The number of older adults with cancer will continue to rise as the American population ages. Older adults with cancer report decreased quality of life, and their limitations within instrumental and other activities of daily living persist after cancer treatment. Restricted perceptions of adults' beliefs of what should be or could be activities for participation (i.e., occupational possibilities) may also lead to a decline in this population's quality of life. Access to occupational therapy services to support participation in occupation and improve quality of life is critical to improving the quality of care for older adults. The purposes of this project were: (1) to determine who among this population utilized occupational therapy services and what predicts that use, (2) to develop and validate a new scale designed to assess perceived occupational possibilities, and (3) to examine the relationships among meaningful activity participation and risk factors, including perceived occupational possibilities. I examined older adults (65+) with diagnoses of breast, prostate, lung, and melanoma (skin) cancer between 2004 and 2007 (n = 27,131), using NC Central Cancer Registry data linked to Medicare billing claims and found that adults with stage IV cancers or lung cancer were less likely to use occupational therapy and that previous use of occupational therapy was the strongest predictor of occupational therapy use. The Perceived Occupational Possibilities Scale (POPS) was found to be reliable and valid when tested with a sample of older adults within the Carolina Senior Registry; in addition, the POPS was found to be a significant predictor of meaningful activity participation. The perceived occupational possibilities of older adults were better predictors of participation in meaningful activity than demographics, functional status and emotional support. In combination, the findings of these three studies suggest that, as more adults are diagnosed with and survive cancer, it is imperative they not be assessed solely on functional ability but also on meaningful activity participation and occupational possibilities. In addition, older adults with cancers that are least likely to be seen by occupational therapists should be targeted with appropriate interventions.Doctor of Philosoph
