From equipment to engagement: rethinking how occupational therapy creates impact for older people

Purpose This study aims to propose a conceptual framework to explain how occupational therapy (OT) affects older people (OP). It also attempts to understand why results reported in existing studies vary. Design/methodology/approach This study develops a conceptual framework using the person–environment–occupation (PEO) theoretical framework. It uses 44 articles on OT that affect OP. Each article is coded for the intervention route, setting, outcome level and direction of findings. Findings The majority of studies focus on community settings, rarely examining mechanisms, caregiver or system outcomes. Out of 29 articles based on community settings, the authors find that 18 reported positive, nine mixed and two null results for OT affecting OP. The proposed conceptual framework proposes that OT acts through PEO routes to restore fit. It offers five propositions on fit assessments, namely, links between routes and outcomes, meaning as a mechanism, timing around transitions and the roles of structure, caregiver involvement and service integration. Practical implications Practitioners should assess fit before the selection of an intervention route. They must match routes to outcomes that matter to the person and review fit at transitions. Managers and commissioners need to reduce fragmentation between settings, provide clear referral routes and look beyond equipment and adaptations. Originality/value This study provides a theory-driven, practice-oriented explanation for the variability in OT effects. It connects the profession’s core concepts to decisions about services for OP.