Date of Award


Document Type

Critically Appraised Topic


Occupational Therapy

First Advisor

Anne Haskins

Second Advisor

Breann Lamborn

Third Advisor

Gail Bass/Devon Olson Lambert


The focus population for this critically appraised topic (CAT) was older adults aged 65 years and older who lived in an urban setting in SNFs. For the purpose of this CAT, an urban setting is defined as an area with 50,000 or more people residing (US Census, 2010). According to Lui (2018) who synthesized available data on productive aging for senior citizens in a SNF, stated that the global generation of older adults is currently more populous than ever recorded in world history. The extent of this demographic is expected to dramatically increase as a result of continued advances in medicine for aging and chronically ill populations. In a systematic review on social participation of community-dwelling older adults by Smallfield (2018), the United States’ population of older adults is predicted to reach 84 million within the next 30 years. Generally speaking, present day SNFs nation-wide showed a lack of client-centered occupations that have beneficial aspects of productive aging such as an increased knowledge on leisure education (Liu, 2018). Rafeedi, Metzler, & Lamb (2018) literature review on the cultural environment in SNFs says that routines in SNFs are predictable and leave residents lacking meaning in their lives. He also explains how this leads to higher rates in depression and loneliness among residents which are often targeted with offering cliché games and activities in SNF that show little evidence of effectiveness (Rafeedi et al., 2018).