Occupational therapists, by virtue of their name (at least in English) and their history, have always been concerned with occupation, also called “meaningful activity.” This concern has taken two forms: occupation as means and occupation as goal. The former, often captured under the rubric “therapeutic use of activity,” has been a focus of occupational therapy¹ (OT) for most, if not all, of its history.

The latter, however, captured under the rubric “occupation-based practice,” only became a major focus of practice at the end of the twentieth century. For much of its history, OT’s use of occupation, or meaningful activity, was from within a medical paradigm, with the aim to improve outcomes for individuals suffering from diseases or disorders through the therapeutic use of activity [1].

An elderly person carries with them their sense of being and doing, even with the risk of unexpected fragility [2] that comes with aging, and the limitations associated with it. Every elderly person has their own personal life course that has contributed to their current situation by the very nature of their past decisions. For example, as we see in the ecological model [3], the way in which each person experiences aging changes according to differences found in everyday situations, social and economical status, gender, and type of housing. The positive and negative events that shape the normal trajectory of life is modeled by the cultural environment, composed of socioeconomic conditions, career choices, health status, family relationships, and friendships.