Actions and Personal Attributes of Community-Dwelling Older Adults to Maintain Independence

Older Adults' Perspectives of Independence Through Time: Results of a Longitudinal Interview Study

BACKGROUND AND OBJECTIVES

Understanding how older people experience independence has implications for person-centered care. Existing understanding of older people's experience of independence, generated through methods that provide a "snapshot" view of a person's independence at a given time point, provides little insight into the process of maintaining independence through time. The aim of this study was to explore older participants' perceptions to understand the processes and resources that were most important for maintaining independence.

RESEARCH DESIGN AND METHODS

Two semistructured interviews were conducted longitudinally to explore the perspectives of 12 community-dwelling, older people, aged 76-85 years. A social constructivist approach, using dramaturgical and descriptive codes, facilitated the interpretation of the data. Sixteen analytical questions guided the exploration of participants' perceptions of independence through time.

RESULTS

Older people suggested that objective representations underestimated, and omitted, important aspects of their independence through time. Some participants perceived "snapshot" judgments of their independence as insensitive to their individual values and context. Change over time required some participants to adapt their methods for maintaining independence. The stability of participants' sense of independence was value dependent and informed by the purpose a participant ascribed to maintaining independence.

DISCUSSION AND IMPLICATIONS

This study augments the understanding of independence as a complex and multifaceted construct. The findings challenge the congruence of common interpretations of independence with older people's views, showing areas of commonality, and discrepancy. Exploration of independence in terms of form and function provides an important understanding of how function takes precedence to form in determining the maintenance of independence through time.

Hybrid Tele and In-Clinic Occupation Based Intervention to Improve Women's Daily Participation after Breast Cancer: A Pilot Randomized Controlled Trial

BACKGROUND

Women after breast cancer (BC) cope with decreased daily participation and quality of life (QOL) due to physical, cognitive, and emotional symptoms. This study examined a hybrid occupation-based intervention, Managing Participation with Breast Cancer (MaP-BC), to improve daily participation in their meaningful activities.

METHODS

Thirty-five women after BC phase were randomly allocated to the MaP-BC intervention (n = 18) or control (n = 17) group (standard care only). Assessments were administered at baseline (T1), 6-week (T2), and 12-week (T3) post-T1.

MAIN OUTCOME

perceived performance and performance-satisfaction with meaningful activities according to the Canadian Occupational Performance Measure.

SECONDARY OUTCOMES

retained activity levels (Activity Card Sort), QOL (Functional Assessment of Cancer Therapy-Breast), cognitive abilities (Montreal Cognitive Assessment and Behavior Rating Inventory of Executive Function), and upper-extremity functioning (Disability of Arm, Shoulder, Hand). Results showed significant interaction (group x time) effects for the primary outcome in performance, F(2,66) = 29.54, p = 0.001, ɳP2 = 0.472, and satisfaction, F(2,66) = 37.15, p = 0.000, ɳP2 = 0.530. The intervention group improved more in performance, t = 5.51, p = 0.0001, d = 1.298, and satisfaction, t = -5.32, p = 0.0001, d = 1.254, than the control group between T1 and T2. Secondary outcomes demonstrated within-group improvements.

CONCLUSION

MaP-BC, a comprehensive occupation-based hybrid intervention tailored to women's functional daily needs after BC, improved participation in meaningful activities within a short period.

Can strengthening older adults' problem-solving skills through occupational therapy improve their occupational performance? A protocol for a systematic review and meta-analysis

BACKGROUND

Older adults' occupational performance is challenged due to chronic health conditions, aging processes, and deteriorating functioning. Thus, their occupational performance cannot be expected to remain stable in the long term after an occupational therapy intervention. Older adults may therefore need to strengthen their problem-solving skills during occupational therapy not only to solve current occupational performance issues but also to maintain their improvements and deal with new such issues a later point in time.

AIMS

This systematic review and meta-analysis aims to identify, analyse and present current scientific knowledge about the effectiveness and contents of occupational therapy interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills.

METHODS

MEDLINE, EMBASE, CINAHL and PsycINFO will be searched systematically to identify trials of occupational therapy interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills. We will include randomized controlled trials and quasi-experimental trials in populations aged 65+. Three reviewers will independently screen and select references, extract data and assess the quality of included studies using the Cochrane Collaboration's risk of bias tool.

SIGNIFICANCE

The findings can inform and inspire clinical practice and will help to identify the need for further research.

Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition

Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.

Identifying the enablers and barriers to community participation amongst older adults

Introduction

The proportion of older adults throughout the world has increased significantly over the last decade and continues to rise. Such substantial growth highlights the importance of facilitating older people’s wellbeing. This research aimed to identify enablers and barriers to participation in community-based activities experienced by active older adults.

Method

This qualitative study employed the evidence-based paradigm of occupation and Model of Human Occupation to underpin protocol and discussion. Ten participants (females = 9, males = 1) who were aged 64–83 years and actively engaged in their community took part in semi-structured interviews. Participants reported mixed health levels including chronic/terminal illnesses and normal degenerative changes. Interview transcripts were analysed using thematic analysis.

Findings

Analysis identified four themes of enablers and barriers to community participation. These were: relationships; interests; personal knowledge and awareness towards health and wellbeing; and resources and the environment.

Conclusion

Intrinsic factors such as developing or maintaining strong relationships and developing interests were identified as enabling community participation. Barriers identified within this study included unappealing group cultures or structures, such as having limited opportunity to develop friendships or explicitly targeting ‘seniors aged 60+ years’ and accessibility limitations. Recommendations were established to inform the development of programmes to increase community participation among this group.

Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care.

Factors associated with older people's independent living from the viewpoint of health and functional capacity: a register-based study

Aim

The aim of this study was to identify factors associated with independent living of older people from the point of view of health and functional capacity.

Background

Living independently at home is major wish for older people but is depending on health and functional capacity among others. Objective and subjective assessments have been considered important in determining threats for independent living but both of these views have rarely included in the same study.

Design

Descriptive, cross‐sectional register‐based study was conducted.

Methods

Data were collected using the Health and Functional Capacity survey by identifying the factors of health examinations of a cohort (N = 292) of 75‐year old's, born in 1936 (N = 388), in one Finnish medium‐sized municipality in 2011. This study is part of the Functional Ageing project Kaste 2013. The data were analysed statistically by using descriptive analysis, cross‐tabulation and logistic regression.

Results

Partly, different factors were associated with subjective and objective health and functional capacity showing wide range of individuality. Worsening subjective health was associated with worsened self‐assessment of life situation. Worsening subjective health threatens independent living. Factors statistically significantly associated with worsening subjective health were low physical activity, falls during the last 6 months, not managing heavy housework, being sometimes lonely or dejected, having diagnosed diseases or health problems and polypharmacy.

Occupational competence strategies in old age: a mixed-methods comparison between Hispanic women with different levels of daily participation

In this pilot study, we explored the difference in the use of occupational competence strategies for daily participation between more active and less active older Hispanic women. Twenty-nine women who were 70 and older and lived alone participated in this study. We used a mixed-methods design by which the principal investigator administered a tool to measure participation restrictions during the quantitative phase and conducted in-depth interviews with a subsample in the qualitative phase. More active women predominantly used transportation resources, emotional social support, and spirituality to support participation in life activities. Less active women used more practical social support, assistive technology, and environmental modifications. Personal facilitators seemed to directly modify these strategies. These results suggest that older women with different activity levels use distinct internal and external resources to maintain or enhance daily participation. Future studies should explore whether these resources remain consistent across gender, living status, and ethnicity.

Independence: An Analysis of a Complex and Core Construct in Occupational Therapy

Introduction:

Independence is a core concept in occupational therapy, but there is little consensus within the profession upon a universal definition. The present study employed a critical interpretive synthesis to examine two fundamental research questions: ‘How is independence conceptualised in quantitative and qualitative research within occupational therapy?’ and ‘How does the term “independence”, in its present use, critically impact occupational therapy policy and practice?’

Method:

Articles pertaining to occupational therapy and contributing to the definition of independence within the profession were examined. Three successive levels of coding — open, axial and selective — were used to analyse 19 final articles.

Findings:

From the literature, nine definition themes emerged: function, autonomy and competence, control, context, culture, environment, personal attributes and safety. These themes were then organised into three categories: personal factors, environmental factors and continuum, which were synthesised together to create a model that addresses all factors critical to the composition of independence. In addition, four clinical themes developed: goal of occupational therapy, client-therapist relationship, variable definitions in occupational therapy practice and limitations of present practice.

Conclusion:

Through the formalisation of the integral components of independence, this study enables a standardised foundation for the examination of this core concept across the profession.

Strategies Older New Zealanders Use to Participate in Day-To-Day Occupations

Aim:

This exploratory study aimed to uncover the strategies that older adults employ to ameliorate the impact of impairments and barriers to participation.

Method:

Eight participants were interviewed in their own homes, in a town or city in New Zealand.

Findings:

Inductive analysis of data revealed four main categories of strategies: strategies to keep safe, to recruit and accept help, to meet social and biological needs (nutritional and medical), and to conserve financial, material and bodily resources.

Discussion:

The study supports some previous findings of strategies used by older people, and demonstrates that enquiring into the strategies that older people devise and adopt into their own lives is a productive line of inquiry. The strategies described differ from those that occupational therapists recommend, and do not incorporate public health messages about the benefits of physical activity or recommendations about falls prevention.

Conclusion:

The findings suggest that asking older clients about the strategies that they use will uncover valuable information for therapists giving advice or issuing equipment to help older adults to manage in the community.

Well Older Adults within an Urban Context: Strategies to Create and Maintain Social Participation

Introduction:

Social participation has been found to promote health and wellbeing for older adults. In this study, well older adults participated in photovoice to explore how they create and maintain social participation while living alone in an urban community in California.

Method:

Photovoice is an action research method in which people create and discuss photographs, and then share them with legislators, policy makers and health care providers to generate personal and community change. Photographs convey the participants' points of view directly and show others what life is like for a given group of people.

Findings:

The study found that social participation is promoted through a sense of belonging, acceptance of differences and change, and healthy and active living. Barriers to social participation included access to safe transportation and costs associated with resources.

Conclusion:

The results of this study are important and inform occupational therapy intervention, such as advocating for community resources, connecting people with available resources, helping older adults to develop healthy routines, and promoting a sense of membership through participation in valued activities to support social participation for older adults living alone in urban environments.