Background: For the elderly with visual impairment, they encounter different barriers and difficulties in their life. Nevertheless, there is little research exploring the real life experience from the perspective of elderly with both dementia and visual impairment. In addition, current conceptual Occupational Therapy models of practice have been identified as culturally insensitive. There is limited research has been conducted on the use of Kawa model. In order to fulfill the need of the profession for a culturally relevant model, case study about Hong Kong elderly with dementia and visual impairment with Kawa model application is developed.

Methods: Semi structured and face to face interviews were completed with elderly who lives in residential home experiencing with dementia and visual impairment by utilizing an East Asian Occupational Therapy conceptual model named Kawa Model to examine and uncover their own life need. The results of the interviews will then be transcribed and coded for further analysis. The Kawa (Japanese for river) model uses a familiar metaphor e.g river (life flow), drift (problems) and riverbed (environmental influence) etc of nature as an effective medium to translate subjective views of elderly own self, life, well-being and their meaning of occupations into treatment goals. This familiarity of the metaphor make the client and therapist more understand their real life situation and prompt need of therapy treatment. This model can be easily understood both for elderly and empowered their quality of life in the aging process.

Results: The results reflected that elderly with dementia and visual impairment encountered health problems such as poor memory, deteriorating physical cognitive condition, loss of sight and perception of being burden to family are identified as their rocks to impede his life flow. By using the Kawa model river framework, OT begins to identify those assets, which enable the client’s life, water continues to flow. These assets such as strong relationships with family members and positive personal attributes are key factors in promoting personal potential, positive aging and quality of life. The client also highlighted the meaningful activities such as playing Chinese chess, listening to classical music, reading newspaper and classical Chinese novels are important in promoting and supporting life water flow.

Conclusions: The findings have encouraged occupational therapists to address the inner perspectives of client by using the Kawa Model framework instead of using the conventional occupational therapy approach, which focused only on medically defined impairments and disability. Before the Kawa model emerged, Occupational Therapists were largely seen as professional who helped ameliorate functional disabilities, difficulties with ADLs and cognition. It further expanded to include the elderly social and physical environment, assets and quality of life issues of the client.