**Abstract**

When we are faced with problems that have arisen or are secondary to a particular pathology, the first thing that comes to mind is that we should go to the psychologist, social worker or physiotherapist, but what about functionality and personal autonomy? How can this influence our daily life activities? The occupational therapist, unfortunately little known or undervalued, plays an essential role in this type of situation and especially in work with the elderly.

**Keywords:** rehabilitation, occupational therapy, personal autonomy, geriatrics, functionality, daily life

#### **1. Introduction**

During the last few years, Gerontology and Geriatrics have experienced a great impulse from both classical research and the growing interest in the processes of population ageing in the search for quality of life and personal independence in the last phases of life [1].

Cognitive abilities or skills such as memory, evocation or recovery of information (sensory, short or long term) or contrary as the loss of efficiency in the performance of the activity, secondary to any of the functions mentioned above, can cause further deterioration of the subject that reduces both the quality of life and their level of autonomy [2].

Active ageing as we know it today emerged in the sixties and seventies with a focus on life satisfaction related to the activity people were carrying out, requiring new roles to compensate for those lost and in turn a feeling of being active and participating in society [3].

### **2. Care in geriatrics and gerontology**

It is difficult to choose the appropriate care resource for the person, considering the intervention process and the level of care based on the factors or means available, which can sometimes influence the final treatment and, therefore, the planning, methods and techniques key to the treatment goals set.

Regarding rehabilitation, both the functional recovery, extension or time of the intervention and the quality of it are based on the patient's premorbid state, the evolution or prognosis of the pathology and the involvement of the social environment [4].

Starting with the preparation of a patient profile, gathering as much information as possible from family members, the user and other professionals, we complete what we call an occupational history. This history provides us with information about the patient's lifestyle, interests and evolution, which allows us to identify the activities that are most appropriate for the patient's condition and tastes, with the aim of involving the user during the treatment or operation in order to maintain both their attention and their predisposition towards the objectives previously set, whether these objectives are established or agreed upon with the patient.

Taking into account that multipathology, common both in this type of population either by age or symptoms, usually accompanies the geriatric population, achieving greater independence or autonomy prior to the current situation is a difficult task, since the body's own systems are not as they were in years or states prior to the current one, so in some cases it is only possible to partially recover the systems or alleviate this deficit with the use of external tools or support products that allow users to bridge the gap with their previous state, allowing them to perform the activity in the most standardized way possible [5, 6].

The training and adequacy of an adequate care team is key to offering an optimal comprehensive geriatric service, which allows the realization and design of an appropriate and personalized intervention plan according to the characteristics of the user. The difficulty of intervening in a geriatric patient requires the inclusion of different disciplines that can complete all the areas in which the patient may present some type of problem (physical, functional, psychological and social).

The fact that the multidisciplinary team is an important part of the user's approach allows us to identify different points of view on the same areas of intervention, being able to exchange information and work towards a common goal [7].

#### **2.1 Occupational therapy and activity**

According to the World Federation of Occupational Therapy (WFOT), occupational therapy is defined as a profession that promotes health and well-being through the use of occupation as a means. The main objective is to encourage people to become independent in their activities in order to improve their participation. These activities allow the user to increase the independent functions that he or she maintains, enhance development, prevent disability, and improve independence and quality of life [8]. Through this objective, it allows the development of performance components necessary to carry out the activities without problems based on the therapeutic use of the activity with purpose during the intervention process [9].

Therefore, occupational therapy can be understood as the profession that deals with through a meaning or directed to a purpose, with the activity as a base, evaluate, facilitate, restore and maintain a function. Depending on the objectives set by the occupational therapist, it can provide the means to enhance strength, promote social action, stimulate cognitive functions, etc. [10] (**Figure 1**).

The activity is a set of actions carried out with the aim of meeting the goals of an operational program. It consists of the execution of processes and tasks, using certain human, economic and material resources assigned to the final activity.

Such action must maintain or contemplate a meaning for the individual or a feeling of competence that will be important to engage the user during the therapeutic process and thus produce positive feedback.

On the other hand, the activity (meaningful for the user) can be graduated or adapted to facilitate or promote the full implementation of the activity [11].

**Figure 1.** *AOTA Model 2014 [6].*

Depending on the focus or direction you want to take on the type of activity to be used, level of demand or qualities needed to carry it out, so during the previous design a challenge will be proposed that is sufficiently important to motivate your positive participation in the activity.

Associated with the sense and meaning that human activity should carry about emotional well-being, Csikszentmihalyi proposes a different way of understanding activities adapted to the different capacities of people, providing that sensation of flow or letting go, thus giving birth to the "Flow Theory". This emotional experience after carrying out the activity allows to report during the participation a positive and pleasant feeling while carrying out [12].

This theory is developed around the search for optimal user experiences during the performance of activities, based on previous experience, skills and abilities in a balance between the possibility of realization and the ability to act of the subject.

This level of challenge or demand for the activity must be appropriate to their capacities/skills, encouraging, as mentioned above, their participation, promoting positive feedback and a balance between the patient's demands and skills.

Happiness is defined as the basis of the quality of life of people, but it also requires what one does to be happy, developing goals that bring meaning to our lives, giving a feeling of satisfaction for something well done through the construction of one's own goals, development of potential, intrinsic motivation enjoying the performance of the activity and motivation in its completion [13]. On the other hand, this lack of time or feeling causes adverse feelings such as stress, increased social concerns or even decreased physical and mental health.

The Flow Theory cites the conditions in which an activity can be considered therapeutic, which are when commitment and concentration are allowed and the user has the necessary tools to carry it out.

Another theory related to the application or use of activities is the DOiT Model (Dynamic Occupation in Time Model) developed by Larson. This model proposes a continuous development of the activity and its skills related to the passing of time together with the subjective experience (Well-Being). The dynamic participation of the therapists in the selection of the activities allows to suggest different forms and strategies of approach, looking for the most positive experience during the time of accomplishment (**Figure 2**) [14].

A greater commitment in developing activities will awaken a feeling of competence, causing a diversion of your energy towards those things in which you show the greatest interest, the greatest need and therefore the search for feedback after completion.

This commitment is generated once the patient actively participates in the activity, Flaherty [15] proposes that some activities provoke an emotional response or interest that leads to commitment, but at the same time these are influenced by their capacities and abilities, past experiences, etc.

If we base ourselves on what Flaherty mentions, quality of life is a determining factor in the individual's interest in participating, in the emotional response and in the level of commitment to the activity.

**Figure 2.** *DOiT Model Interaction. (Extracted from [14]).*
