and appreciated the flexibility of goal areas and person-centered focus. ActiveOT participants demonstrated improved performance of health-promoting daily activity and evaluated the intervention favorably. Future work will focus on implementation of ActiveOT in primary care contexts.