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This article has been peer reviewed. It is the author’s final published version in The American Journal of Occupational Therapy, Volume 47, Issue 2, February 1993, Pages 147-153.

The published version is available at DOI: 10.5014/ajot.47.2.147. Copyright © American Occupational Therapy Association


This paper describes an occupational therapy home-based intervention in which purposeful activities were used to promote adaptation and competence in older adults with chronic disabilities. Seven home care therapists visited 17 randomly selected, community-living elders who were chronically disabled and who volunteered to participate in the program. The number of visits ranged from 3 to 10 and occurred over a 3-month period according to clients' needs and wishes. Therapists enhanced their ability to enter the client's social and cultural system by using participant-observation techniques and collaboratively identified activities. Therapists documented each home visit with a structured fieldnote form. An analysis of 112 field-notes indicated that therapists were able to understand a client's needs; this understanding resulted in small qualitative gains in areas identified as important by the client. Reilly's concept of an activity continuum was a useful framework from which to work with this population. The implications for program development, treatment outcomes, and accountability with this approach promote improved future treatment planning with the elderly with chronic disability.

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