Developing multidimensional participation profiles after traumatic brain injury: a TBI model systems study

Purpose. To characterize societal participation profiles after moderate-severe traumatic brain injury (TBI) along objective (Frequency) and subjective (Satisfaction, Importance, Enfranchisement) dimensions.Materials and Methods. We conducted secondary analyses of a TBI Model Systems sub-study (N = 408). Multiaxial assessment of participation included the Participation Assessment with Recombined Tools-Objective and -Subjective questionnaires (Participation Frequency and Importance/Satisfaction, respectively) and the Enfranchisement Scale. Participants provided responses via telephone interview 1-15 years post-injury. Multidimensional participation profiles (classes) were extracted using latent profile analysis.Results. A 4-class solution was identified as providing maximal statistical separation between profiles and being clinically meaningful based on profile demographic features. One profile group (48.5% of the sample) exhibited the "best" participation profile (High Frequency, Satisfaction, Importance, and Enfranchisement) and was also the most advantaged according to socioeconomic indicators. Other profile groups showed appreciable heterogeneity across participation dimensions. Age, race/ethnicity, education level, ability to drive, and urbanicity were features that varied between profiles.Conclusions. Societal participation is a critical, but inherently complex, TBI outcome that may not be adequately captured by a single index. Our data underscore the importance of a multidimensional approach to participation assessment and interpretation using profiles. The use of participation profiles may promote precision health interventions for community integration.Implications for RehabilitationOur study found unidimensional measures of societal participation in traumatic brain injury (TBI) populations that focus exclusively on frequency indicators may be overly simplistic and miss key subjective components of participationTaking a multidimensional perspective, we documented four meaningfully distinct participation subgroups (including both objective and subjective dimensions of societal participation) within the TBI rehabilitation populationMultidimensional profiles of participation may be used to group individuals with TBI into target groups for intervention (e.g., deeper goal assessment for individuals who do not rate standard participation activities as important, but also do not participate and do not feel enfranchised).

Predictors of Multidimensional Profiles of Participation After Traumatic Brain Injury: A TBI Model Systems Study

OBJECTIVES

To identify personal, clinical, and environmental factors associated with 4 previously identified distinct multidimensional participation profiles of individuals following traumatic brain injury (TBI).

SETTING

Community.

PARTICIPANTS

Participants (n = 408) enrolled in the TBI Model Systems (TBIMS) Participation Module, all 1 year or more postinjury.

DESIGN

Secondary data analysis of cross-sectional data from participants in a multicenter TBIMS module study on participation conducted between May 2006 and September 2007. Participants provided responses to questionnaires via a telephone interview at their study follow-up (1, 2, 5, 10, or 15 years postinjury).

MAIN MEASURES

Participants provided responses to personal (eg, demographic), clinical (eg, function), environmental (eg, neighborhood type), and participation measures to create multidimensional participation profiles. Data from measures collected at the time of injury (preinjury questionnaire, injury characteristics) were also included. The primary outcome was assignment to one of 4 multidimensional participation profile groups based on participation frequency, importance, satisfaction, and enfranchisement. The measures used to develop the profiles were: Participation Assessment with Recombined Tools-Objective, Importance, and Satisfaction scores, each across 3 domains (Productivity, Social Relationships, Out and About in the Community) and the Enfranchisement Scale (contributing to one's community, feeling valued by the community, choice and control).

RESULTS

Results of the multinomial regression analysis, with 4 distinct participation profile groups as the outcome, indicated that education, current employment, current illicit drug use, current driving status, community type, and Functional Independence Measure Cognitive at follow-up significantly distinguished participation profile groups. Findings suggest a trend toward differences in participation profile groups by race/Hispanic ethnicity.

CONCLUSIONS

Understanding personal, clinical, and environmental factors associated with distinct participation outcome profiles following TBI may provide more personalized and nuanced guidance to inform rehabilitation intervention planning and/or ongoing clinical monitoring.

Association Between Participation and Satisfaction With Life Over Time in Older Adults With Traumatic Brain Injury: A TBI Model Systems Study

OBJECTIVE

To examine the association between participation and satisfaction with life at 1, 2, 5, and 10 years after traumatic brain injury (TBI) in older adults.

SETTING

Community.

PARTICIPANTS

Participants (N = 2362) who sustained complicated mild to severe TBI, requiring inpatient rehabilitation, at age 60 years or older and had follow-up data on participation and satisfaction with life for at least 1 follow-up time point across 1, 2, 5, and 10 years. Age at each time period was categorized as 60 to 64 years, 65 to 75 years, and 75 years or older.

DESIGN

Secondary data analysis of a large multicenter database.

MAIN MEASURES

Three domains (Productivity, Social Relations, Out and About) of the Participation Assessment With Recombined Tools-Objective (PART-O); Satisfaction With Life Scale (SWLS).

RESULTS

SWLS increased over the 10 years after TBI and was significantly associated with greater frequency of participation across all domains. There was a significant interaction between age and PART-O Social Relations such that there was a weaker relationship between Social Relations and SWLS in the oldest group (75 years or older). There was no interaction between Productivity or Out and About and age, but greater participation in both of these domains was associated with greater life satisfaction across age groups.

CONCLUSIONS

These findings indicate that greater participation is associated with increased satisfaction with life in older adults, across all participation domains over the first 10 years postinjury, suggesting that rehabilitation should target improving participation even in older adults. The decreased association of social relations with satisfaction with life in the oldest age group suggests that frequency of social relations may not be as important for life satisfaction in the oldest adults, but quality may still be important.

'Ageing well': Discursive constructions of ageing and health in the public reach of a national longitudinal study on ageing

Established in 2006, the Irish Longitudinal Study on Ageing (TILDA) investigates the health, economic and social circumstances of a nationally-representative sample of people aged fifty years and older in a series of biennial data collection waves. Irish newspapers have been reporting the results of TILDA for over a decade and a half, and their texts represent reports of scientific research distilled through the pen of journalists. In their totality, their texts constitute a public discourse on ageing and health. Using critical discourse analysis, we examined the discourse within the texts of a purposive sample of two national daily newspapers. As sites of public discourse, newspapers reflect social life and are influential in forming and legitimating public attitudes. Like other sites of discourse, their language-in-use is contextually located, is rarely neutral and may employ strategies to discursively construct, sustain and privilege particular social identities, including ageing identities. Discursively constructed as 'ageing well', our analysis of newspaper texts revealed a discernible meta-discourse on ageing and health in which ageing was framed as a life course stage that may be cultivated, diligently self-nurtured and exploited for its positive aspects. When considered in light of literature on health and social inequalities, the consequences of this broadly positive ageing discourse can, somewhat perversely, frame older adults in unintended negative ways, including homogenising them and attributing to them capacities for ageing well that they may not possess. Discursively constructing older adults as a social and economic resource can also impose unrealistic expectations on them and may legitimise exploitation and demonstrate how normative ideologies of ageism and ableism are conveyed through legitimising language. Despite these potentially unintended consequences, the available media resources associated with TILDA may represent one of the most important contributions of the study, in terms of informing positive public attitudes towards ageing.

Positive health and ageing policies for older Irish travellers and older people who have experienced homelessness in Ireland: Life-course meanings and determinants

Marginalised groups of older people remain neglected in positive health and ageing (PHA) agendas, whether they concern healthy or active ageing concepts. Questions exist around the meaning of such constructs and the factors that enable disadvantaged populations to achieve equitable later-life experiences. Focusing on two such groups in Ireland, this study investigates the constituent dimensions of PHA for older Irish Travellers and older people who have experienced homelessness and the role of life-course and structural determinants in constructing PHA trajectories for these groups. The study involves a qualitative, participatory voice-led methodology, with analysis based on 49 in-depth life-course interviews with people aged 50 years and over from the two populations. Five interconnected dimensions of PHA are identified and presented. Four determinants related to life-course experiences and structural factors are identified as contributing to these dimensions: social relations, material and accommodation circumstances, formal supports and systems, and critical transitions and resilience. While illustrating the validity of PHA agendas for these groups when understood through their lived experiences, the findings highlight the significant deprivations and risks to rights that must be accounted for to secure meaningful gains in PHA for the groups.

Optimizing older adult co-researchers’ involvement in PAR: proposed evaluation tool

Purpose

This paper aims to share a practical evaluation tool intended to guide and support the participation of older people in PAR projects. Participatory action research (PAR) studies with older adults have been increasing over the past ten years. Scientific evidence provides key principles for PAR projects to achieve meaningful participation by older people; however, respecting the ideals of PAR is not always straightforward.

Design/methodology/approach

This paper presents a case study that evaluated the involvement of nonacademic researchers in a PAR project using an evaluation tool derived from a literature review of PAR undertaken with this population (Corrado et al., 2020). The study goals were first to assess the assets and limits of the older co-researchers’ participation within the PAR project, and second to provide a revised version of the evaluation tool to support future PAR with older people. First, the authors designed an evaluation tool for nonacademic participation in PAR studies by older people that covers three main themes: older people positioned as prominent research partners; symmetrical power relations between academic and nonacademic researchers; and commitment regarding inclusiveness and long-term collaboration. Second, the authors performed an evaluation using this tool within the Active Aging with Dignity PAR Project.

Findings

Third, the authors used the results of this experiment to suggest improvements for an enhanced version of the evaluation tool aiming at supporting fuller involvement of older nonacademic researchers in PAR studies.

Originality/value

To the authors’ knowledge, this evaluative tool is a methodological innovation in gerontology.

Social participation of community-dwelling older adults in western China: A latent profile analysis

Objective

Social participation has become a policy framework to address population aging. However, little is known about the social participation of older adults in western China, and extensive, multicenter, regional research is lacking. This research investigated the profiles of social participation of older adults in western China and explored the characteristics and factors influencing social participation.

Method

This cross-sectional study was conducted in 3 provinces (Chongqing, Sichuan, and Inner Mongolia) in western China from March 2021 to December 2021 and included 3,456 participants aged 60 years or older. Social participation was assessed using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Latent profile analysis (LPA) was performed to extract latent classes of social participation among older adults in western China. The chi-square test and multinomial regression analyses were used to identify differences between these classes.

Results

Three social participation classes were identified by LPA: high social participation (25.2%), moderate social participation (55.1%), and low social participation (19.7%). Being older, having a primary school education level, having mobility or speaking impairment, using assistive devices, and having a chronic disease were highly associated with the low social participation class (P < 0.05). Furthermore, older adults with no dependence (OR = 0.018, 95% CI = 0.005-0.062) or mild dependence (OR = 0.039, 95% CI = 0.011-0.139) in activities of daily living (ADLs) were less likely to be in the low social participation class. Older adults who were cared for by non-spouse primary caregivers were more likely to be assigned to the moderate social participation group (OR = 2.097, 95% CI = 1.501-2.930) than to the high social participation group.

Conclusions

Most older adults in western China have a moderate level of social participation. Advanced age, reduced ADL ability, reduced speech ability, reduced mobility, and non-spouse care are related to the level of social participation. Healthcare professionals should pay attention to the predictors for different classes, identifying high-risk groups as early as possible.

Exploring the Relationships Between Four Aging Ideals: A Bibliometric Study

When examining research articles on the aging strategies, four ideals (i.e., successful aging, healthy aging, productive aging and active aging) could be explored by conducting bibliometric analyses. For the literature analysis, general information on the four aging ideals was understood through visualization analysis; the intellectual base and research hotspots were intuitively observed. CiteSpace was used as the method to conduct the co-occurrence analysis of keywords in order to obtain research trends and cutting-edge knowledge in the field of aging-related policies. Subsequently, the study revealed the nature of the link between these four aging ideals and disclosed the connection between their fundamental principles. The study ultimately enhanced the understanding of the diverse contexts that have impacted the way in which these ideals influence policy, which has caused dissimilar strategies for policy development. The study also extended the discussion of the definitions of and relationships between these four ideals with the goal of identifying new directions for aging-related practice and providing innovative insights and references for investigators.

Give Older Persons a Voice in the Society-By Using Information Compiled during Preventive Home Visits on a Societal Level

Preventive home visits (PHVs) are offered to older persons with the purpose of promoting health and preventing risks on an individual level. However, aspects of health need to be considered on a societal level as well. This study aims to get a deeper understanding of perceptions of the usability of the information compiled during the PHVs to promote health, among older persons, on a societal level. Three online focus groups were conducted with heads of unit of PHVs, heads of department, and politicians responsible for health and welfare in seven municipalities in Sweden (n = 12). The findings were visualised in the core category Enable an inclusive society and the interrelated categories Monitoring determinants of health and Enabling exchange of information. The information from the PHVs could be used to monitor determinants of health by identifying assets, challenges, shifts, trends, and future needs in the society. Moreover, exchange of information from the PHVs could occur within and outside the health and welfare organisation. However, the potential use was affected by hindrances illustrated in the category Obstacles to interpreting and communicating the information. To conclude, using the information from the PHVs could possibly contribute to an inclusive society, where persons not usually represented in decision making are given a voice.

Positive health among older Traveller and older homeless adults: A scoping review of life-course and structural determinants

Concepts related to positive health in later life are increasingly prevalent within community-based health and social care policy. With a greater emphasis on inclusion health for older populations, there is a critical need to understand the determinants of such states for those most at risk of societal disadvantage. Focusing on two such groups, the aim of this article is to synthesise international research on the life-course and structural determinants of positive subjective health for older homeless people and older Irish Travellers. Two scoping reviews were conducted (one for each group) to capture state-of-the art knowledge published from 1998 to 2020. The reviews were completed from July to December 2018, and repeated from March to April 2020. Thirty-eight publications were included in the final sample (older Travellers: 10 sources; older homeless: 28 sources). Specific life-course and structural factors were evident for both groups, as well as commonalities with respect to: accumulated exclusions; complexity of needs; accommodation adequacy/stability and independence and resilience. Research gaps are identified concerning: lack of conceptualisation of positive health; the application of life-course perspectives and the absence of an environmental gerontological analysis of the situations of both groups.

The Experience of Aging and Perceptions of "Aging Well" Among Older Migrants in the Netherlands

BACKGROUND AND OBJECTIVES

In this study, we examine the experience of aging and subjective views of what it means to age well among older adults with a migrant background in the Netherlands. We embed the study within the successful aging debate and tackle two of its most persistent critiques: the failure to adequately include subjective views in the definition of aging well and the failure to recognize that the process of aging is culturally determined.

RESEARCH DESIGN AND METHODS

The research draws on qualitative data collected through eight focus-group discussions with the six largest migrant groups in the Netherlands, namely Indo-Dutch and Moluccans, and migrants with Western, Surinamese, Antillean, Turkish, and Moroccan background.

RESULTS

The study findings show that in general older migrants experience aging more positively than commonly assumed. Nevertheless, some negative aspects of aging were also mentioned. These together with fears about the future underpin participants' perceptions about aging well. Key aspects of successful aging include remaining healthy, independent, and engaged. Differences between and within groups exist in the meaning given to these concepts and the extent to which other specific aging-related wishes were mentioned. These differences are rooted in participants' experiences of the migration event, employment history, and their current socioeconomic conditions.

DISCUSSION AND IMPLICATIONS

We conclude that the life course perspective is essential in understanding migrants' aging process and their views on successful aging, and suggest that policies and interventions which promote disease prevention and tackle social exclusion will be beneficial for older adults with a migration background.