Engagement in Occupational Activities and Purpose in Life amongst Older People in the Community and Institutions

The impact of mobility scooter on occupational participation among older adults in Singapore: an exploratory study

PURPOSE

With an ageing population, the use of mobility scooters by community-dwelling older adults with mobility limitations has been increasingly prevalent in Singapore. Their experiences in using mobility scooters remain unclear. This study aimed to explore the impact of mobility scooters on occupational performance and engagement among elderly Singaporeans.

MATERIALS AND METHODS

Mobility scooter users were recruited via purposive and snowballing sampling. Semi-structured interviews were conducted in English or Mandarin via phone call or face-to-face and audio-recorded with permission. Interviews were transcribed verbatim in their original language and translated to English (when applicable) for thematic analysis.

RESULTS

Twelve eligible participants (mean age: 75 years) completed the interviews. They were predominantly female Chinese with 7 receiving training from occupational therapists (OT). Four main themes emerged from the interviews describing their experiences of using mobility scooters: factors of decision-making in getting a mobility scooter, enhanced occupational participation with the use of the mobility scooter, enablers for community participation and barriers to community participation. Despite having barriers, older adults with mobility limitations generally still had positive experiences to continue using mobility scooters to perform occupations in the community.

CONCLUSIONS

This study highlights the benefits of mobility scooters in supporting users' occupational performance and engagement in the community. Continual efforts are required from all stakeholders to provide an accessible environment and improve societal attitudes to further support the mobility scooter users.IMPLICATIONS FOR REHABILITATIONMobility scooter users can be deterred from performing their preferred occupations if they had a prior negative encounter and they mainly rely on self-developed coping strategies to overcome possible barriers in the community.Occupational therapists should identify and address the potential barriers when prescribing mobility scooters to older adult users.Occupational therapists should work collaboratively with other key stakeholders, such as external vendors and government agencies, to co-create a universal guideline to support and safeguard mobility scooter users.

Perceived occupational engagement and gaps among community-dwelling older adults in Malaysia

Introduction:

Engagement in occupations is an essential aspect of daily life among older people. Changes in age are often associated with changes in the pattern of engagement in occupations. However, the relationship between the actual and desired activities pattern of occupational engagement remains unclear among community-dwelling older adults in Malaysia. This study aimed to determine occupational engagement for each activity and occupational gaps related to domains among the older adults.

Method

A cross-sectional study was conducted among 335 community-dwelling older people, using the Malay version of the Occupational Gaps Questionnaire (OGQ-M).

Findings:

The findings indicate that there are significant differences in occupational engagement across domains: leisure ( p < 0.001), social ( p = 0.04) and total occupational domains ( p < 0.001). There is a significant difference between actual and desired performed activities in doing laundry ( p = 0.031), outdoor activities ( p < 0.001), listening to the radio and watching television/video ( p = 0.003), helping and supporting others ( p = 0.019), travelling for pleasure ( p < 0.001) and performing voluntary work ( p = 0.025).

Conclusion:

In conclusion, OGQ is a useful tool in screening the occupational gaps among community-dwelling older adults. Age, health and continuity of roles and responsibility as caretakers of the family are several factors that lead to higher occupational gaps among the older people in the community. With the emergence of occupational engagement and gaps, advancements in health care delivery are necessary for retirement planning among community-dwelling older adults in enhancing active participation towards better retirement life.

Capturing the Features of Physical Activity in Old Adults during the COVID-19 Pandemic: Results of an Italian Survey

The restriction measures adopted to control the COVID-19 pandemic had significant consequences on individuals’ lifestyles. This study is aimed at assessing the amount and type of habitual physical activity (PA) in older adults during the advanced phase of the pandemic and their possible relationships with sociodemographic aspects. A questionnaire that included sociodemographic characteristics and the Physical Activity Scale for the Elderly (PASE) was administered online to elderly subjects living in the Apulia region, South Italy. A sample of 939 participants (57.1% F; mean age 75.9 ± 6.3) was obtained. In total, 68.8% of female respondents reported a decrease in PA during the pandemic, while 55.1% of men maintained their previous levels (<0.001). The total PASE score did not differ between gender groups (median value 91.7 in males vs. 90.0 in females; p = 0.067). However, differences were registered in leisure activities, particularly regarding walking (23.8 ± 14.8 in males vs. 20.2 ± 14.6 in females; p = 0.001). Higher PA levels were related with lower age (OR 0.253; 95% CI 0.192−0.333; p = 0.001). Since inactivity can affect elderly health and wellbeing, and considering the impact of the COVID-19 lockdown on this habit, health promotion strategies to counteract the negative effects of the pandemic should include interventions aimed at increasing PA in this sub-group of the population, especially among women and elderly subjects.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Background

Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.

Methods

The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.

Results

Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.

Conclusions

Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Comparing sleep quality in institutionalized and non-institutionalized elderly individuals

Objectives: Sleep is a physiological function essential to general health and well-being. Insomnia is a sleep disorder frequently reported by older adults. Institutionalization in nursing care homes may contribute to increase the risk of sleep disorders in this population. The aim of this exploratory study was to compare sleep quality among a group of institutionalized (GI) and a group of non-institutionalized (GNI) elderly individuals.Method: We selected 100 individuals over 65 years of age. Participants were divided into two groups (N = 50 in each group) according to their institutionalization status (GI and GNI). The following assessment instruments were used: Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sonolence Scale (ESS) and Geriatric Depression Scale (GDS). Study groups were compared in their sociodemographic, social and clinical characteristics with statistical analysis performed to detect correlations between variables.Results: GI elderly presented worse overall sleep quality and higher levels of daytime somnolence and depressive symptoms. A positive correlation was found between sleep quality, daytime sleepiness (ESS) (p < 0.01) and depressive symptoms (GDS) (p < 0.01).Conclusions: Our results are consistent with the possibility that elderly individuals admitted to long-term care and residential institutions present with worse sleep quality. Higher levels of depressive symptoms, lower occupational activity and sunlight exposure are specifically associated with a worse sleep quality. Further studies with larger and more diverse samples, including community-dwelling individuals, may be important to consolidate these findings.

The Rio Health Gym Program: Daily life, leisure and health of older adults

Abstract Objective: to identify the activities performed by older adults as part of the Rio Health Gym Program in their daily lives, and analyze the contributions of these practices to their health and quality of life. Method: a qualitative, exploratory and descriptive study was conducted using interviews with 30 older adults who attended a health center in the city of Rio de Janeiro (RJ). Lexicographic analysis was performed using the Alceste software program. Results: five lexical classes were generated. Physical and leisure activities comprised classes 2 and 3. The statements that made up the lexical classes showed that older adults carried out their daily activities with autonomy and independence. According to their assessment, the activities promote the integration of participants, increase social participation and benefit health and quality of life. They attribute their proactivity to participation in the social group. Conclusion: the activities bring diversity to daily living, increase socialization and leisure opportunities, and consequently improve the health of older people by facilitating social relationships.

Characteristics of the built environment for people with dementia in East and Southeast Asian nursing homes: a scoping review

ABSTRACTBackground:This scoping review explores the characteristics of the current built environment used to accommodate people with dementia in East and Southeast Asia. It is structured around the eight principles of design found in the Environmental Audit Tool High-Care. In addition, the review examines the level of knowledge and other influences contributing to the development of nursing homes in the region.

METHODS

The review was carried out utilizing the methodological framework recommended by Arksey and O'Malley. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses provided an overarching structural framework for the reporting process and the Population, Intervention, Comparison, Outcomes, and Context framework defined the scope of the review and focused on the research question. Six databases were accessed for the search, and 1,846 publications between 2001 and 2015 were retrieved.

RESULTS

A total of 48 articles from 9 countries met the inclusion criteria. All articles presented discussions that fundamentally included at least one principle of design and with some including all principles. The most prevailing principle discussed, found in 59% of all the articles was the need for familiarity for residents in the environmental design of facilities.

CONCLUSIONS

The review found that the eight principles of design, when applied with cultural sensitivity in countries in East and Southeast Asia can identify gaps in knowledge of the design for dementia enabling environments and suggest areas for improvement. An assessment tool based on the principles of design will be able to provide a guide for stakeholders in the design, development, or modification of nursing home environments.

Cognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes

BACKGROUND

Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life.

OBJECTIVES

To evaluate the effects of cognitive rehabilitation on return to work, independence in daily activities, community integration (occupational outcomes) and quality of life in people with traumatic brain injury, and to determine which cognitive rehabilitation strategy better achieves these outcomes.

SEARCH METHODS

We searched CENTRAL (the Cochrane Library; 2017, Issue 3), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), and clinical trials registries up to 30 March 2017.

SELECTION CRITERIA

We identified all available randomized controlled trials of cognitive rehabilitation compared with any other non-pharmacological intervention for people with TBI. We included studies that reported at least one outcome related to : return to work, independence in activities of daily living (ADL), community integration and quality of life.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials. We used standard methodological procedures expected by Cochrane. We evaluated heterogeneity among the included studies and performed meta-analysis only when we could include more than one study in a comparison. We used the online computer programme GRADEpro to assess the quality of evidence, and generate 'Summary of findings' tables.

MAIN RESULTS

We included nine studies with 790 participants. Three trials (160 participants) compared cognitive rehabilitation versus no treatment, four trials (144 participants) compared cognitive rehabilitation versus conventional treatment, one trial (120 participants) compared hospital-based cognitive rehabilitation versus home programme and one trial (366 participants) compared one cognitive strategy versus another. Among the included studies, we judged three to be of low risk of bias.There was no difference between cognitive rehabilitation and no intervention in return to work (risk ratio (RR) 1.80, 95% confidence interval (CI) 0.74 to 4.39, 1 study; very low-quality evidence). There was no difference between biweekly cognitive rehabilitation for eight weeks and no treatment in community integration (Sydney Psychosocial Reintegration Scale): mean difference (MD) -2.90, 95% CI -12.57 to 6.77, 1 study; low-quality evidence). There was no difference in quality of life between cognitive rehabilitation and no intervention immediately following the 12-week intervention(MD 0.30, 95% CI -0.18 to 0.78, 1 study; low-quality evidence). No study reported effects on independence in ADL.There was no difference between cognitive rehabilitation and conventional treatment in return to work status at six months' follow-up in one study (RR 1.43, 95% CI 0.87 to 2.33; low-quality evidence); independence in ADL at three to four weeks' follow-up in two studies (standardized mean difference (SMD) -0.01, 95% CI -0.62 to 0.61; very low-quality evidence); community integration at three weeks' to six months' follow-up in three studies (Community Integration Questionnaire: MD 0.05, 95% CI -1.51 to 1.62; low-quality evidence) and quality of life at six months' follow-up in one study (Perceived Quality of Life scale: MD 6.50, 95% CI -2.57 to 15.57; moderate-quality evidence).For active duty military personnel with moderate-to-severe closed head injury, there was no difference between eight weeks of cognitive rehabilitation administered as a home programme and hospital-based cognitive rehabilitation in achieving return to work at one year' follow-up in one study (RR 0.95, 95% CI 0.85 to 1.05; moderate-quality evidence). The study did not report effects on independence in ADL, community integration or quality of life.There was no difference between one cognitive rehabilitation strategy (cognitive didactic) and another (functional experiential) for adult veterans or active duty military service personnel with moderate-to-severe TBI (one study with 366 participants and one year' follow-up) on return to work (RR 1.10, 95% CI 0.83 to 1.46; moderate-quality evidence), or on independence in ADL (RR 0.90, 95% CI 0.75 to 1.08; low-quality evidence). The study did not report effects on community integration or quality of life.None of the studies reported adverse effects of cognitive rehabilitation.

AUTHORS' CONCLUSIONS

There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.

Aging With Purpose: Systematic Search and Review of Literature Pertaining to Older Adults and Purpose

Purpose can provide a sense of intentionality, guide behavior to achieve personal aims and living objectives, and may offer insight into how and why certain people remain healthy over time. A review of the literature sought to identify contemporary research pertaining to purpose and older adults. Thirty-one studies were selected for evaluation based on inclusion criteria. Research outcomes suggest that greater reported purpose is related to a range of better health and well-being outcomes for older adults. With few exceptions, the literature demonstrates that purpose declines with age. Nevertheless, the potential to experience purpose persists across the life span, by providing opportunities for older adults to continue contributing roles, participate in meaningful activities, and sustain their social value and sense of relevance. Further research could explore how purpose is experienced by the oldest-old age-group, those living within noncommunity settings, and people with age-related cognitive impairment such as dementia.

Capturing Interactive Occupation and Social Engagement in a Residential Dementia and Mental Health Setting Using Quantitative and Narrative Data

Objectives: Despite an abundance of research acknowledging the value of interactive occupation and social engagement for older people, and the limits to these imposed by many residential settings, there is a lack of research which measures and analyzes these concepts. This research provides a method for measuring, analysing and monitoring interactive occupation and social engagement levels of residents in a secure residential setting for older people with mental health problems and dementia. It proposes suggestions for changes to improve the well-being of residents in residential settings. Method: In this case study design, the Assessment Tool for Occupational and Social Engagement (ATOSE) provided a ‘whole room’ time sampling technique to observe resident and staff interactive occupation and social engagement within the communal sitting room over a five-week period. Researchers made contemporaneous notes to supplement the ATOSE data and to contextualise the observations. Results: Residents in the sitting room were passive, sedentary, and unengaged for 82.73% of their time. Staff, who were busy and active 98.84% of their time in the sitting room, spent 43.39% of this time in activities which did not directly engage the residents. The physical, social and occupational environments did not support interactive occupation or social engagement. Conclusions: The ATOSE assessment tool, in combination with narrative data, provides a clear measurement and analysis of interactive occupation and social engagement in this and other residential settings. Suggestions for change include a focus on the physical, social, occupational, and sensory environments and the culture of care throughout the organization.