Occupational Therapy And Diabetes: Understanding Our Role .
Occupational Therapy andDiabetes: Understanding our Rolein Chronic Care ManagementOccupational Therapy Association of CaliforniaAnnual ConferenceOctober 14, 2011Camille Dieterle, OTD, OTR/LShanpin Fanchiang, PhD, OTR/LMichelle Farmer, OTD, OTR/LBeth Pyatak, PhD, OTR/LChantelle Rice, OTD, OTR/LKatie Salles-Jordan, OTD, OTR/LAshley Uyeshiro, MA, OTR/L
Learning Objectives Describe the clinical presentation, management, andcomplications of diabetes. Articulate OT‟s unique contribution in improvingpatients‟ diabetes self-management and diabetesrelated health and quality of life. Understand billing and reimbursement mechanismssupporting OT services for patients with diabetes. Identify implications of healthcare reform and thechanging healthcare climate on OT‟s role in primarycare and chronic condition management.
Who are you? What setting do you working in?ooooooPediatricInpatient acuteInpatient rehabOutpatientHome healthOther? How often do you see patients with diabetes?o As comorbidityo Primary reason for OT referral How would you describe your comfort level addressingdiabetes with your patients?
Today‟s Session Part I: What is diabetes? How does it impact occupation? Part II: Case Studies: Intervention approaches for diabetes Part III: Reimbursement, advocacy, and healthcare reform
Part I: What is diabetes? Clinical presentation and treatmentooooTypes of diabetesNatural course and progression (including complications)Medical/pharmacological therapiesLifestyle treatment approaches
Fast Facts on Diabetes25.8 million people in the U.S. have diabeteso Among U.S. adults, diabetes is the leading cause of:oooooDiabetes is the 7th leading cause of deathooKidney failureNontraumatic LE amputationsNew cases of blindnessNOT including deaths due to heart disease and strokeCompared to non-Hispanic whites, diabetes risk is:ooo77% higher for non-Hispanic blacks66% higher for Hispanics18% higher for Asian Americans
Fast Facts on DiabetesoOT practitioners address physical, cognitive,psychosocial, and sensory aspects of everyday lifeactivities, including the integration of diabetes self-careinto clients‟ existing habits and routinesoNeed for services: there are 25.8 million people withdiabetes in the U.S. and onlyooo4,000 endocrinologists (one for every 6450 patients)15,000 certified diabetes educators (one per 1720 patients)Occupational therapy is one of 13 disciplines eligible tobecome certified as diabetes educators (CDE)
Key players in diabetes:Glucose: The body‟s main source of energy (made inthe liver and comes from the foods we eat)Insulin: Hormone made by the pancreas that transportsglucose from the blood into the body‟s cells to be usedfor energyPancreas: Organ responsible for insulin productionBeta cells: located on the pancreas, responsible forinsulin production
What is diabetes? Disorder of glucose metabolism Chronic disease with progressive course Related to insulin deficiency and/or insulinresistance:ooInsulin deficiency: insulin is no longer produced by thepancreasInsulin resistance: insulin is produced but no longer ableto perform its function of putting glucose into the cells
What is diabetes?INSULIN DEFICIENCYINSULIN RESISTANCE
Classification of diabetes Type 1 (T1DM): Absolute insulin deficiency Type 2 (T2DM): Relative insulin deficiency insufficient toovercome insulin resistanceooooStep 1: Insulin resistanceStep 2: Extra production of insulinStep 3: Beta cells burn outStep 4: Deficiency of insulin Gestational Diabetes (GDM): Relative deficiency of insulin during pregnancy,when insulin resistance is higher Other forms (including MODY; drug/chemical-induced; infection-induced;genetic defects or syndromes)
What‟s the difference?TYPE 1 DIABETES (T1DM) Etiology: autoimmune (mostcommon), idiopathic Prevalence: 0.4% (and rising) Onset: Rapid, acute Treatment: Insulin therapyo Fixed regimeno Flexible regimen (multipledaily injections)o Insulin pumpTYPE 2 DIABETES (T2DM) Etiology: genetic, behavioral,environmental risk factors Prevalence: 8.6% (and rising) Onset: Gradual, “silent” Treatment: Combination of:o Lifestyle change (weightloss, physical activity)o Oral medicationo Insulin therapy (see T1DM)O’Keefe, J. H., Bell, D. S., & Wyne, K. L. (2009). Diabetes Essentials (4th Ed.). Sudbury, MA: Jones and Bartlett Publishers.
Testing for Diabetes Fasting plasma glucose (FPG) Oral glucose tolerance test (OGTT) Amount of glucose in the blood after 12-hour(overnight) fastAbnormal Impaired fasting glucose (IFG)Amount of glucose in the blood after consuminghigh-glucose beverageA1C % (hemoglobin A1C/HbA1c) Average blood glucose levels over 3 months
Prediabetes Increased risk ofdiabetes Any of the following:Impaired fasting glucose(IFG)o Impaired glucosetolerance (IGT)o Elevated hemoglobin A1CoMetabolic Syndrome Increased risk of diabetes Increased risk ofcardiovascular disease At least 3 of the following:oooooImpaired fasting glucose (IFG)Triglycerides 150 mg/dLBlood pressure 130/85Abdominal obesity Waist circ. 40” in men, 35”in womenLow HDL cholesterol 40 mg/dL in men, 50mg/dL in women
Progression of Type 2 evention/pre-diabetes/how-to-tell-if-you-have.html
Progression of Type 2 DiabetesDiagnosis:Cutoff based onrisk of long-termcomplicationsUKPDS Study Group. (1995). Overview of six years' therapy of type 2 diabetes – a progressive disease. Diabetes, 44, 1249–1258.
ABCs: Cornerstones of Diabetes CareA: A1C (average blood glucose) Every percentage point drop in A1C can reduce the risk ofmicrovascular complications by 40%B: Blood pressure Every 10 mm/Hg reduction in systolic blood pressure canreduce the risk for any diabetes complication by 12%C: Cholesterol Improved control of LDL cholesterol can reducecardiovascular disease risk by 20% to 50%Center for Disease Control and Prevention. National diabetes fact sheet, 2007 . Retrieved 3/1/09 from: http://www.cdc.gov/diabetes/.
Know your numbers: Treatment targetsA1C Target for healthyadults: 7% Higher for:– Children/teens– Recurrenthypoglycemia– Limited lifeexpectancy– Advancedcomplications/comorbiditiesBlood Pressure 130/80 mm/Hg Research onbenefits of lowerblood pressuretargets has shownmixed resultsCholesterol LDL cholesterol: 100 mg/dL 70 mg/dL whenovert CVD present HDL cholesterol: 40 in men 50 in women Triglycerides: 150 mg/dL Lower forpregnant womenAmerican Diabetes Association Standards of Medical Care in Diabetes – 2011. Diabetes Care, 34(Supp. 1), S11-S61.
Treatment: T1DM Insulin therapyooFixed regimenFlexible regimen (vary dose by food intake and activity level) Multiple daily injections Insulin pump Blood glucose monitoring (4 times daily) Screening for and managing complications
Treatment: T2DM Combination/progression of:oLifestyle modification More effective at prevention Can sometimes control diabetes after dx for a period of timeoOral medication Metformin is first-line medication Others added in different combinationsoInsulin therapy Typically begins with long-acting insulin 1-2x daily Progression to short-acting insulin with meals
Acute complicationsHypoglycemia(low blood sugar)SxTxDiabetic ketoacidosis(DKA)Headache, confusion, sweating,Excessive thirst, rapidanxiety, loss of coordination, hunger, breathing, abdominallethargypain, fruity breath,vomiting, lethargy 15/15 Rule: Give 15 grams ofglucose, repeat after 15minutes4 t. sugar, 4 hard candies, 4glucose tablets, 6 oz. juice orregular sodaIf unable to take glucose, giveglucagon injectionIf no improvement, treat asmedical emergencyNotes More common in patients treatedwith insulin or sulfonylureas.Hyperglycemichyperosmolarsyndrome (HHS)Excessive thirst,weakness, lethargy,nausea, headache,confusionTreat as medical emergencyMore common in T1DM. More common inRare in T2DM, triggered T2DM, particularlyby illness.older adults.
Long-term complicationsMicrovascular Retinopathy Neuropathyo Peripheralo Autonomic NephropathyMacrovascular Peripheral arterialdisease Cardiovasculardisease (MI, CHF) Cerebrovasculardisease (stroke, TIA)Other Diabetic footulcers (2 toperipheral arterialdisease, sensation, wound healing) Infections (e.g.UTI, skininfections)Leading cause of excessmortality in people withdiabetes
Common Diabetes MedicationsFunctionInhibit hepaticglucose outputDrug ClassificationTrade NamesBiguanides (Metformin)Glucophage , Glucophage XR Sulfonylureas (2nd gen.)(non-glucose dependent)DiaBeta , Micronase , Glynase,Prestabs , Glucotrol Glinides(glucose dependent)Prandin , Starlix Enhance insulinsensitivityThiazolidinediones* (TZDs,Glitazones)Actos Avandia (restricted due to adverseCVD effects)Delay recose , Glyset Enhance incretin fxGLP-1 agonistsByetta , Victoza (injectables)DPP-4 inhibitorsJanuvia (injectable), Onglyza Stimulate insulinrelease( satiety, glucagon secretion,delay gastric emptying)Sisson, E. (2010). Quick Guide to Medications (4th Ed.). Chicago, IL: American Association of Diabetes Educators.
Insulin & Insulin AnaloguesTypes of insulinRapid-acting (before meals) Onset 15 minBolusShort-acting (before meals) Onset 30-60 minIntermediate-acting (2x daily) Duration 10-16 hoursBrand namesHumalogNovologApidraHumulin R (regular)Novolin R (regular)Humulin N (NPH)Novolin N (NPH)BasalLong-acting (once daily) Duration 20-24 hoursLantusLevemirSisson, E. (2010). Quick Guide to Medications (4th Ed.). Chicago, IL: American Association of Diabetes Educators.
Lifestyle Change:AADE 7 Self-Care Behaviors1.Healthy eating2.Being active3.Healthy coping4.Problem solving5.Risk reduction6.Monitoring7.Taking medication
Healthy Eating Goals of intervention: Attain/maintain optimalABC levels Prevent/manage diabetescomplications Address individualnutrition needs Address barriers tohealthy eating Maintain the pleasure ofeating!
Healthy Eating Role of OT: Creating sustainableroutines around meals Safety – adaptations incooking Planning and mealpreparation Grocery shopping Meaning of food andcooking
Being ActiveBenefits of Physical Activity: Improve insulin resistance (increase insulinsensitivity) Decrease LDL (bad) cholesterol Increase HDL (good) cholesterol Decrease triglycerides Decrease blood pressure Decrease risk for stroke, heart attack and diabetescomplicationsHomko, C. J., Sisson, E. M., Ross, T. A. (2009). Diabetes education review guide: Test your knowledge, (2nd ed.).Chicago, IL: American Association of Diabetes Educators.
Being ActiveSet SMART goals: SpecificMeasurableAttainableRealisticTime SensitivePhysical activity recommendations: Resistance exercise 3 days per weekAND EITHER 150 minutes/week of moderate intensity aerobic activityOR 75 minutes of high intensity aerobic activityHomko, C. J., Sisson, E. M., Ross, T. A. (2009). Diabetes education review guide: Test your knowledge, (2nd ed.).Chicago, IL: American Association of Diabetes Educators.
Being ActiveTake precautions with complications: Risk of hypoglycemia If blood sugar 150, have snack before exercise Hyperglycemia Test for ketones when blood sugar 240; no strenuous activity if present Retinopathy Heavy weight lifting and high impact activity contraindicated LE sensory impairment Ensure good fitting footwear; inspect feet after exercise Peripheral vascular disease Risk of CAD Autonomic neuropathyHomko, C. J., Sisson, E. M., Ross, T. A. (2009). Diabetes education review guide: Test your knowledge, (2nd ed.).Chicago, IL: American Association of Diabetes Educators.
Healthy copingDiabetes increases risk for: StressAnxietyDepressionEating DisordersTypes of support: EmotionalInformationalInstrumentalAffirmational
Healthy copingUnhealthy Coping Mechanisms: DistractionDenialSubstance abuseBehavioral disengagementSelf blameHealthy Coping Mechanisms: HumorActive copingSupportPlanningAcceptanceReligionBrief Cope, retrieved on October 7, 2011 rCOPE.html
MonitoringNew occupations. Determine how frequently the patient needs toself monitor blood glucose (SMBG)ooo Incorporate into routinesKeeping a logIdentifying patternsBlood pressureFoot inspectionsWeightActivity levelAOTA, Sokol-McKay, D.A. (2011). Fact sheet: Occupational therapy's role in diabetes self management.
Taking medications The patient should have an idea of howmedication works in the body Know when, how and how much to take OTs can help their patients: organize medication track medications embed into routines identify environmental supports orbarriersHomko, C. J., Sisson, E. M., Ross, T. A. (2009). Diabetes education review guide: Test your knowledge, (2nd ed.).Chicago, IL: American Association of Diabetes Educators.
Taking medications Oral medications Single or combination therapy Non-insulin injectables Insulin Basal, premixed, or short-acting Delivery via syringe, pen, or pump Medications to meet ABC goals Aspirin, anti-hypertensives, cholesterollowering agentsHomko, C. J., Sisson, E. M., Ross, T. A. (2009). Diabetes education review guide: Test your knowledge, (2nd ed.).Chicago, IL: American Association of Diabetes Educators.
Reducing risk Screen for complicationsEach visit: BP, foot exam, depressiono Every 3-6 months: A1Co Annually: lipids, albumin (kidney fx), eye examo Minimize cardiovascular riskAchieving ABC targetso Smoking cessationo Stress reductiono Diet and physical activityo Manage hypoglycemia and sick days Keep trackAppointmentso Medical records & test resultso
Problem solving Assess readiness to change Assess literacy and cognitive level Problem solving:oooDirect Instruction--clear problem, clear solutionOT / Patient collaborationPatient as the problem solver Identify barriers and supports Incorporate into routines to increase consistency andsustainability Safety first!Homko, C. J., Sisson, E. M., Ross, T. A. (2009). Diabetes education review guide: Testyour knowledge, (2nd ed.). Chicago, IL: American Association of Diabetes Educators.
Problem solving Stages of onMaintenanceRelapse/recycle Motivational interviewing Avoid arguing – roll with resistance Support autonomy (invite participation, offer choice,gain consent) Develop discrepancies – benefits of change,drawbacks of staying the same
Part I: Conclusion Questions and answers (5 min)
Case studies: Interventionapproaches
Occupational Therapy InterventionDiabetes impacts the individual’s personal,environmental, social, spiritual and physical wellbeing. In order to promote successful prevention andmanagement, adaptations to daily routines andlifestyle may include:
Case Studies Outpatient private practiceo “Lisa” – type 1 diabeteso “Melanie” – prediabeteso “Rosa” – type 2 diabetes Primary care: family medicine clinico“Jose” – prediabetes Rehabilitation hospital“Lydia” and “Tom” – diabetes post-strokeo “Betty” – diabetes post-spinal cord injuryo “Edward” – diabetes with advanced complicationso
Diabetes and Occupation: “Lisa” 21 year old college junior, dx T1DM age 15Double majoring in theater and psychologyWorks part-time on campusUses insulin pump and continuous glucose monitorFrustrated by difficulty losing weightHas been experiencing hypoglycemia at night andduring activities Most recent A1C 8.2%
Diabetes and Occupation: “Lisa” On-the-go lifestyle: Full-time classes and part-time job Participates in school drama productions Lots of activity: dance classes, rehearsals, goingto gym, walking around campus Likes to „party‟ on weekends Feels self-conscious about diabetes self-care inpublic/attracting attention Doesn‟t feel diabetes self-care recommendationswork with her busy lifestyle
Diabetes and Occupation: “Lisa” Personal goals for Lisa: Create more consistent routine for meals andsnacks Manage hypoglycemia while on-the-go Improve glucose control overnight (avoiding lows) Deflect questions from acquaintances aboutdiabetes Plan ahead of time for drinking at parties
Outpatient Private PracticeDiabetes “Lisa" Session Topics: Healthy eating routines/strategies for eating out Lifestyle balance Developing bedtime routine/good sleep habits Creating morning routine/eating breakfast Time management Stress management Diabetes education Drinking and blood sugar Weight loss and diabetes
Outpatient Private PracticeDiabetes “Lisa" Behavior changes: Stabilized nighttime glucose with consistentbedtime routine Created more regular meal and snack times duringthe day Planned strategies to monitor alcohol when out atparties with friends Lost 5 lbs. while maintaining A1C below 8%
Prediabetes and Occupation: “Melanie” 35 year old female, BMI 26.7Dx of PCOS, glucose intolerance, metabolic D/OMexican ancestry, father died of T2DM complicationsRecently decided not to pursue flight in aviationIncreased feelings of depression leading to:ooooIncreased binge eating (excessive sweets, esp. at night)Weight gainDecreased exerciseDecreased self-esteem Infertile Lives with boyfriend
Prediabetes and Occupation: “Melanie” Personal goals identified by client:o 15 lbs weight losso Diabetes preventiono Healthy eating choices/healthier cookingo Have a career in aviationo Have a baby
Outpatient Private PracticePrediabetes "Melanie"Session Topics (8 sessions total, unlimited allowable) Pt. education on diabetes Healthy eating routines Physical activity Time management / appointment managemento Nutritionisto Chiropractoro Fertility specialisto Psychologisto Physical therapist Stress management Assertive communication
Outpatient Private PracticePrediabetes "Melanie"Behavior changes Regular eating routine of 3 meals/day with F&V snackso Decreased use of food as a coping mechanism forboredom, stress, anxiety and depressiono No binge eating Regular exercise (reduced due to fertility Tx) Adaptation of social/family activities to be more healthpromoting Increased self-efficacy, improved mood, and decreaseddepression, anxiety and stress 5 lbs. weight loss Diabetes prevention Career in aviation
Diabetes and Occupation: “Rosa” 42 year old woman, BMI obesity class 3Diagnosed with T2DM for approx. 15 yearsMexican and Jewish ancestryReferred to OT for lifestyle modification prior to gastricbypass surgery Weight loss necessary to control diabetes for surgery toremove tumor in genital area Surgery deemed dangerous at current weight of 463lbs. (consultation for surgery at 480 lbs) without bloodsugar control
Diabetes and Occupation: “Rosa” A1C 10.1% Diabetes complications:o nocturiao diabetic retinopathyo peripheral neuropathyo excessive thirsto fatigueo stress, anxiety, depression and confusion
Diabetes and Occupation: “Rosa” Decreased activity/walking tolerance due to tumor Poor self-image due to weight and tumor Decreased socialization, increased sedentaryoccupations On leave from Masters program Diabetes affected ability to work, socialize,perform ADLS, engage in home management, goout in public, and put a strain on marriage(husband had left).
Diabetes and Occupation: “Rosa” Personal goals identified by client:o Implement healthier eating routineso Increase physical activitieso Increased tolerance for walkingo Go out in public without drawing attentiono Find clothes that fit
Outpatient Private PracticeDiabetes "Rosa"Session Topics: Pt. education on diabetes Healthy eating routines Meal planning on a budget Physical activity Lifestyle Balanceo adjust sleep routineo increased productivity (paying bills, home management,etc.) Stress management Assertive communication
Outpatient Private PracticeDiabetes "Rosa" Regular eating routine of 3 meals and F&V snacks(using smaller plates) Increased physical activity (wii fit, arm exerciseswhile sitting) Use of C-Pap nightly Fitting into smaller clothing Decreased frequency and duration of napsthroughout the day Increased level of comfort with going out in publicdue to decreased attention drawn
Outpatient Private PracticeDiabetes "Rosa" Decreased blood sugar levelsDecreased insulinBetter energy levels and decreased fatigueImproved mood and attitudeIncreased self-efficacyA1C 7.1%Decreased weight 41 lbs.
Family Medicine Clinic: “Jose”Medical History Steady weight gain over past few years Decreased physical activity & mobility (in lastyear especially) Decreased social engagement Increased stress
Family Medicine Clinic: “Jose” Session topics:o Current daily routine Eating routines Physical activity Environmental barrierso Incorporating healthy choices into existingroutineo Social eatingo Overcoming environmental barriers
Family Medicine Clinic: “Jose” Short-term goals:o Drink 6 cups of water per dayo Have a healthy breakfast 5/7 dayso Walk back from subway 4/7 dayso Go swimming 1/7 Supports: parents, co-workers, past experience Barriers: job environment, fatigue
Family Medicine Clinic: “Jose” Follow-upo Patient did not return to clinic forscheduled 1-month F/U
Occupational Therapyfor Special Populationswith DiabetesShanpin Fanchiang, Ph.D., OTR/LRancho Los Amigos National Rehabilitation Center63
Special Populations Stroke Spinal cord injury (SCI) Amputation with Diabetes Mellitus
Special Populations Stroke Spinal cord injury (SCI) Amputation with Diabetes Mellitus
Your inpatient, Lydia, is a 65-year old woman with 10-year history of type 2diabetes mellitus status post stroke with left hemiparesis. Her husband is a 66year-old man, Tom, with a 20-year history of type 2 diabetes mellitus. He stated itis hard to care for his wife in functional transfer due to blurring of both near anddistant vision that has worsened over the past two weeks.In the past, his diabetes had been treated with oral medications, but hisprescription expired 5 years ago and Tom has not had it refilled. Other thanoccasional over-the-counter medications for headaches and cold symptoms, hehas not taken any medication.You are about to discharge your inpatient, Lydia, and prepare to conductpatient/family education regarding health management. What should you addressin the family-focused discharge program?
What proportion ofstroke population hasdiabetes?
68
What proportion ofdiabetic population havestroke?
Stroke Risk in DiabetesKaplan–Meier curves:Stroke in patients with type 2 diabetes mellitus, with andwithout previous cardiovascular disease (CVD), by sex.With CVDWomenMenNo CVDMenWomenGiorda C B et al. Incidence and Risk Factors for Stroke in Type 2 Diabetic Patients. Stroke 2007;38:1154-60.
Special Populations Stroke Spinal cord injury (SCI) Amputation with Diabetes Mellitus
Betty, a 42-year-old woman, had spinal cord injury. Her bloodsugar used to be low, and she experienced hypoglycemia.Since she has been injured, it turned around. Instead ofhaving morning blood sugars of 130-150, now her morningblood sugars are 200-300.Diabetes runs in her family: her mother, brother, grandfather,and now her. Knowing that it is very similar to many patientswith spinal cord injury, what will you, as an OT, do differentlyfor your patient’s OT program, for those who have spinal cordinjury who have also worked through adjustment issues?
Long Term SCI & Diabetes 20% of SCI survivors have type 2 diabetes SCI alters the body’s metabolism: muscle massis lost and fat tissue increases. Inactivity impairs glucose tolerance; causesabnormal insulin levels. The older the patient, the greater the chance ofdeveloping diabetes since age-related changesare accelerated in SCI .asp last visit Oct 12, 201173
Special Populations Stroke Spinal cord injury (SCI) Amputation with Diabetes Mellitus
Edward is a 68- year-old man with an 18-year history of T2DM. Hehas long-standing diabetic neuropathy and has had an ulcer overhis fifth metatarsal head at the site of a former callus for 1month. Because the ulcer was painless, he did not initially seekmedical attention.During the past week, there has been increased drainage from theulcer and erythema around the ulcer site. The ulcer is about 1 cm,appears to be moderately deep with foul-smelling drainage. Hedoes not want to have foot surgery and prefers other types ofintervention. In addition, his hypertension is not well-controlled.Occupational therapy consultation is requested. What do you thinkOT should focus on?Erythema is a skin condition characterized by redness or rash.
Foot Amputation in Diabetes Incidence of diabetic foot ulcers: 5.3-7.4% 9%-20% of people with diabetes have a newamputation within 12 months after anamputation 5 yrs following 1st: 28%-51% had 2nd amputation Perioperative mortality (death 30 days) amongdiabetic amputees averaged 5.8% Five-year mortality following amputation was39%-68%To change how OTs rica/pdf/chapter18.pdf Last visited Oct 2, 2011
The Goal forOccupational Therapy InterventionTo incorporate Diabetes SelfManagement Education (DSME)Lydia/Tom?Betty?Edward?
Diabetes SelfManagementOTIntervention Ecological approach Years with diabetesSpecialPopulationsFactors toconsider Severity 2nd prevention Occupational Performance Client/family-centered
Individualized OT Assessment –Factors to Consider Health literacy – learning stylesCultural Diversity – meaning of illnessAge/gender – muscle mass, changesOn the Job Environment – med managementFamily & Social Support – health promotion, Duration of Diabetes – status of complicationsPrevious effort in diabetes self-caremotivation79
Individualized OT Assessment –Factors to Consider Health literacy – learning stylesCultural Diversity – meaning of illnessAge/gender – muscle mass, changesOn the Job Environment – med managementFamily & Social Support – health promotion, Duration of Diabetes – status of complicationsPrevious effort in Diabetes Self-Caremotivation80
Health LiteracyThe degree to which individuals have thecapacity to obtain, process, and understand basichealth information and services needed to makeappropriate health decisions.It is “RUDD”.Read, Understand, & Do Diligently.U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S.Government Printing Office.81
Health Literacy & DiabetesInability to interpret low blood sugar %Inadequate Literacy* Gazmararian, 1997Marginal HealthLiteracyAdequate HealthLiteracy82
Health Literacy & ycemicControl* Schillinger, et al. 2002InadequateLiteracy33%22%20%30%83
Individualized OT Assessment –Factors to Consider Health literacy – learning stylesCultural Diversity – meaning of illnessAge/gender – muscle mass, changesOn the Job Environment – med managementFamily & Social Support – health promotion, Duration of Diabetes – status of complicationsPrevious effort in Diabetes Self-Caremotivation84
Cultural Diversity & Diabetes-Notice that cultural norms may affect how a disease is perceived & how healthcare communication is done.-Be aware of culturally specific language &metaphors.-Incorporate patients’ metaphors to make thecare more meaningful and relevant to them.* Huttlinger et al., 199285
Cultural Diversity & Diabetes-Adapt communication styles during clinicalencounters ask processes“Can you tell me how you take your medicineevery day?”“How many times per week do you miss takingyour medication?”vs. “Do you take your medicine every day?”* Huttlinger et al., 199286
Individualized OT Assessment –Factors to Consider Health literacy – learning stylesCultural Diversity – meaning of illnessAge/gender – muscle mass, changesOn the Job Environment – med managementFamily & Social Support – health promotion, Duration of Diabetes – status of complicationsPrevious effort in Diabetes Self-Caremotivation87
Age and Diabetes 40 yr old more likely to get type 2 diabetes Age Increased insulin resistance Lifestyle factors contributing to age-associateddecrease in insulin sensitivity include: dietary changes: higher intake of saturatedfat and simple sugars reduced physical activity: less skeletalmuscle mass and reduced strength Gambert & Pinkstaff (2006) Emerging epidemic: diabetes in older adults:demography, economic impact and pathophysiology.88Diabetes Spectrum (19): 221-228
Estimated Prevalence of Diabetes in U.S.Adult Men and WomenPercent of Population30MenWomen21.120.22017.817.512.9 12.4106.8 6.11.6 1.7020-3940-4950-5960-7475 Age (Years)Adapted from: Harris et al. Diabetes Care. 1998;21:518-52489
Individualized OT Assessment –Factors to Consider Health literacy – learning stylesCultural Diversity – meaning of illnessAge/gender – muscle mass, changesOn the Job Environment – med managementFamily & Social Support – health promotion, Duration of Diabetes – status of complicationsPrevious effort in Diabetes Self-Caremotivation90
Individualized OT Assessment –Factors to Consider Health literacy – learning stylesCultural Diversity – meaning of illnessAge/gender – muscle mass, changesOn the Job Environment – med managementFamily & Social Support – health promotion, Duration of Diabetes – status of complicationsPrevious effort in Diabetes Self-Caremotivation91
Tools for Intervention
What have you been doing?Revised Rating Category, Activity Card Sort1. I do not do it. [Never did.]2. I do it on and off, once in a while.3. I have been doing it as much as I can.4. I have given it up. [Did it in the past.]To assess previous effort in diabetes management
Tools for InterventionPatient/Family Ed
Set SMART goals: Specific Measurable Attainable Realistic Time Sensitive Physical activity recommendations: Resistance exercise 3 days per week AND EITHER 150 minutes/week of moderate intensity aerobic activity OR 75 minutes of high intensity aerobic
Occupational Therapy Occupational Therapy Information 29 Occupational Therapy Programs 30 Occupational Therapy Articulation Agreements 31 Occupational Therapy Prerequisites 33 Physical Therapy Physical Therapy Information 35 Physical Therapy Programs and Prerequisites 36 Physical Therapy Articulation Agreements 37 Physical Therapy vs .
(2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625-683. American Occupational Therapy Association. (2013). Guidelines for Documentation of Occupational Therapy. American Journal of Occupational Therapy, 67 (6), S32-S38. American Physical Therapy Association. (2009).
1When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy assistants (AOTA, 2015b). Occupational therapists are responsible for all aspects of occupational therapy service delivery and are accountable for the safety and effectiveness of the occupational therapy .
Both the Occupational Therapy Assistant program and Occupational Therapy Doctorate programs are housed in the Occupational Therapy Department. The Chair of the Occupational Therapy Department is Dr. M. Tracy Morrison, OTD, OTR/L who also serves as the Director of the Occupational Therapy Doctorate Program.
Documentation of occupational therapy services is necessary whenever professional services are provided to a client. Occupational therapists and occupational therapy assistants1 determine the appropriate type of documentation structure and then record the services provided within their scope of practice. This document, based on the Occupational .File Size: 540KBPage Count: 9Explore furtherDocumentation & Reimbursement - AOTAwww.aota.orgNEW OT Evaluation and Reevaluation - AOTA Guidelinestherapylog.typepad.comWriting progress notes in occupational therapy jobs .www.aureusmedical.comDocumentation & Data Collection For Pediatric Occupational .www.toolstogrowot.comSOAP Note and Documentation Templates & Examples Seniors .seniorsflourish.comRecommended to you b
therapist or an occupational therapy assistant. (6) "Occupational therapy assistant" means a person licensed by the board as an occupational therapy assistant who assists in the practice of occupational therapy under the general supervision of an occupational therapist. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Sec. 454.003.
professional excellence in occupational therapy. MISSION STATEMENT Entry-Level Doctor of Occupational Therapy Program Through its innovative curricular design and delivery model, the entry-level Doctor of Occupational Therapy (O.T.D.) program prepares qualified students to become successful occupational therapy practi-
occupational therapy, is Misericordia Univer-sity's occupational therapy honor society. This honor society is a national organization which recognizes the academic accomplish-ments of hardworking occupational therapy students. It also pro-motes research and scholarship among stu-dents as a means to advance the field of occupational therapy.
