Food-related activities and occupations relevant to older adults include meal preparation/clean up, shopping, self-feeding, eating and swallowing, community mobility, and financial management for food purchases. Community-dwelling older adults have been found to have challenges performing food-related activities and occupations independently, requiring assistance from others in areas such as self-feeding, meal preparation, shopping, and transportation to food stores (Chang & Roberts, 2008). Additionally, older adults have demonstrated poor adherence to food safety practices, as indicated by a lack of refrigerated food storage knowledge, the prevalence of expired or rotten food, and difficulties reading expiration labels. The profession of occupational therapy can serve as a resource for this population, given their scope of practice based on the American Occupational Therapy Association (AOTA) document Occupational Therapy Practice Framework: Domain and Process 4th ed. (AOTA, 2020c) and the Philosophical Base of Occupational Therapy (AOTA, 2017). Occupational therapy practitioners can teach strategies and establish reminders to label food and exercise safe, proper storage practices. Self-feeding may be resolved by educating on the use of adaptive equipment such as scoop bowl/plate, built-up utensil handles, or a rocker knife; and fall risk interventions may be tailored to address fall prevention in the kitchen and during food-related activities. Occupational therapy practitioners can assess and treat eating and swallowing difficulties by addressing oral–motor skills, bolus management, or dysphagia. Teaching financial management and budgeting strategies can also support older adults in their ability to afford nutritious meals on a fixed income. Lastly, community mobility is a multifactorial issue that includes home accessibility, neighbor safety, driving, and alternative transportation. Occupational therapy practitioners can address mobility concerns by recommending the installation of a ramp or railings on the exterior of the home, identifying age-friendly routes for accessing food stores, teaching an older adult how to use various alternative transportation options, and/or referring an individual for an older driver assessment. Community-dwelling older adults are at distinct risk for food insecurity as opposed to those who reside in residential or assisted living facilities (Wright et al., 2015). Therefore, occupational therapy practitioners who provide community-based services may be in a prime position to integrate basic food security screening/assessment measures into their encounters with older adult clients to identify those at risk for food insecurity and who have difficulties performing food-related activities.

When assessing the person, occupational therapy practitioners consider a range of skills and characteristics specific to their clients, including but not limited to neuromusculoskeletal functions, gait patterns, psychosocial status, social skills, routines, and roles (AOTA, 2014). All these factors can either support or impede food security and/or engagement in healthy food-related activities. Research has shown impairments in motor, cognitive, and psychosocial functions have all been found to limit older adults’ performance in food-related activities, including feeding, dining with others, and preparing meals (Chang & Roberts, 2008; Clegg & Williams, 2018; Eckel et al., 2012; Poole et al., 2011).

In addition to appreciating personal factors related to food insecurity, occupational therapy practitioners have had a long-standing role in recognizing how the environment can either promote or inhibit participation in occupations, such as meal preparation or shopping (AOTA, 2014). Law and colleagues (Law et al., 1996) described the environment in the PEO model as physical and social considerations and also recognized the significance of cultural, socioeconomic, and institutional aspects of the environment as well. The physical environment, for instance, may refer to an older adult’s home or the neighborhood in which they reside. With regard to the home environment, a recent systematic review suggested home modifications, such as adding task lighting, providing adaptive equipment, and installing assistive technology devices can have a positive impact on kitchen-related food activities, especially when these modifications are implemented by an occupational therapist (Stark et al., 2017). Other researchers have suggested occupational therapy interventions can help improve older adults’ independence in daily activities in the home, including in the kitchen space (Liu et al., 2013).

Fried and colleagues (2001) suggest there is an increased burden both physically and financially on families and the healthcare system when there are inadequate environmental supports for those living in the community who have functional limitations. Home assessments and modifications can help address these concerns and are intended to increase safety, accessibility, and independence for older adults in their homes. Home modifications, for instance, can be implemented in the kitchen to decrease fall risk, improve overall safety with food-related activities, and maximize older adults’ ability to remain in their own homes—where the majority of older adults prefer to reside. Specific options for interventions can include adapting the kitchen space to allow for cookware to remain in reach at the shoulder or waist level, installing task lighting to reduce the risk of injury when chopping food or handling hot items, modifying how a cooking task is completed by applying energy conservation techniques, training older adults on the use of adaptive equipment and devices, or adding railings to enter and exit a home after shopping.

Occupational therapy practitioners are also encouraged to increase their cultural awareness of food preferences of other cultures and educate certain subgroups on healthy alternatives to preferred foods while still respecting the cultural backgrounds of older adults who may perceive less nutritious foods to be an integral part of their cultural identity. In particular, occupational therapy practitioners are recommended to assist diverse older clients in identifying healthy meals that are culturally valued, budgeting for food expenses, developing healthy shopping lists, and preparing nutritious meals that are appealing but still align with cultural norms and beliefs.