Question 1

The number of U.S. adults age 65 and older is projected to double by:

Accepted Answer

According to the Centers for Disease Control and Prevention (CDC, 2017a), chronic diseases such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis are the most common, expensive, and preventable of all health problems (CDC, 2017). In 2014, 7 out of the top 10 causes of death were chronic diseases (CDC, 2017a). Heart disease, cancer, and stroke account for more than 50% of all deaths per year (Kung et al., 2008), and of the top 30 causes of self-reported disability in adults, the following chronic conditions were ranked among the top 15: arthritis, spine and back pain, heart disease, lung and respiratory problems, mental health and emotional issues, diabetes, stroke, cancer, hypertension, and kidney problems (CDC, 2009). Additionally, the number of U.S. adults age 65 and older is projected to double by 2030, and experts are expecting to see an increase in the incidence of disability from chronic conditions (CDC, 2009). The top chronic conditions experienced by adults over the age of 65 are chronic obstructive pulmonary disease (COPD), Alzheimer's disease, depression, heart failure, chronic kidney disease, diabetes, ischemic heart disease, arthritis, high cholesterol, and hypertension (National Council on Aging, 2017).

Question 2

One of the most common comorbid conditions for adults who are obese is:

Accepted Answer

The most common comorbid conditions associated with overweight/obesity include hypertension, hypercholesterolemia, heart disease, and type 2 diabetes. Other common diagnoses for weight management include pre-diabetes, glucose intolerance, metabolic syndrome, coronary heart disease (CHD), coronary artery disease (CAD), hypertriglyceridemia, fatty liver, morbid obesity, joint pain, sleep apnea, thyroid issues, depression, anxiety, and multiple sclerosis (MS), among others. A comorbid diagnosis is usually necessary for reimbursement by a third-party payer, since overweight/obesity is not currently considered a reimbursable diagnosis for occupational therapy in most cases. This requirement is especially challenging for pediatric clients who are overweight or obese but have not yet acquired a comorbid condition.

Question 3

Lifestyle redesign is focused on changing one's daily life to help enhance occupational engagement. The occupational therapy practitioner focuses on client lifestyle changes that:

Accepted Answer

The Lifestyle Redesign approach aims to facilitate gradual lifestyle changes over a prolonged period, which has a profound and extensive effect on occupation, health outcomes, and quality of life. The goal is to help clients determine lifestyle changes that they want to make and would like to maintain indefinitely, because Lifestyle Redesign is an ongoing lifelong process. As clients undergo the process of Lifestyle Redesign, they acquire tools, including attitudes, beliefs, strategies, and actions, that will eventually allow them to continue this process for the rest of their lives.

Question 4

Which of the following occupational science concepts shapes Lifestyle Redesign?

Accepted Answer

Additionally, occupational science greatly influences Lifestyle Redesign (Carlson, Clark, & Young, 1998). Mandel et al. (1999) and Jackson, Carlson, Mandel, Zemke, and Clark (1998) describe the four occupational science concepts that shape Lifestyle Redesign as:
• The "dynamic and generative quality of occupations," which have the power to create transformation;
• The meaning evoked from occupation, including life narratives;
• Dynamic systems theory; and
• The "view of the human as occupational being" (pp. 14-17, 1999).

Question 5

An important outcome of the Well Elderly Study demonstrated:

Accepted Answer

Several steps were taken to develop the Lifestyle Redesign intervention implemented in the study, including an extensive needs assessment, pilot study, qualitative studies, and literature review (Mandel et al., 1999). One of the qualitative studies examined the adaptive strategies that were being utilized by successful community-dwelling elderly persons not living with disabilities. Researchers interviewed 29 community-dwelling well older people and found that the following 11 life domains were most threatening to the participants: activities of daily living (ADLs), adaptation to a multicultural environment, use of free time, grave illness and death, spirituality, health maintenance, mobility maintenance, personal finances, personal safety, psychological well-being and happiness, and relationships with others (Clark et al., 1996). This study was especially significant because it identified certain areas that occupational therapy had not traditionally addressed at the time with elders. These needs were specific to this particular group of elders and their environment: an urban, multicultural high-rise apartment building. This pilot study was important because it highlighted the need for occupational therapists to perform extensive needs assessments for the specific populations they work with to tailor interventions. Thorough needs assessments allow occupational therapists to identify significant factors affecting a unique population that may be different from those associated with the general population.

Question 6

Mr. Asch is a 67-year-old male in a Lifestyle Redesign program. The occupational therapist asks him to tell his story about how his diabetes affects his life. The OT is enacting which part of the Lifestyle Redesign program?

Accepted Answer

Service delivery incorporated four key methods, as outlined by Mandel et al. (1999): didactic presentation, peer exchange, direct experience, and personal exploration. Didactic presentation included new information about a topic relevant to the participant(s), as well as about occupation and how it affects each participant. Occupational therapists led the participants through a process of occupational self-analysis in regard to the topic (Mandel et al., 1999). The therapist facilitated peer exchange, where each participant had the opportunity to tell stories from his or her own life and how his or her experiences related to the topic at hand. Time was provided for group problem solving, and group members were encouraged to offer solutions to each other. The Lifestyle Redesign intervention also provided direct experience through an activity or outing. Some examples from the Well Elderly Study include: creating resource booklets with transportation information and inexpensive things to do in the community, performing the range-of-motion (ROM) dance, planning, shopping for and preparing a meal together, and creating and displaying personal history time lines. Direct experience, both inside and outside of sessions, provided participants with the opportunity to increase their self-efficacy and sense of control, and to better self-regulate (Mandel et al., 1999).

Question 7

An important occupation-based intervention in the Lifestyle Redesign Weight Management Program is:

Accepted Answer

Through occupational self-analysis, clients can begin to enact change. They become savvy consumers regarding food labels, dining out, and fad diets. They address psychosocial and emotional issues related to healthy habit formation and find new healthy pleasures and meaningful activities to replace habits related to overeating. Weight Management Program occupational therapists ensure that clients have the experience and understanding to independently make the best choices for themselves to manage their weight effectively. Clients gain experience in reading food and menu labels, and learn how to reach comfortable satiety while consuming less calories, balancing blood sugar, and choosing foods to decrease cholesterol and blood pressure. A registered dietitian provides consultation during the development of the program and approves an eating plan.

Question 8

Mrs. Frank is a 72-year-old woman involved in the Lifestyle Redesign Weight Management Program and she desires to engage in walking. She goes to church daily and the church is walkable from her home. She asks her friend to walk with her to church weather permitting. In the Lifestyle Redesign program, this is an example of:

Accepted Answer

The occupational therapist helps the client to create his or her own accountability structures in order to increase the likelihood of achieving short-term goals and to have accountability when occupational therapy intervention is complete. Examples of accountability structures include making an appointment to walk or exercise with a friend or family member; being responsible for walking the dog once or twice per day; or paying for a service, such as a class or massage, in advance. It is essential for clients to determine their own goals and accountability structures each week with the therapist and other group members (if applicable). Developing relationships with other group members and the occupational therapist, practicing the new habit, and performing the weekly check-in are each a crucial part of the habit change process (Clark, 2000).

Question 9

After surgery, a bariatric client is engaging in Lifestyle Redesign and is losing significant weight. An important consideration by the occupational therapy practitioner when considering occupational engagement is:

Accepted Answer

Because clients must drastically decrease their caloric intake and food options after surgery, many clients lose some of their cherished, meaningful occupations that revolve around mealtimes and pleasure from food. As a result, they must begin to identify other healthy pleasures, reward systems, and emotional outlets to replace eating. Similarly, eating routines change drastically. Prior to surgery, as part of the Lifestyle Redesign program, bariatric clients prepare to change their eating routines to eat more frequently, decrease portion sizes, and incorporate new nutritional needs such as supplements and protein. Clients who undergo bariatric surgery must also increase their physical activity in order to prevent muscle loss. The OTFP has partnered with the bariatric surgeons at USC to provide this service.

Question 10

The REAL Diabetes study demonstrated that a Lifestyle Redesign approach was effective in improving:

Accepted Answer

The Lifestyle Redesign for Diabetes program naturally evolved from the weight management program to address the growing population with diabetes. In 2015, 9.4% of people in the United States, or 3 million, had diabetes (CDC, 2017b). This program utilizes similar didactic content but adds information about both preventing and managing diabetes and its associated comorbid conditions, sustaining healthy eating routines and blood sugar levels, and engaging in physical activity and stress management to help to decrease blood sugar levels and symptoms of diabetes. The REAL Diabetes study demonstrated that a Lifestyle Redesign approach was effective in improving HbA1c levels and diabetes-related quality of life in ethnically diverse young adults who have diabetes (Pyatak et al., 2018).

Question 11

Adjusting to college roles can be challenging. For a student with which of the following diagnoses would Lifestyle Redesign for the College Student be an effective intervention?

Accepted Answer

Out of 529 university and college counseling centers surveyed in 2016, 57% reported an increase in the severity of student mental health concerns (Association for University and College Counseling Center Directors AUCCD Annual Survey, 2016). In 2015 college students reported that their greatest mental health concern was anxiety, and almost 9% had taken prescription medications prior to coming to college (American Psychiatric Association, 2015). College students experience frequent habit and routine changes every year and often every semester. Many students, away from home for the first time, have to learn how to engage in new occupations, create their own occupational routines, and structure their time independently. Lifestyle Redesign helps students acquire the skills to successfully meet academic, social, and other developmentally appropriate demands. The program helps students manage time, become more self-motivated, improve focus, problem-solve, better organize their activities, decrease procrastination, optimize study/work environments, reduce stress, engage in healthy dating and other social occupations, and promote lifestyle balance (see Fig. 24-1). Other topics include leisure, money management, community transportation, effective communication, eating routines/cooking, exercise, substance abuse, psychosocial issues, learning styles, and goal setting. Common diagnoses include difficulty adjusting to college roles, learning disabilities, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), mental health diagnoses, and acute reactions to stress, as well as diagnoses related to weight management and chronic pain.

Question 12

The most common reimbursement mechanism for the Lifestyle Redesign program at USC is:

Accepted Answer

Reimbursement for the Lifestyle Redesign programs offered at the OTFP primarily comes from the clients' preferred provider organization (PPO) health insurance. Common occupational therapy codes are used, such as evaluation, therapeutic group, functional therapeutic activity, ADLs, and therapeutic exercise. Even though the diagnoses treated using Lifestyle Redesign may be different from those of more traditional occupational therapy practice, many insurance companies pay for occupational therapy services for these diagnoses. For example, students who have the USC student health insurance are entitled to 26 visits per academic year for occupational therapy shared with physical therapy and chiropractic services and pay a small co-payment. Often students have not used any of these visits for other services, so they are able to come once per week for almost two full semesters per year.

Quiz 24: Lifestyle Redesign Programs Introduction