Western New York’s Aging Resource

Life Space and Environment Fit

Buffalo Occupational Therapy

 

Aging in Place and Productive Aging | Buffalo NY | Buffalo OT

Michelle Eliason, MS, OTR/L, C.D.S., CKTS

 

Occupational Therapy is a Leader in Productive Aging and Aging in Place 

Occupational therapy is grounded in theory, evidence based research, and a well-written framework. Buffalo Occupational Therapy, a subsidiary of Aging with Purpose, believes in a holistic approach in its evaluation and treatment execution in order to maintain alignment with the transactional relationship between the person, his environment, and his occupational activites/performance. The importance of ‘The Ecological Theory of Aging, Person-Environment Fit, Life Space, and Person-Environment-Occupation Theory is undeniable to the execution of an Aging in Place rehabiliative approach.

Occupational Therapy | Aging in Place Approach

The Ecological Theory of Aging (ETA), (Lawton & Nahemow, 1973) emphasizes that there is a unique combination of personal competence and environmental characteristics that together help support a person’s optimal level of functioning, maximizing both their comfort and performance potential. Personal competence factors can include sensory and physical abilities, mobility, and cognition; whereas environmental characteristics may include compliance with housing standards, overall neighborhood conditions, and access to public transportation, among others (Wahl, Iwarsson, & Oswald, 2012).  In terms of assessing physical environment, both personal and environmental factors are important to determine the “just right” fit for each individual with varying competencies and surrounding environmental characteristics. The P-E fit approach through the lens of the ETA can assist in the evaluation and assessment of comfort, independence, and safety in the home.

There continues to be a very large number of older adults who prefer to age in place (Wahl, Iwarsson & Oswald, 2012). Remaining in a familiar home environment provides continuity and a sense of control over important aspects and activities of daily life. Wahl et al. (2012) also discuss the P-E fit related processes of belonging and agency. The process of belonging describes how people form a relationship, whether it is affective, cognitive, behavioral, and/or social, to their environment. The process of agency focuses on the older adult’s behavior related to the environment, including housing-related control and autonomy. Overall, these additional P-E fit processes may further contribute to a greater understanding of the meaning and behaviors inherent in person-environment relationships.

The concept of person-environment (P-E) fit is defined as a balance, or match between a person’s functional skills and capacities and the supports or barriers in their surrounding environment (Iwarsson, 2005). This concept is centered on the hypothesis that the physical and social environment can either enhance or hinder a person’s performance and/or comfort with daily activities. Environmental challenges are physical and psychosocial barriers that people may experience in their home and home life that ultimately affect the ability to live independently. Physical environmental challenges include, but are not limited to, steps at the entrance of the house, living in a two-story home, and home and yard maintenance, among others. Psychosocial barriers may include a lack of motivation to maintain the home and/or remain active, a perceived lack of support for daily activity, and feelings of helplessness or dependence that hinder an older adult from feeling capable of living independently and safely at home and in the community. These environmental challenges are known to impact mobility, which is defined as the ability of a person to move around freely, safely, and reliably within their surrounding environment (Satariano et al., 2012). Lack of physical movement or activity can lead to health declines and other negative outcomes, including lowered well-being, an increased need for assistance or care, morbidity, and/or mortality, which ultimately affects a person’s overall quality of life.

Life-space refers to the area a person moves through in daily life.  It includes specific rooms within the home, the area immediately outside the home, the neighborhood and town.  Life space has a tendency to shrink with age due to functional limitations caused by physical and cognitive changes during aging (Rantanen et al., 2012).  As people age, health declines can influence the ability of an older adult to remain independent at home. Reduced physical health status includes the presence of chronic health disease, declines in cognition, and decreases in muscle endurance, that influence the safe performance of physical activity. Older adults may also face psychosocial changes such as depression and reluctance to be independent at home, ultimately leading to an increased need for assistance with everyday tasks and subsequent impacts on physical health, mental well-being, and overall QOL (Keui-Min, Mei-Hui, Yueh-Chin, Hsin-Ting, & Chun-Huw, 2012).

Person-Environment-Occupation Theory

A model within the model of Human Occupation frame of reference is entitled, Person-Environment-Occupation. When designing a program for aging in place and holistic treatment, it is important to address the dynamics and transactional relationship between the person, environment, and occupational performance. The PEO Model emphasizes an individual’s “intrinsic need for involvement, expression, skill development, and enjoyment.  Where occupation serves as the means for satisfying this need” (Cole, p. 295). According to the PEO model, attributes/factors of the person, environment and occupation/occupational performance work synchronously and interdependently of one another. Quality of life diminishes when one of these aspects is affected. Furthermore, its foundation lies in a client-centered approach where every experience is subjective to individual. By addressing the who (person), where (environment), and why (occupation), this program will increase occupational functioning. Functional, as opposed to dysfunctional, occupation performance is increased when flow is increased. Flow occurs when the individual’s environment and meaningful activity (occupation) matches the sense of self and skill set of the individual. Because of this, program development begins with addressing the person, his environment, and his occupational performance as well as their applicable sub-categories.

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Michelle Eliason, MS, OTR/L, C.D.S, CKTS  is both an occupational therapist and CARES Dementia Specialist. She has been an elder care professional for 7+ years. Working in various aspects of the elder care industry has given her a generalist skill set and a broad knowledge base of elder care approaches and resources. Michelle is passionate about influencing the elder care industry advocating against nursing home negligence and elder abuse, and working with older adults to enable them to live in their own homes throughout the aging process.

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