Outcomes of protocol-based and adaptation-based occupational therapy interventions for low-income elderly persons on a transitional unit

Objectives. The study objectives were to describe (a) adaptation trajectori es of elderly persons treated on a transitional unit for deconditioning and tracked after their return to the community, (b) an individualized adaptat ion-based intervention provided to selected elderly persons in addition to protocol-based treatment for deconditioning, (c) goals and outcomes of thes e two interventions, and (d) contrasting perceptions of outcomes by elderly persons, their family members, and their therapists. Method. A longitudinal qualitative design was used to track 8 participants from transitional unit to community. Data on the protocol-based interventio n were obtained from chart review and therapist interviews. Data on the ada ptation-based intervention were obtained fi om the Client-Centered Evaluati on and Community Adaptive Planning Assessment, which were used for goal set ting and problem solving. In the community, contrasting perspectives on out comes were obtained from the participants, their family members, and their therapists through semistructured interviews. Results. Participants' adaptation trajectories revealed that half relocated to new living arrangements after discharge from the transitional unit. At the time of follow-up, 91 % of the protocol-based goals and 100% of the ada ptation-based goals had been met in some fashion, with modification in the goal or development of new solutions in some cases. Outcomes valued by the participants were returning to former occupations and relationships;family members valued getting quality care for the participant; and therapists val ued improvement in strength, endurance, and increased independence in activ ities of daily living (ADL). Conclusion. Findings support use of an individualized consultative interven tion that addresses occupational performance areas and performance contexts combined with a protocol-based hands-on intervention that addresses perfor mance components and basic ADL for elderly persons with multiple chronic il lnesses.