In Reply.—Dr Landi and colleagues raise several important issues. First, they note that a more complete assessment of the value of our treatment program would be possible if outcomes on the participants' subsequent patterns of health care utilization and medical costs were available. We agree and are in the process of analyzing data to present these results in a future publication. The findings were omitted from our prior report because at the time of submission the cost-effectiveness data analysis was not yet completed and because space limitations prevented its inclusion. In considering this issue, however, we believe that the OT program's demonstrated ability to enhance elders' self-perceived health, vitality, role functioning, and life satisfaction represents a very important outcome quite apart from any concomitant economic benefits to society that would be expected to accrue in the form of reduced medical expenditures. Because society has an obligation to promote a high quality of life for all its members, the capacity of OT to mitigate against the health risks of older adulthood may in many cases be sufficient to justify its use in selected contexts.
Clark FA. Occupational Therapy and Outcomes for Older Adults—Reply. JAMA. 1998;279(8):582. doi:10.1001/jama.279.8.582a
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