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Introduction: This article describes the efficacy of occupational therapy for community-dwelling elderly people based on the results of a systematic review. Methods: We searched for relevant literature in Cinahl, Embase, Amed, Scisearch and the Cochrane Controlled Trials Register (July 2002) and in MEDLINE (May 2006). The search result (21 studies) included randomised controlled trials (RCTs) and controlled clinical trials and before-and-after comparisons. There were 13 RCTs, 8 of which met the criteria for methodological quality. We distinguished four occupational therapy interventions and analysed them independently of one another. For combining the outcomes of the separate studies we used best-evidence synthesis, which assesses the strength of the proofs obtained using decision rules on the design employed, the methodological quality, the type of outcome measure and statistically significant outcomes. Results: There is strong evidence that advice on the use of helping devices at home is effective in aiding older people to retain their independence. A combination of advice and training in skills also appears to reduce the risks of falling. Moreover occupational therapy helps older people without any specific medical condition to improve or retain their independence, social participation and feeling of well-being. Studies of the effects of occupational therapy aimed at the carer are of insufficient quality to justify claims of the effectiveness of such an intervention. Discussion: A number of systematic reviews present results consistent with our findings. Occupational therapy makes a substantial contribution to the older person's functioning safely and independently at home. Also studies of the cost-effectiveness of occupational therapy show that it helps save on health care costs.