This article presents an overview of concepts used by therapists and caregivers in rehabilitation of the physically and cognitively disabled elder to facilitate participation in valued life activities and social roles. Intervention strategies are described that are responsive to a central dilemma in the gerontological literature: the mismatch between the strengths and capacities of the aged and the lack of role opportunities to utilize and sustain those strengths. An analytic framework of the relationship between activity adaptations that compensate for physical limitations and those that compensate for cognitive limitations is presented as a guide in designing interventions to compensate for the limitations experienced by the elder who is both physically and cognitively disabled. It is intended as a reference point in initiating activity adaptation responsive to the strengths, capacities, and limitations experienced by physically and cognitively disabled older adults.