20Q: A Gerontology Expert

Regula Robnett, Gerontology Expert

Regula Robnett, a fellow of the American Occupational Therapy Association, has had a distinguished career as an occupational therapy clinician, professor, mentor, and researcher, with strong expertise in gerontology. She is the author of the book Gerontology for the Health Care Professional, which is now in its 4th edition (Robnett et al., 2020).

Franklin Stein, PhD, OTR/L, FAOTA

Contributing Editor

Salute to OT Leaders Series

20Q: An Expert in Gerontology

Before we even get started, I would like to thank Dr. Franklin Stein for his innovations such as this project. I am humbled and honored to be asked to contribute. He is the epitome of aging well and life-long engagement in occupational therapy and the many other meaningful activities that interest him. He has provided an excellent example of healthy aging for all of us, and I wish him many more years of amazing role-modeling!

Research

1. You have devoted much of your academic career to studying the aging process. Can you describe how you became interested in aging from an occupational therapy perspective?

Even before I became an occupational therapist, I enjoyed engaging with older adults. I had a close relationship with my grandparents, and my grandfather spent the last four years of his life living with our family. He was a WWI war hero and had so many stories to share, some of which I may not have appreciated as much then as I do now. I believe strongly that older adults have much wisdom to impart if we listen carefully and respect what they say.

Being a life-long learner, I knew that I would need to continue my education after becoming an occupational therapist, so I explored available PhD programs, including neuroscience and OT. I found the Gerontology PhD Program at UMass Boston, where I knew that I could meld gerontology with OT (and spend the rest of my life enthusiastically pursuing this endeavor). The venture took me 8½ years (involving a 100-mile journey from Portland to Boston once or twice a week). I believed then, as I believe now, that we have much to learn about aging (especially brain functioning, which I find the most fascinating). Although we have only scratched the surface of healthy brain aging, we are making progress, so this is a very exciting time.

2. You have published and edited a book on aging. Can you summarize the major points in the book?

Gerontology for the Health Care Professional is now in its 4th edition (Robnett et al., 2020). It is an interprofessional textbook that focuses on aging, specifically presenting a realistic and hopeful view of the aging process. It offers evidence and food for thought towards eradicating ageism, which unfortunately is present among health care providers (as well as family members and even the elders themselves). Not only does the book aim to eliminate the stereotypes of aging (see Levy, 2009), but it also provides compelling explanations to demonstrate that older adults are an extremely heterogeneous group; a group that gets increasingly heterogeneous with age. This acceleration of diversity occurs because our fixed genetics get bombarded in a cumulative fashion by our lifestyle choices (both positive and less healthy) as well as whatever life throws at us. The good news is that evidence has shown that we can make positive life changes to improve the quality of aging at any age. One simply cannot, or should not, lump those 65 and over under one big unified label (the “elderly,” which is becoming a derogatory term). In the textbook, we explore typical and atypical characteristics of biopsychosocial aspects of aging, including brain health. Atypical brain health includes different forms of major neurocognitive disorder or dementia (for example, AD, Dementia with Lewy Bodies, and frontotemporal dementia) as well as delirium and the cognitive impairments related to depression. While the text does not get into detail on interventions for people with cognitive impairments, it does offer helpful hints and resources.

The textbook is a comprehensive practical text covering the field of gerontology. Chapters include grief and loss, pharmacology, nutrition, communication (health literacy), cognitive, emotional, and physical changes related to aging, physiology, and pathology, social gerontology, aging in place, sexuality, and reframing aging, including what we should call people when they reach old age--older adults or perhaps elders, not the elderly (or old codger, or old biddy, or old fogey…). Through this book, we seek to help professionals in all fields of health care understand the field of gerontology and to offer concrete information which can promote the best care/interventions for older adults. Since loss is common among those who have lived a long life, we explore theories related to loss and share ideas about supporting someone who has recently sustained a loss. One key element is not to “find the right words,” but rather just to listen. Simple as it sounds, by listening, you likely cannot go wrong.

Current Work

3. You are currently the Associate Director for the Center for Excellence in Aging and Health (CEAH) at the University of New England in Portland, Maine. What are the major purposes of the Center?

The CEAH started in 2018 with a million-dollar gift from a local architect who renovates historical buildings into affordable housing for older adults (Cyndy Taylor, philanthropist extraordinaire). A center such as the CEAH is perfect for Maine, as the state has the oldest mean age of any state in the US, with 19% of Mainers aged 65 or older. During my recent sabbatical (2018-2019), I joined the CEAH as a volunteer. Dr. Tom Meuser, the founding director, was happy to have me as a collaborator, so when I returned to UNE after my sabbatical, I was privileged to be named the associate director of the CEAH, a half-time position. The rest of the time, I am a professor of OT at UNE.

The mission of CEAH is to “advance inclusive, narrative-informed and outcome-oriented research on healthful aging.” This research takes many forms, often involving students as research collaborators. Our largest, perhaps most impactful project is a longitudinal registry of over 500 people aged 55 and older (our “Legacy Scholars”) who regularly volunteer as participants for various studies and fill out detailed yearly health and wellness surveys. Our studies on healthful aging encourage integrative thinking and span several “pillars of healthful aging,” including Identities, Functions, Transitions, Generations, Practices, Economics, and the Environment. A few example studies have involved knee health (“Got Knees”), technology and people living with dementia (PLWD), the attitudes and behaviors of older adults related to COVID-19, informed consent in dentistry, telehealth for medication management, ageism and public health, and a telehealth tablet program to teach older adults technology use from a distance (with dozens of student teachers). Several of these studies are still ongoing. One of our true strengths as a university is our deep and abiding commitment to interprofessional work.

The CEAH provided various services (e.g., educational and activity sessions, assistance for finding resources) for older adults in an affordable housing center (a renovated religious convent) near the university. However, when the pandemic closed public places and banned visitors in mid-March 2020, we stopped direct face-to-face services and began offering Zoom sessions for our Legacy Scholars (and friends). We have offered dozens of sessions and included 35 occupational therapy students who developed sessions on wellness and topics of interest, including balance, sleep hygiene, and embracing diversity. These sessions were well-received by the older adults and used to fulfill the OT Level I fieldwork requirement in the summer of 2020 (under our supervision). Initially, the students were not terribly pleased. In the end, they loved the connections they made with our Legacy Scholars. This spring, we are offering a Zoom series called the E-Power series featuring experts from the university community. E-Power is our acronym for “Electronically Engaging Elders for Enjoyment & Education.”

Partnerships are critical for successful research on human aging. The CEAH has a new contract with a local housing authority for new office space that will be open as soon as it is safe to do so. In the space we have been granted, activities related to wellness, a student-run wellness clinic, and a cost-free dental/denture clinic are all planned. All of these activities will, sooner or later, involve research as we are committed to promoting evidence-based practice.

4. How can you apply the findings of your research on aging to occupational therapy?

Much as I have a positive view of aging (I am an older adult myself, and my independent-living mother is 98), we need to accept the fact that older adults like myself are more likely to have chronic conditions and are more susceptible to neurocognitive disorders. One of the most common major neurocognitive disorders is Alzheimer's Disease (AD). AD and other forms of dementia are not a normal part of aging, but they are common. While only 1 out of 10 people over age 65 have a form of dementia such as AD, the prevalence of people living with dementia (PLWD) increases to more than 3 out of 10 after age 85, and this has no cure. OT is an integral component of intervention for PLWD and their care partners. We can assist PLWD to maintain everyday function and engagement (often through compensatory activities and adaptation), and we can work with caregivers to decrease the burden of assistive care. Older adults with acute and chronic conditions, as well as elders who want to improve their functioning and/or health, can benefit from OT to assist them to “live life to its fullest.”

As a fervent proponent of engagement in research, I am convinced that in the profession of OT, we need to push harder to uncover valid evidence to promote best practice in geriatrics. I have taught research for many years. I try to get the students enthusiastic about conducting meaningful research projects that have the potential to promote best practice or client-centered intervention. Once a colleague told me that I was “a clinicians’ researcher.” I was delighted because that is exactly my goal, to conduct research that is viewed as meaningful and practical for both OTs and our clients.

I have focused much of my research on aging in developing assessment tools that examine functional behavior in one’s environment. My interest in functional assessment started when I was working in a skilled nursing facility. I often was asked to evaluate the patient’s readiness to safely return home. As a relatively inexperienced OT, I naively thought I could just design an assessment tool to help answer that question—hence the development of the Safe at Home, a quick screening tool that assesses a person’s ability to identify and fix common hazards in a kitchen area (e.g., “glass shards” on the floor, overloaded electrical outlet). Then with students, I also designed a few other tools, including the ManageMed Screen (a tool to quickly assess someone’s knowledge of medications and ability to manage a moderately difficult medication routine; the ChoRo (a visual perception test related to driving); a home safety self-assessment interview (HSSI) to help structure interviews related to independent living and aging in place, and finally the Qual-OTv2, which is a quality of life tool specifically related to OT and OT goal setting. All these tools are available for free on the website (www.NEATtests.com). OTs can assemble the assessment kits—and I appreciate getting feedback so that we can improve the validity, reliability, and usefulness of these tests. References related to these tools are also available on the website.

Healthy Aging

5. What are your thoughts regarding healthy aging?

Healthy aging is really about aging well, with or without chronic health conditions. Most older adults (85%, according to the Centers for Disease Control) have at least one chronic condition, and 65% have more than one. However, although these conditions signify that we are not in perfect physical health, they may influence levels of “aging well” less than might be expected. Aging well may correlate more significantly to a resilient, positive, and accepting attitude. Numerous studies have demonstrated that positive attitudes toward life (even in young adults, according to the Nun Studies, Danner, et al., 2001) can not only increase longevity by 10-15% but also decrease anxiety and worry in older adults (Eagleson et al., 2016). We (yes, we are all aging!) can lament getting older and feel sad about no longer being able to do the activities we enjoyed in our youth, or we can figure out how to “redesign” our lives (perhaps with the assistance of an occupational therapist). One of my catchphrases is: “If you can’t do it, do something else.” Meaningful occupations abound, and one need only get creative to keep engaging. I know it is cliché to say age is just a number, but in many ways, this is true. Assumptions about anyone, based on their age, is judgmental and downright unfair. I recall a patient I had in rehab who was 94 and had just undergone a knee replacement. One of the nurses said to her: “Oh, you poor thing, having to go through this at your age.” My patient was livid and wanted to write up the nurse (or even get her fired) for saying this. My patient emphatically stated, “I am 94, and I live by myself; why should this procedure be harder for me than anyone else? She obviously thinks I am too old.” We did talk to the nurse, gently, about her unintentional ageist remarks. In the end, we think she understood.

We recently completed a qualitative study on ageism among older generations (the silent generation and the baby boomers). Several participants brought up how they dreaded going to the doctor only to be told that they need to expect to get certain ailments “at your age.” A few even mentioned staying away from the physician even when they had ailments for this very reason!

One of the aims of gerontologists such as myself and others at the CEAH is to lengthen the time of “healthspan.” Simply stated, healthspan is the time of our lives when we are living well or thriving. The goal is for life span and healthspan to be nearly the same--living well until we die, not clinging to life by a thread over time, without the benefit of a high quality of life. As gerontologists, we seek to follow the advice of Adlai Stevenson (1987), who said: “It is not the years in your life but the life in your years that counts.” Another goal for those of us working with older adults is to “nurture, protect, and enhance the longevity dividend” (O’Neill, 2011). In general, people are living longer. Our life expectancy has increased significantly, adding over 30 to life years since 1900. However, our society’s view of aging tends to be ageist in which the view of the aged is one of diminishment, whereas youth is lauded as a time of growth. As explained by Desmond O’Neill (2011) at Trinity College in Dublin, both growth and loss can occur at any life stage. Unfortunately, ageist attitudes start early and are reinforced throughout life. Levy (2009), who studies the stereotypes of aging, has found that children already at ages 4 and 5 describe elders as frailer and less able. These stereotypes get reinforced throughout life by the media, jokes, and behaviors towards older adults until the elders themselves become the worst perpetrators of ageism, in the form of self-fulfilling prophecy. Levy (2009) coined this phenomenon the “stereotype embodiment theory.” We must constantly work to combat ageism, whether in defiance, by aging well, or through advocacy to help others age well.

6. What research studies are you currently involved in at the Center?

CEAH was founded in 2018. Although not (yet) funded by large national grants, we are supporting or conducting a number of innovative studies. Below are just a few of the current studies that our students are involved in.

The OT students I am working with are involved in three studies. One group is working with Dr. Michael Pizzi, OTR (who developed the Pizzi Occupational Losses Assessment). We adapted the assessment specifically to explore adults’ (age 18 and over) perceptions of occupational losses related to Covid-19. A second group is working on a project related to technology and aging, specifically to explore if the degree of technology use (or comfort level with technology) relates to loneliness and/or social isolation. For this research project, we are recruiting people aged 55 and over. While anyone is eligible, we are specifically looking for older adults who are either familiar with digital technology, do not use it, or are not comfortable using digital technology. My third group is examining how different groups (the residents themselves, families, and staff) view factors contributing to the quality of life in assisted living facilities.

Another qualitative study that is ongoing (with an OT student), currently with over 60 respondents, is a study on paradoxical lucidity (PL). When people have serious mental or cognitive disorders such as psychosis or Alzheimer's Disease (AD), they are no longer lucid (clear thinking), at least not on a day-to-day basis. PL entails episodes of unexpected lucidity, often very near the end of life. Although the phenomenon has been described anecdotally for hundreds of years, little scientific research has been conducted on PL (Mashour et al., 2019). The National Institute of Aging called for researchers to study this area, so we are answering the call. Our study, for which I am the principal investigator, asks those who have witnessed episodes of PL to share their experiences. I became interested in this topic because I was a witness to a PL experience my mother-in-law Fran had two days before she died. She had end-stage AD, and in many ways, we had lost the essence of Fran months before she died. Like many of our current study participants, experiencing the PL episode with her was both emotional and amazing. For nearly an hour, Fran returned to her loving former self. We reminisced and healed hurts that we had caused for one another over the years (she had lived with us for three and a half years, and her personality had become paranoid and cantankerous—through no fault of her own). During her period of PL, she was lucid and engaging; we both laughed and we cried. I understood even in the midst of this episode that this was an extraordinary experience.

Background

7. Where did you grow up and spend your childhood and early adult years?

I was born in Switzerland (hence the unusual name, Regula, which is actually quite common in Zurich). I immigrated to the US with my mother when I was nearly five. I have dual citizenship, with deep Swiss roots. Not long after settling in, my mother met a widower at a Parents Without Partners meeting and soon thereafter we became a blended family, as my step-dad had two children. We moved to Vermont when I was nine, so most of my childhood memories are from the “green mountain state,” a wonderful place to grow up if you love nature and the outdoors.

I loved making/playing creative games and playing outside all day with my friends. One of my favorite indoor occupations was reading, and one of my favorite books was Karen and the sequel With Love from Karen by Maria Killilea. Karen was a child born prematurely weighing only 2 pounds. She was diagnosed with cerebral palsy. Through her story, I learned a lot about living with a disability or as Karen herself stated: being “permanently inconvenienced.”  Even though OT was not mentioned often, the tenaciousness of both Karen and her family allowed her to live a rich and long life (she died at age 80 in 2020). I think her story planted the seed of occupational therapy in my heart, even though I did not know it at the time. The story of Karen also taught me that persistence can pay off! (Persistence is one of my strengths, which can also turn into a weakness when it is overused—so I have to be careful not to be a pest!)

Much as I loved my home state, when I turned 18 and started thinking about college (or a gap year, as it turned out), I thought to myself, “if I don’t leave Vermont now, I will never leave." So off I went, driving my Mercury Capri by myself to Colorado, where I embraced the roles of ski bum and very-early-morning waitress. I also lived in Texas where I worked as a counselor at a camp to integrate the 5th-grade children of Houston. I missed winter, so ended up back in Vermont, and then back to Colorado, after another year, this time to buckle down and study.

School

8. Where did you obtain your undergraduate degree before becoming an occupational therapist?

Colorado State University (CSU) was my institution of choice for many years. I double-majored in Psychology and German. I still was oblivious to occupational therapy. I loved the student role and was motivated to do well, graduating Pi Theta Kappa, but my academic career at CSU did not end with my first graduation.

9. After graduating from the University what was your first position?

My first position was not really a position at all, it was an opportunity. Just prior to finishing my master's degree in education, I received a year-long Fulbright scholarship to study in Germany. I ended up doing my thesis comparing the guidance counseling system in Germany and the US. While in Germany, I gave birth to our son, which added another layer of complexity and excitement to our lives.

After returning to Fort Collins, CO, and graduating with my MEd, my first position was related to both OT and social work. I was a community programmer in Loveland, CO. We managed a federal architectural barrier removal grant and organized both a garden gleaning program and a free dental care program in which most local dentists offered a pro bono half day per month for disadvantaged people. I loved the position and thought I had found my life’s calling. We were, after all, helping people to live their best lives. Unfortunately (or as it turned out later, fortunately), government cutbacks resulted in my position being eliminated after only three years.

I was devastated, for a bit, until one day a tiny newspaper article changed the course of my life. Just a paragraph long, the insert mentioned that CSU was starting a basic master's program in occupational therapy. It took me approximately two seconds to decide that I would apply, not realizing how competitive this would be. I spent the summer taking neuroscience and gross anatomy, and I was hooked. The OT “plant” was now thriving. That summer I also returned home to Vermont to visit my family including my (step) brother, Bobby, who had cancer and was in rehab in Burlington, VT. The cancer had metastasized to his spine so he was slowly becoming a quadriplegic. I finally got to see an OT in action. His primary OT crafted a number of “dial enhancers” using splinting material so that Bobby could manage his stereo. I was so impressed! I left with Bobby’s encouragement to become an OT.

Occupational Therapy

10. How did you learn about occupational therapy?

Although my BS was in Psychology and German, my undergraduate experience at CSU did plant that OT seed. During my senior year, I was offered a position in the Office of Academic Advising (OAA) as a peer advisor. As part of the job, I was required to learn details about all the majors offered. When I read about OT I was mesmerized, but being a senior, aged 23, with limited funds, I was sure it was too late to change my major. I also took the Strong Campbell Interest Inventory and of course, OT came out very high—not a huge surprise. I graduated, and the OAA offered me the continuation of my position as a Graduate Service Assistant. I was able to get my MEd at no cost.

11. What was the first position that you had in occupational therapy?

My first position was in a rehabilitation hospital. Somehow, I managed to get the position in Portland, Maine, although I lived in Colorado at the time. I was a new graduate and had not even taken my certification exam. In that first position, I learned so much and was able to become the primary OT for the brain injury program. I remember as a new grad that the learning curve was so steep that every night I would go home and plan for the next day. I would also dream about my patients so I ended up doing OT 24/7 until I gained the experience to practice OT effectively without having to have it be my entire life. Nonetheless, I loved my fun and challenging position!

12. What have been your other clinical experiences in occupational therapy?

After a few years at the rehabilitation hospital, I was recruited to be the first OT in the state of Maine for a rehab company providing contract services for skilled nursing facilities. I loved that job as well. I have also worked in home care. Homecare has the distinct advantage of real-life context. There is no need to contrive simulated activities when the home has everything the person might need for their day-to-day occupations. It doesn’t get more real than that. Of course, there are disadvantages to home care as well. You might get to do visits in gorgeous mansions with marvelous (and distracting) views of the ocean or you might need to visit someone who lives in squalor. (The latter client probably needs us most.) I learned to appreciate people from all walks of life. I also worked with an ophthalmologist at a low vision clinic in 2019. This was an amazing opportunity to expand my knowledge about functional vision as well as techniques and compensatory measures/equipment to promote the best use of whatever vision the person has available. The most common diagnoses our clients had were age-related macular degeneration, although glaucoma and diabetic retinopathy were common as well. Fortunately, although cataracts are the other primary condition found in older adults, cataract surgery is a relatively simple surgery that tends to lead to greatly improved eyesight without rehabilitation.

Academia

13. What attracted you to go into academia?

Even though I was a lazy, sometimes silly student in high school, even getting comments in my report card such as “could do better—needs to apply herself,” in some ways I was an academic most of my life. My family called me an “absent-minded professor” ever since I can remember. After two separate “gap years” to gain life experience, I was finally motivated to study, and I have not stopped since. Lifelong learning is one of my most cherished occupations!

14. What courses have you taught at the University of New England?

I have worked at UNE for 25 years, so over that time, I have taught almost all aspects of occupational therapy. The only courses I have not taught were in the realm of pediatrics, as my passion lies at the other end of the age spectrum. At one time, our students had a course just devoted to the biopsychosocial dimensions of older adults. What a grand time I had teaching that course. I have also taught in the mental health realm, problem-based learning, and research methods.

15. What are your personal strengths as a professor?

If I am to believe my course evaluations, students describe me as caring, approachable, and enthusiastic about OT (and about research). I have high standards (not always seen as a strength by students) and give timely feedback. While I am not successful at getting all the students to embrace research and evidence-based practice, I think I do a good job of offering support to complete doable projects that sometimes get published and often are shared through presentations at AOTA or regionally.

16. What is your personal philosophy of teaching?

My philosophy of teaching is primarily providing the support the students need in their quest for learning. I do not believe in imparting a lot of information with the belief that having heard it, they now know it, which is unfortunately common in health care (and the educational system in the US). Of course, I do lecture sometimes like most teachers, but I always incorporate application or applied learning, through which I try to entice students to deepen their understanding by exercising their brains with relevant practice scenarios. I challenge myself to find the just-right educational challenge for my students. My techniques fall along the lines of Jerome Bruner’s educational theory of scaffolding (Takaya, 2013). Bruner was a teacher for over 70 years and lived to be 100 (1915-2016). Scaffolding in the classroom is like the support needed to build a solid building, the top of which is the entrance into the profession of OT. We need to organize the building blocks so they fit together for a strong foundation. An example is learning about activity analysis, which becomes second nature for OTs, but is totally foreign to students just entering the field. In an in-class exercise, instead of starting with a full-blown analysis (with task steps, client factors, performance skills, etc.), the students start with a page of simple tasks such as “changing an overhead lightbulb” or “erasing an answer with a pencil eraser” and are asked to think only about the primary motions and/or types of grasps needed to complete the task. (In the case of the lightbulb changing, the motions were shoulder flexion, supination, and gross grasp). The students enjoyed the exercise, and the discussion was lively, as they simulated the tasks to figure out the motions. (They were also taking kinesiology). This scaffolding exercise supports engagement with the learning material, which then could be followed up with a more in-depth and specific activity analysis.

Overall, I adore my students, and they continue to give me hope for the future. I make it a goal to learn each of their names and get to know them personally (which has been much more challenging on Zoom). Their feedback makes me a better teacher, and after contemplation, I appreciate even the comments that are difficult to read. I am convinced that the best way to learn is to teach. Teaching has reinforced my life-long love of learning. In addition, I am convinced that I have learned at least as much from my students as they have learned from me; how fortunate I am!

As a raconteur, I often share quotes to elucidate my thoughts, and a couple are appropriate here:

“Education is not the filling of a pot but the lighting of a fire.” W.B. Yeats, Writer

“I am not a teacher, but an awakener.” Robert Frost, Poet

“I never teach my students; I only attempt to provide the conditions in which they can learn.” Albert Einstein, Scientist

Tell Us More About You

17. Tell us more about who you are as a person…

I do believe that occupational therapists have certain personality tendencies. We tend to be caring, we appreciate science, and we are creative (or aspire to be). I think that I, as many OTs, tend to be a role collector. Besides being an OT, a professor/teacher, researcher, and gerontologist, in my personal life, I am a wife (43 years and counting), a mother of two wonderful grown children, a mother-in-law of two (couldn’t-ask-for-better) children in law, a grandmother (“grandmamar” for now), a volunteer, a worker, and a friend.

I am a bit of a Pollyanna, perhaps because that was the very first movie I watched (and it stuck). Looking on the bright side generally helps me to cope and pushes me to take life a little less seriously than I would have a tendency to do otherwise. I like to write quips about life so this one fits here:

“Take life with a grain of salt and a sense of humor—it tastes best that way.”

I am a fortunate person who found her calling, an occupational therapy career that felt entirely right, yet challenged me every day to improve and to learn to be better as a person and as a professional. I am reaching the end of my official career, but not the end of my learning. My goal and my hope are that this is not the culmination of my work, but that I will be given the opportunity to use my precious time to continue to do good and to use my energy to promote “living life to its fullest” with every fiber of my being (and doing).

OT Today and in the Future

18. How would you define occupational therapy to a beginning graduate student?

That question should be easy, but after almost a third of a century, developing a succinct “elevator speech” has not gotten easier. One reason for this is that the profession is dynamic and evolving. However, I generally perhaps say something to the effect of:

“Everyone wants to live their best life, or as AOTA states, ‘live life to its fullest.’ Occupational therapists help people of all ages in many creative ways. We may work with premature infants or people living with dementia in its final stages (or anyone in between). Our mission is to help them do the things they want and/or need to do. We can assist by considering the person holistically from every angle (biopsychosocially) and collaborating on goals which will promote successful engagement in their meaningful life activities—their occupations!”

In the typical fashion of an unrelenting optimist, I truly believe the future for OT is bright! We are listed in the top 20 ranking occupations and in the top 10 health care professions in the USA (2021's 100 Best Jobs in America | Best Jobs Rankings | US News Careers and Best Health Care Jobs | Best Jobs Rankings | US News Careers). We have much to be proud of and much to look forward to, I am convinced. However, each of us in the profession has the responsibility for promoting OT and advocating for the profession and for our clients to brighten the already rosy outlook.

19. From your experience as a mentor in occupational therapy what advice would you give to a new graduate?

I have four suggestions to offer as follow:

1. Embrace occupation! When I started as an OT 30 years ago, a common treatment session involved stacking cones. The client would move cones from one side to the other putting cones on top of one another, and then the process was repeated going the other way. I hope new graduates have not heard of this technique, but unfortunately, the use of nonsensical movements/activities is still part of OT practice. We need to toss those cones, or better yet recycle them, in order to get creative and think of 100 ways to use them purposefully (e.g., for an obstacle course, simulated ice cream cones, for use as supplies for art projects…). Promoting engagement in the client’s occupations does take creativity. Here’s an example. I entered the patient’s room in the rehab hospital planning to work on ADLs, but she was agitated because she could not find the letter from her son. Instant new goal—find letter! We completed functional mobility looking under the bed, opening drawers, and opening the closet door, and rifling through the items on the shelf. I listened to her story about her son, and we almost made it into a game. By the time we were done, the letter was found and the clothing was gathered for an ADL session.

2. Embrace evidence and create evidence through scholarly endeavors: Evidence-based practice relies on various levels of high-quality research. Our professional responsibility involves conducting this research. Mentoring from expert OT researchers regarding research design and support is crucial. OT has not been on the leading edge of research to date. We need to do better. Community OTs and hospital clinicians who are doing awesome OT, need to share those practice-based questions begging for scientific examination, whether these are potentially promising techniques or newly designed functional assessment tools. By working in practitioner/student/academic and perhaps even interprofessional teams, we can promote excellent OT based on solid, replicable, and meaningful scientific evidence.

3. Listen, listen, listen! Usually, we are listening for an opening in the conversation so that we can begin to talk, but in true client or person or family-centered practice, we need to listen for what truly matters to the speaker. Motivational interviewing (MI) is an approach that promotes listening as well as asking open-ended questions to explore the client’s motivation to make changes related to improved health and wellness (Miller & Rollnick, 2103). The OT practitioner needs to listen to ensure an adequate understanding of the underlying volition influencing the client’s behavior. Seeking understanding promotes truly collaborative goals. If unsure that you heard correctly, you can use other MI techniques such as reflection and summarizing to sharpen your therapeutic skills. The client will lead you to where they need to go, if you listen hard enough, guaranteed.

4. Never stop learning! This emphatic recommendation is made not only for the future of our profession, which deserves professionals who are lifelong learners and will promote best practice, but also for our own personal journeys into middle and late adulthood. Vanderbilt (2021) in his new book about lifelong learning implores us to not only learn new facts (knowing that) but also to learn new skills (learning how). One cannot use the excuse that one is too old to learn ever, because humans have no set age that correlates with optimal cognitive performance. Cognition is a complex construct, so while the speed of processing may decline relatively early in adulthood, other skills such as vocabulary and aspects of emotional intelligence peak much later. Hartshorne and Germine (2015) write about this “considerable heterogeneity,” which is evident in older adults. Remember there is hope for late bloomers, with multitudes of examples of elders displaying spectacular blooming powers (e.g., Cézanne, Darwin, and Grandma Moses). Of course, this claim holds true also for OT practitioners. No excuses.

Our personal futures and the future for the profession are bright and will bring enticing challenges!

Summary

20. How would you summarize your major contributions to the field of occupational therapy?

First of all, I would like to say that I am hopeful that my major contributions are still to come. Yes, I am of retirement age and yes, I have been an OT for 30 years, but I have always been a late bloomer, so I am convinced there is much more for me to do.

Having had the privilege of teaching over a thousand OT students during the past quarter-century, my hope is that I have had a bit of a positive influence on at least a few of them. Perhaps a number of alumni from our program have turned more enthusiastically toward working with and for older adults. I hope many have embraced occupation and evidence-based practice. Over the years, the research projects conducted mutually with our students (and students from other health professions) have resulted in ten publications (with a few pending) and 18 presentations. Several alumni have reached out to me to work on research projects together or for research advice, a role for which I am grateful. Once in a store, a random person asked me if I had a fulfilling profession (she was about to go for an interview and was concerned about the fit for her). I had to think for only about two seconds—yes, I am so fortunate to have found my calling in practicing and teaching OT. That being said, I need to reiterate, I am not done yet! I am preparing for the second half of the game.

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