Valued Activities among Individuals with and without Cognitive Impairments: Findings from the National Health and Aging Trends Study

Characteristics of Informal Caregivers and Social Participation of People With Dementia

BACKGROUND AND OBJECTIVES

Social participation is associated with increased quality of life and well-being but declines following the onset of dementia. Informal caregivers may facilitate social participation among people with dementia. This study aims to identify characteristics of informal caregivers associated with social participation of people with dementia in valued activities.

RESEARCH DESIGN AND METHODS

This cross-sectional study used data from the 2011, 2015, and 2017 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving. NHATS respondents with possible or probable dementia and an informal caregiver were included (N = 1,060). Respondents were asked whether they participated in each of 5 social activities during the past month. Valued activities were considered somewhat or very important. Survey-weighted logistic regression models were computed to identify characteristics of primary informal caregivers associated with participation of people with dementia in social activities.

RESULTS

Social participation of people with dementia was not independently associated with sociodemographic variables or relationship to the primary caregiver (spouse/partner, adult child, or other relative/nonrelative). Social participation of primary caregivers was associated with increased participation of people with dementia in the same activity for visiting friends/family (odds ratio [OR] = 1.88, p = .016), attending religious services (OR = 4.82, p < .001), and volunteering (OR = 3.25, p = .015), whereas greater caregiver external support was associated with increased participation of people with dementia in organized activities (OR = 1.37, p = .022).

DISCUSSION AND IMPLICATIONS

Assets of informal primary caregivers found to promote social participation of people with dementia include traveling to the person with dementia's home, being socially active themselves, and utilizing support services.

Self-stigma in people living with dementia in Chile: A qualitative exploratory study

BACKGROUND

Self-stigma is a dimension of stigma concerning how individuals internalize negative attributes and discriminate against their own selves. Dementia is a stigmatizing condition, and there is a paucity of research exploring the manifestations and implications of self- stigma in people living with dementia in various contexts.

AIM

To examine how self-stigma manifests in the experiences of people living with early-stage dementia in Santiago, Chile.

PARTICIPANTS

Six men and five women living with early-stage dementia of the Alzheimer's type, aged between 64 and 82 years old (mean = 70).

METHODS

One-on-one interviews were conducted, focusing on the experience of people living with early-stage dementia to provide insights on how self-stigma manifests. Interviews were analyzed with a qualitative content analysis approach using Corrigan's social cognitive model of self-stigma (2016).

RESULTS

Self-stigma manifested as devaluation and blame at a cognitive level, and as restriction of participation at a behavioral level. Families and dementia education emerged as contextual elements that influenced the internalization of negative attributes in the participants' experiences.

CONCLUSIONS

Consistent with previous qualitative research, we found that self-stigma has negative consequences as it concerns emotions, self-prejudices, and self-discrimination. This study provides distinctive insights on the process of internalization of stigma and the influence of external elements. Self-stigma remains an understudied but important feature of the dementia experience, an understanding of which can lead to developing and testing supportive approaches upon diagnosis to minimize its adverse effects.

Examining subjective well-being among older adults using pain medications

PURPOSE

To examine the relationship between social participation and subjective well-being (SWB) among older adults using pain medications and evaluate the impact of sex on this relationship.

METHODS

A cross-sectional analysis was conducted using the 2019 National Health and Aging Trends Study data, a nationally-representative sample of Medicare beneficiaries 65 years and older. Individuals were included if they reported taking pain medications for five days or more per week over the last month. Social participation was operationalized using the sum score of four items: visiting family and friends, going out for enjoyment, attending religious services, and participation in other organized activities. SWB was operationalized as a latent variable using four items reflecting positive and negative emotions, and three items reflecting self-evaluation. Structural equation modeling was used to test the relationship between key study constructs, as well as the moderating effect of sex on the relationship between social participation and SWB.

RESULTS

A total of 964 (weighted N = 7,660,599) participants were included in the study. Most participants were female (61.3%), White (81.0%), community-dwelling (94.9%) older adults. Confirmatory factor analysis showed appropriate fit for SWB. Social participation had a statistically significant association with SWB (unstandardized regression coefficient = 0.133; 95% CI 0.071, 0.196; p < 0.001) after adjusting for covariates. However, this relationship was not moderated by sex (p = 0.836).

CONCLUSION

Social participation is positively and significantly associated with SWB among older adults using pain medications. Interventions aimed at improving SWB should consider incorporating a social activities component.

Engagement in Favorite Activity and Implications for Cognition, Mental Health, and Function in Persons Living With and Without Dementia

Little is known about the impact of engagement in personally meaningful activities for older adults. Thus, this study examines the impact of engagement in one's favorite activity on cognitive, emotional, functional, and health-related outcomes in older adults with and without cognitive impairment. Data were obtained from 1,397 persons living with dementia (PLWD) and 4,719 cognitively healthy persons (CHP) who participated in wave 2 of the National Health and Aging Trends Study (NHATS). Sociodemographic characteristics were examined by cognitive status. A multivariate analysis of variance indicated that, for PLWD, engagement in favorite activity was associated with greater functional independence and decreased depression. For CHP, engagement in favorite activity was associated with greater functional independence, decreased depression and anxiety, and better performance on memory measures. Findings suggest that engagement in valued activities that are considered personally meaningful may have significant and distinct benefits for persons with and without dementia.

Driver Rehabilitation Utilization and Need Among Community-Dwelling Older Adults

IMPORTANCE

Driving is one of the most important instrumental activities of daily living. As adults age, many face challenges with maintaining independent driving, leading to risk for decreased occupational engagement and quality of life. The extent to which occupational therapy services meet the driver rehabilitation needs of older adults is unknown.

OBJECTIVE

To characterize driver rehabilitation service utilization among a nationally representative sample of community-dwelling older adults.

DESIGN

Exploratory, descriptive cross-sectional study using the National Health and Aging Trends Study 2016 wave.

PARTICIPANTS

Community-dwelling adults age 65 and older who received rehabilitation services in the past year (N = 1,173).

OUTCOMES AND MEASURES

Sociodemographic information, comorbidities, rehabilitation use, community mobility, and participation restrictions were collected using self-report and performance-based measures.

RESULTS

Of this sample of older adults, 63.0% reported driving as their primary mode of transportation, 25.8% reported limitations in community participation related to transportation, and 9.2% reported having received rehabilitation focused on driving or other transportation goals in the past year. Findings from this study suggest a discrepancy between utilization of driver rehabilitation and self-reported need.

CONCLUSIONS AND RELEVANCE

Many older adults reported limitations in community participation for transportation-related reasons, yet driver rehabilitation represented only a small proportion of services used. As experts in driver rehabilitation, occupational therapy practitioners should lead the way in advocating for increased utilization of driver rehabilitation and development of innovative, accessible transportation options to promote community mobility and participation among older adults.

WHAT THIS ARTICLE ADDS

The results of this study illustrate an important discrepancy between self-reported need for and utilization of driver rehabilitation services. Occupational therapy practitioners can play an important role in meeting older adults' driving and transportation needs to enable them to fully participate in their community and daily routines.

A need-based, multi-level, cross-sectoral framework to explain variations in satisfaction of care needs among people living with dementia

BACKGROUND

Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction.

METHODS

Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories.

RESULTS

The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need.

CONCLUSION

The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.

The Neural Basis of Religious Cognition

Religion’s neural underpinnings have long been a topic of speculation and debate, but an emerging neuroscience of religion is beginning to clarify which regions of the brain integrate moral, ritual, and supernatural religious beliefs with functionally adaptive responses. Here, we review evidence indicating that religious cognition involves a complex interplay among the brain regions underpinning cognitive control, social reasoning, social motivations, and ideological beliefs.

Multi-Level Factors Associated with Social Participation among Stroke Survivors: China's Health and Retirement Longitudinal Study (2011-2015)

Background: This study aims to examine the impact of individual-level and community-based factors on popular social participation activities of Chinese middle-aged and older adults post-stroke. Methods: Sub-samples of survivors of stroke (2011: n = 413, 2013: n = 395, 2015: n = 441) recruited by the China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. Zero-inflated Poisson and multi-level logistic regression models were used to explore factors associated with social participation. Results: More than half of individuals (55.0%) had no social participation and 23.4% participated in multiple social activities. The most popular social activities that individuals participated in were interacting with friends (32.6%) and going to a community club to play table games (22.7%). Multiple individual-level factors were negatively related to social participation (e.g., depressive symptoms and multiple measures of functional limitations) while the allocation of an outdoor exercise facility in the community/village was positively associated with going to a community club to play table games. Conclusion: Stroke survivors are at high risk of limited social participation. Policymakers and other key stakeholders should consider community design among other potential solutions when identifying ways to link at-risk stroke survivors to both opportunities for rehabilitation (e.g., physical function) and social participation.

Preference for emotionally meaningful activity in Alzheimer's disease

Objectives: Socioemotional selectivity theory (SST) contends that future time perspective is the central determinant of healthy older adults' prioritization of emotional gratification. We have shown elsewhere that individuals with Alzheimer's disease (AD) are disoriented to future time perspective. This study examined whether these same participants would prioritize emotional gratification despite having distorted time perspective. Method: Performance of individuals with Alzheimer's disease (AD) was compared against young, young-old, and old-old adults on a social activity preference card-sort task. We examined whether activity preferences differentially related to subjective wellbeing. Results: Multidimensional scaling revealed common dimensions along which groups considered social activities. The importance of these dimensions varied across healthy participant groups in ways predicted by SST. Dimensions related to knowledge acquisition were more important in youth than older age; emotional dimensions were more important to the older age groups. Despite AD, these individuals also prioritzed emotional gratification, suggesting that cognitive impairment is not a barrier to socioemotional selectivity. Preference for emotionally meaningful activities was positively associated with subjective wellbeing. Conclusion: Persons with AD are motivated towards emotionally meaningful ends and retain high levels of wellbeing. These findings have implications in the caregiving context for shaping social programs to better match goals and preferences.

Perspectives of caregivers and volunteers on Stepping Stones for people with dementia

Rationale

Current knowledge in experiences and potential benefits of group-based activity programmes on people with dementia and their caregivers is inconsistent, depending on the quality of interventions. Lacking standardisation in the programme's content and structure, therefore, requires research in a structured group-based activity programme with more details.

Objectives

This study explored perspectives of spouses of people with dementia and older volunteers about Stepping Stones, involving a theme-based activity group and a support group.Methodology: Interpretative phenomenological analysis was used to analyse individual interview data with 12 people.

Results

Findings suggest that (1) Stepping Stones promotes participation of people with dementia in a happy, comfortable and accepting environment; (2) Stepping Stones fulfils a deep need of family caregivers; (3) Stepping Stones is well organised with a purpose and expertise and (4) The partnership between the community and the university makes the programme unique.

Conclusion

Programmes like Stepping Stones can be beneficial by promoting participation of people with dementia and fulfilling a need of caregivers. These findings contribute to evidence of group-based activity programmes, in which activities were well planned by a faculty and students in occupational therapy.

Valued activities among individuals with and without functional impairments: Findings from the National Health and Aging Trends study (NHATS)

Using the National Health and Aging Trends Study (NHATS), we examined baseline activity and functional status. Respondents were classified as High (n=1,662), Moderate (n=1,973), or Low (n=989) Function and rated importance of and actual participation in four activities. Transportation and health were also examined. Individuals classified as low function were less likely to engage in valued activities and more likely to report that poor health and transportation limited participation, compared to individuals with no or moderate functional impairments. Data suggest the importance of developing interventions which bridge the gap between activity preferences and participation for older adults with functional limitations.

Walking in the neighbourhood: Performing social citizenship in dementia

The proliferation of community-based activity programs for people with dementia suggests an appetite for new approaches to support quality of life and well-being for this population. Such groups also have potential to promote social citizenship, although this remains poorly understood. This article presents findings from a subset of data from an ethnographic study of a community-based program for people with young onset dementia; it focuses on Paul's Club and the experiences of 12-15 members who are physically healthy, with moderate to moderately severe dementia. Analysis suggests how aspects of social citizenship are constructed and revealed through the Club's everyday practice of walking in the neighbourhood. Three major themes emerged: Keeping the focus off dementia; Creating a place of belonging; and Claiming a place in the community How the group balances consideration of members' vulnerability and agency is discussed, and the article concludes with implications for future practice and research initiatives.