ORCID

Abstract

This thesis investigated the occupational needs of older adults with long-term conditions to determine how these needs could be met through primary care, acknowledging this as a contemporary area of occupational therapy practice. Combining three studies offered a comprehensive, occupationally centred analysis of a growing area of practice that remains underexplored. Strand One involved conducting a scoping review to map existing models of primary care for adults with long-term conditions. It demonstrated that current approaches largely neglect occupation, favouring biomedical outcomes and fiscally related priorities. However, growing awareness to quality of life and the role of an integrated multidisciplinary team showed growing promise. Strand Two employed interpretative phenomenological analysis with older adults to understand the lived experiences of long-term conditions and their impact on occupational needs. Participants explored loss and subsequent disruption to routine, identity and their connections to others. This required adaptation, resilience, and the use of occupation to hold on to their sense of self. Their accounts revealed the occupational needs were deeply existential, extending far beyond the clinical markers of health that usual care provides. Strand Three employed reflexive thematic analysis to examine how primary care occupational therapists meet occupational needs in primary care among older adults with long-term conditions. Occupational therapists described delivering holistic therapy to meet the needs of this complex population. However, they felt on the periphery of primary care, highlighting both the profession's distinct value and its ongoing challenge for recognition and integration. Together, these studies offer a first multi-lens examination of occupation, long-term conditions, ageing and primary care within the UK. The thesis contributes new knowledge by articulating the occupational dimensions of living with long-term conditions in older adulthood, evidencing the unique potential of occupational therapy, and identifying the contextual, cultural and conceptual needs required to embed occupation within primary care successfully.

Awarding Institution(s)

University of Plymouth

Supervisor

Tanja Krizaj, Sara Demain, Kate Turner, Rosi Raine

Keywords

Primary care, Occupational science, chronic health conditions, Older adults, Occupational Therapy, Occupational Participation

Document Type

Thesis

Publication Date

2026

Embargo Period

2026-04-30

Deposit Date

April 2026

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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Additional Files

2026Wakley10406498PhD_Appendix_E.pdf (730 kB)

2026Wakley10406498PhD_Appendix_N.pdf (684 kB)

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