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For our parents, older family, friends, and clients, who are wonderful role models for
aging gracefully.
—BRB and VDBH
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PREFACE
It is hard to believe that more than 20 years have passed since and publishing a text of this scope takes time, and science
the first edition of this volume was published in 1994. It has and reality march on in the meantime. We hope readers will
been a fascinating process analyzing the situation in 2017 check the literature regularly to see what has happened since
and comparing it to years past. And it’s been heartening to this book was written.
see the many ways in which older adults around the world As one way to promote such exploration, we’ve added an
have seen improvements in their circumstances. At the same online site to provide elaboration, additional resources, items
time, the ongoing challenges are sobering for those of us in of interest, and materials you might find useful in working
health care. with clients. We hope you’ll find it helpful, and that you’ll
Updating and expanding the text has taken on personal visit it often.
immediacy over the years. We, the editors, and many of our We made a concerted effort to address interprofessional
longtime and excellent contributors are, ourselves, reaching care, particularly focused on physical and occupational ther-
old age. We have taken care of—and in some instances lost— apy. It is inevitable that there will be those who disagree with
older loved ones. We have adjusted to changes in our physical our delineation of the two disciplines and will wonder why
capacities, activities, social networks, and living situations. we didn’t more fully incorporate others. Those disagreements
As is true for all older adults, these changes have tested our and questions serve to highlight some of the very real chal-
adaptive capacities and required flexibility and, often, lenges of instituting truly interprofessional care. We believe
courage. Thus, the material in this book has increasing such care is in the best interests of clients, but we also know
salience in our own lives. This has encouraged us to be ever that professional boundary disputes and the realities of
more mindful of reflecting not only the facts associated with health-care systems and reimbursement make interprofes-
aging but also the emotional realities of the experience. sional care difficult in the real world. It is worth striving to-
Those of you who have read previous editions will note ward but not easy to enact.
that the content has been dramatically expanded. We have We hope you will find the new content and features of
tried to ensure a comprehensive picture of aging. We are well this book helpful and engaging, and that the updated material
aware that this is not really possible in a single volume. Even is worthy of your time and helpful in your professional and
if we could do so, it would be a snapshot in time. Writing personal lives.
iv
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ACKNOWLEDGMENTS
This edition is a significantly expanded version of Functional We appreciate the input from our students over the years,
Performance. It has been a labor of love for many people and we are deeply grateful to the many clients who have
who’ve been instrumental in making it the best book it could enabled us to learn from their experiences. We also appreciate
possibly be. the students who helped us refine the content of the book,
We thank our many excellent authors for their thoughtful responding to material, checking references, and otherwise
contributions and patience during a lengthy revision process. helping us enhance the product. We are grateful to the many
We also thank our reviewers, who offered helpful observa- people who have read the book, and especially those who
tions that have greatly improved the final product. We thank contacted us with suggestions or posted reviews that helped
Melissa Spor, who provided technical writing assistance, and us continue to improve it.
Rebecca and Jordan Bray who were instrumental in develop- And, as always, we thank our families. The process of
ing the online materials. bringing this book to completion has been a very long term,
We thank F. A. Davis for its continuing support and con- and at times intensive, effort, and they’ve not only provided
fidence in this project. In particular, Christa Fratantoro, Rose helpful input, but have also cooked meals, handled household
Foltz, George Lang, Amelia Bevins, Nicole Liccio, Megan chores, and been cheerleaders during the process. Patrick Bray,
Chandler, Carolyn O’Brien, and Bob Butler. Our sincere Lisa Gomersall and Aaron Bray, Rebecca and Jordan Bray,
apologies if we left anyone off this list; many F. A. Davis staff and Tom Haas have our profound gratitude.
work hard and effectively behind the scenes.
v
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CONTRIBUTORS
Georgia J. Anetzberger, PhD, ACSW, LISW Lindy M. Clemson, PhD, MAppSc, OT, DipOT
Adjunct Assistant Professor Professor
Department of Medicine Occupational Therapy
Case Western Reserve University University of Sydney
Cleveland, OH Sydney, Australia
Julie D. Bass, PhD, OTR/L, FAOTA Nicole T. Dawson, PT, PhD, MA, GSC
Professor Assistant Professor
Occupational Therapy Department of Physical Therapy
St. Catherine University University of Central Florida
St. Paul, MN Orlando, FL
Brent Braveman, PhD, OTR/L, FAOTA Beth A. Ekelman, PhD, JD, OTR/L
Director Professor and Director
Rehabilitation Services Program in Occupational Therapy
M. D. Anderson Cancer Center Cleveland State University
Houston, TX Cleveland, OH
vi
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CONTRIBUTORS vii
viii CONTRIBUTORS
REVIEWERS
Susan M. Cleghorn, MS, OTRL, TRS, CAPS Ashley Halle, OTD, OTR/L
Assistant Professor Assistant Professor
Occupational Science & Therapy Chan Division of Occupational Science & Occupational
Grand Valley State University Therapy
Allendale, MI University of Southern California
Los Angeles, CA
Erica DeFrancesco, MS, OTR/L
Clinical Assistant Professor Margaret D. Hart, PhD, OTR/L
Occupational Therapy Professor Emeritus
Quinnipiac University Occupational Therapy
North Haven, CT Worcester State University
Worcester, MA
Susan P. Denham, EdD, OTR/L, CHT
Occupational Therapy Nathan B. Herz, OTD, MBA, OTR/L CEAS
Alabama State University Founding Director
Montgomery, AL Occupational Therapy
Murphy Deming College of Health Sciences
Mary Lou Donovan, PhD, OTR/L Fishersville, VA
Assistant Professor
Occupational Therapy Sandra Hobson, BSc(OT), MAEd, LLD, FCAOT
College of St. Scholastica Professor Emerita
Duluth, MN School of Occupational Therapy
The University of Western Ontario
Ruth Ford, EdD, MSBS, OTR/L London, Ontario, Canada
OTD Program Director
Occupational Therapy, Doctorate Brenda Kennell, OTR/L
Huntington University Program Chair
Fort Wayne, IN Occupational Therapy Assistant
Central Piedmont Community College
Susan Friguglietti, DHA, MA, OTR/L Charlotte, NC
Associate Professor of Occupational Therapy
College of Health Sciences Cindy Koehn, OTR/L
Lenoir-Rhyne University Academic Fieldwork Coordinator
Hickory, NC Occupational Therapy Assistant Program
Hawkeye Community College
Lynn Gitlow, OTR/L, PhD, ATP Waterloo, IA
Associate Professor
Occupational Therapy Susan Kristoff, LMT, PTA
Ithaca College President/Owner of a private practice: Homecare PT
Ithaca, NY Massage Therapy, Physical Therapy
Nuebody Therapy
Willow Grove, PA
ix
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x REVIEWERS
Danielle N. Naumann, BA(H), MSc(OT), PhD(c), OT Stacey L. Schepens Niemiec, PhD OTR/L
Reg(Ont) Research Assistant Professor
Occupational Therapist; PhD Candidate Rehabilitation Chan Division of Occupational Science and Occupational
Science Therapy
School of Rehabilitation, Faculty of Health Sciences University of Southern California
Queen’s University Los Angeles, CA
Kingston, Ontario, Canada
Nancy Schneider Smith, PT, DPT, GCS
Terry Peralta-Catipon, PhD, OTR/L Clinical Associate Professor
Department Chair Physical Therapy
Occupational Therapy Winston Salem State University
California State University Dominguez Hills Winston Salem, NC
Carson, CA
Steven Wheeler, PhD, OTR/L
Ann Marie Potter, MA, OTR/L Associate Professor
Lecturer Occupational Therapy
Occupational Therapy West Virginia University School of Medicine
Elizabethtown College Morgantown, WV
Elizabethtown, PA
Caryn Young, BA, BSc, PgDIP, MBAOT, MCOTSS-NP,
Samia H. Rafeedie, OTD, OTR/L, CBIS HCPC Registered OT
Assistant Professor Lecturer in Occupational Therapy
Division of Occupational Science & Occupational Therapy School of Health Sciences
at the Herman Ostrow School of Dentistry Ulster University
University of Southern California Newtownabbey, Northern Ireland
Los Angeles, CA
CONTENTS
PREFACE iv
ACKNOWLEDGMENTS v
CONTRIBUTORS vi
REVIEWERS ix
INTRODUCTION TO THE FOURTH EDITION xxv
PART I Global Health and Aging: Implications for Health and Participation 1
1 Growing Old in Today’s World 3
Bette Bonder
History of Aging 4
Life Expectancy 4
Impact of Economic Circumstances and Gender Throughout History 4
Attitudes About Aging From a Historical Perspective 5
Historical Roles of Older Adults 6
Cohort Effects 6
Aging Today: Factors Affecting the Experience of Aging 7
Physical Environment 7
Sociocultural Factors 8
Individual Characteristics 10
The Impact of Gender in Modern Times 11
Socioeconomic Factors 11
Positive Aging 12
2 Theories of Aging: A Multidisciplinary Review for Occupational and Physical
Therapists 19
Bette Bonder, Renée R. Taylor, and Evguenia S. Popova
Challenges of Societal Aging 19
What Do Gerontologists Want to Explain? 19
Sociodemographic Changes 20
The Current State of Theory in Gerontology 20
Theories of Aging 20
Biological Theories of Aging 20
Neuropsychological Theories of Aging 21
Psychological Theories of Aging 22
Sociological Theories of Aging 24
Client-Centered Approaches With Older Adults 26
The Systems Theory of Motor Control 26
The Model of Human Occupation 27
The International Classification of Functioning, Disability, and Health and the Occupational Therapy Practice
Framework, Third Edition 28
The ICF 28
The Occupational Therapy Practice Framework, Third Edition 29
xi
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xii CONTENTS
CONTENTS xiii
xiv CONTENTS
CONTENTS xv
14 Sensory Function, Function Related to the Skin and Pain: Health Conditions 217
Linda A. Hunt, Bobby Nijjar, and Amanda Stead
Pathological Changes in the Visual System 217
Cataracts 218
Age-Related Macular Degeneration 219
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xvi CONTENTS
Glaucoma 219
Diabetic Retinopathy 220
Functional and Behavioral Adaptations 221
Other Diseases That May Affect Vision, Visual Processing, and Functional Performance 222
Pathology of the Auditory System 224
Skin 224
Pain 225
Assessment 225
Interventions 226
CONTENTS xvii
PART III Active Aging: Supporting Client Activities and Participation 277
18 Self-Care 279
Kristine Haertl
Defining Self-Care 280
Models to Explain Everyday Functional Abilities 280
Competence, Value, and Meaning in Self-Care 280
Significance of Self-Care 281
Prevalence and Type of Limitations of Activities of Daily Living Among Older Adults 282
Effects of Medical Conditions on Self-Care 282
Stroke 282
Cardiovascular Disease 283
Dementia and Cognitive Decline 283
Joint Inflammation and Disease 283
Sensory Problems 283
Measuring Self-Care Performance 284
Assessing Factors Contributing to Self-Care Deficits 284
Assessing Instrumental Activities of Daily Living 285
Assessing Environmental Factors 285
Safety 286
Activities of Daily Living Intervention 286
Skill Training 286
Environmental Modifications 287
Assistive Devices for Self-Care 288
Task Modifications 289
19 Leisure 295
Anita C. Bundy, Sanetta H. J. Du Toit, and Lindy M. Clemson
Leisure and Aging 296
Leisure as a Statement of Identity 297
Leisure as a Fully Engaging Experience 298
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xviii CONTENTS
22 Driving 341
Wendy Stav and Beth A. Ekelman
Overview of National Statistics on Violations, Crashes, and Fatalities 341
Driving as an Occupation 342
Client Factors 343
Performance Skills 343
Performance Patterns 343
Contexts 343
Age-Related Physiological and Disease-Related Changes Affecting Driving Performance 345
Sensory Functions 345
Changes in Other Functions 346
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xx CONTENTS
26 Spirituality 397
Mary Ann McColl
Defining Spirituality 397
Differentiating Religion from Spirituality 398
Spirituality as a Vital Dimension of Rehabilitative Practice 398
As Human Beings 398
As Health Professionals 398
As Occupational Therapists in Particular 398
As Witnesses and Advocates for People With Chronic Illnesses and Disabilities 399
As Specialists in Elder Care 399
Approaches to Spirituality in Occupational and Physical Therapy 400
Acknowledge the Issue 400
Refer to a Spiritual-Care Professional 400
Intervene Directly Using Spiritual Interventions 401
Intervene Indirectly Using Familiar Therapeutic Interventions 401
Narrative 401
Ritual 401
Appreciation of Nature 402
Creativity 402
Work 402
Movement 402
CONTENTS xxi
xxii CONTENTS
32 Rehabilitation 489
Vanina Dal Bello-Haas and Joyce Tryssenaar
Disability in Older Adulthood 490
Psychological Consequences of Disabling Events 491
Aging With a Preexisting Disability 491
Issues for Persons With Intellectual Disability 492
Issues for Persons With Serious Mental Illness 492
Issues for Persons With Physical Disabilities 492
What Makes Older Adult Rehabilitation Unique? 492
Chronological Versus Physiological Aging 492
Progressive Versus Catastrophic Disability 493
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CONTENTS xxiii