Some models based on the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) are being put forward and tested world-wide for various objectives. An Interactional Model of Mental Disability (IMMD) is proposed here as a new practical rehabilitation model based on the ICIDH and the International Classification of Functioning and Disability (ICIDH-2). The IMMD provides a basis for understanding the interaction of mental disabilities (impairments, disabilities and handicaps) and other factors (environmental factors, personal factors). The other feature of the IMMD is that it provides a recording format for a practical application of the model. From our experience with the IMMD, we conclude that it is useful for understanding the client’s condition and disability, for setting goals and implementing a team approach for professionals, and for helping the client understand his/her own condition and the services provided.

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Japan has become an ultra-aging society as people over 65 years of age increase to 17% of the population. The Law of Public Care Insurance for the Elderly system commenced in April of the year 2000. As a result, the payment system for elderly care services was transferred from taxes to national health insurance. Community-based rehabilitation, which includes occupational therapy, will make even greater contributions to the ultra-aging society in Japan.

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The quality of life of the older person is formed by all life experience. The health of a person throughout the growth process from birth to death is greatly influenced by the daily occupation of the individual. Occupational development may be delayed, hindered, thwarted or changed by debilitating congenital or acquired illness or injury at any age and may be temporary or permanent. The individual depends on the knowledge and experience of past years to help with recuperation; future developmental stages will be positively or adversly affected by disability. Retirement from years of work at a job may provide freedom to explore new interests and occupations; or isolation from routine and community and poor self-motivation for activity, often resulting in declining health and quality of life, lacking daily achievement and satisfaction. In the United States increasing programs are available for rehabilitation of the older person both within and outside of the medical environment. With shorter hospital stays, emphasis is on home care, assistive living, and long term care with a homelike atmosphere. The rehabilitation, home care, and long term care teams focus on engaging the older person in new occupations to provide health and quality in the remaining years. With longer life, increased attention to quality is essential in the health care environment, be it in an institutional or community or home setting. Occupational therapists play a key role in educating staff and families in the importance of optimum self-care and self-directed daily activity to enable elders to engage in a life of achievement and satisfaction within individual limits and potentials.

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This paper will describe a program of intervention which is specific to Dementia. Anne-Marie Kidd, an occupational therapist in Cape Town, South Africa, has had success in implimenting the Validation Therapy Approach to the management of the elderly person with Dementia. She is ackowledged for her major contribution to this article. At the outset, the concept of the Validation Therapy Approach will be described in detail. Concepts such as creating a sense of importance in the elderly person, allowing them to feel they have something to contribute, structuring activities so that the person with Dementia feels useful and optimising assets, are key issues in this type of therapy. An example of a unit that employs this type of therapy will be described in detail and a brief discussion will bring the article to conclusion.

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This article is based on a paper presented at JAOT International Conference in Yokohama, 2000. It outlines care provision for elderly people in the United Kingdom, with specific reference to Scotland. It describes some of the problems that people may experience, the range of services available, and some of the challenges and dilemmas influencing the general provision of care. Examples of particular physical and psychological problems and the ways in which the community has responded to the needs of patients and carers, provide an illustration of the difficulties encountered. Reference is made to some of the principal non-governmental / voluntary organizations (NGOs) which provide advice or care. Two brief case histories are included as an appendix.

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Identifying effective preventive interventions which can preserve the autonomy and the maintain health of elderly persons living in the community is paramount. Health service restructuring in Alberta, Canada provided the impetus to implement an integrated community-based program to address the fragmentation and lack of coordinated services for the frail seniors. The program content and approach taken by two organizations in partnership with the Capital Health Authority (CHA) in Edmonton, Alberta is described The outcomes study results of a recent evaluation of the CHOICE program is reviewed.

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