Patterns of occupational engagement among community-dwelling older adults in Singapore: An exploratory mixed method study

Introduction

The aim of this study is to understand the patterns of occupations among community-dwelling older adults in Singapore. The objectives are to describe their occupational engagement using the Activity Card Sort Singapore, understand their occupational preferences and perceived barriers and facilitators to engagement.

Methods

A convergent parallel mixed-method study was conducted over a 5-month period in 2018. Purposive and snowball sampling were used to recruit the participants. Individual 1-h interviews were conducted at participants’ homes. Quantitative data collected include demographic information, Modified Barthel Index scores and activity engagement based on the Activity Card Sort Singapore. Qualitative data was collected using semi-structured interviews.

Results

105 participants were enrolled in the study. Overall, older adults engaged mostly in instrumental and social activities. However, leisure and social activities were most preferred. Gender, educational level and age were found to influence occupational engagement. Overall, six main themes relating to perceived barriers and facilitators to occupational engagement were identified: cognition and physical status, self-efficacy, resources, affect and meaningfulness, social influence and environmental factors.

Conclusion

The findings from this study provided insights into the occupational patterns of community-dwelling older adults in Singapore and their perceived barriers and facilitators to engagement. Recommendations for practice were identified.

Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

Background

Virtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall.

Methods

Seventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures.

Results

There were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F_(1,32) = 154.96, p < 0.0001) with higher step lengths (F_(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F_(1,32) = 95.71–36.06, p < 0.0001) and lower heart rate (F_(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F_(1,32) = 19.77, p < 0.0001) and total time (F_(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F_(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment.

Conclusions

This comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

Selection of Activity Items for Development of the Activity Card Sort-Japan Version

The Activity Card Sort (ACS) can both record the clients' participation and any changes, which is a useful tool for practitioners to establish tailored occupation-focused goals. However, there is a limitation to apply the ACS to Japanese older adults as it consists of culturally relevant activities in the United States. The aim of this study was to select activity items reflecting Japanese older adults' lifestyles and opinions to develop the Activity Card Sort-Japan Version (ACS-JPN). In the item selection process, a two-round questionnaire survey was conducted for community-dwelling Japanese older adults (Round 1: n = 177, M age = 69.9 years; Round 2: n = 178, M age = 74.9 years). Seventy-two activity items were finally included in the ACS-JPN and were classified into four domains. The ACS-JPN has some unique features compared with other ACS versions. This study only selected activity items. Further work on psychometric properties is needed.

Test-Retest Reliability and Internal Consistency of the Activity Card Sort-Australia (18-64)

The Activity Card Sort (ACS) measures activity engagement levels. The Activity Card Sort-Australian version for adults aged 18 to 64 (ACS-Aus (18-64)) was recently developed, and psychometric properties have not yet been determined. This study was established to determine the test-retest reliability and internal consistency of the ACS-Aus (18-64) and describe activity engagement trends for healthy adults. Fifty-four adults aged 18 to 64 participated in this descriptive study. The ACS-Aus (18-64) demonstrated excellent test-retest reliability ( r = .92, p < .001) and acceptable internal consistency (α = .83). Adults aged 18 to 40 retained a lower percentage of activities than adults aged 41 to 64 for personal care, daily life, home maintenance activities ( t = -2.22, p = .03), and recreation and relaxation activities ( t = -2.38, p = .02). The ACS-Aus (18-64) may be used to explore the activity engagement patterns of community-dwelling Australian adults aged 18 to 64. Further research will determine validity for clinical populations.

The face validity and clinical utility of the Activity Card Sort – United Kingdom (ACS-UK)

Introduction

The Activity Card Sort – United Kingdom version is a self-report interview assessment requiring older adults to sort activity photograph cards to evaluate their levels of participation. The face validity and clinical utility of the activity card sort – United Kingdom were explored.

Method

The sample comprised 27 community dwelling older adults (>65 years) and eight assessors. The Activity Card Sort – United Kingdom was administered, followed by a semi-structured interview to explore participants' opinions and experiences of undertaking the assessment. Time taken to administer and score was measured.

Results

Mean administration and scoring time was 14 minutes and 30 seconds, which was considered reasonable by older people and assessors. The majority of participants found the Activity Card Sort – United Kingdom straightforward, easy to do and considered activities and activity labels clear. All participants considered that photographs looked like the activities they were depicting. Participants made recommendations which have led to some improvements to the assessment.

Conclusion

The Activity Card Sort – United Kingdom has good clinical utility in terms of ease of use and time required for administering and scoring the assessment. Face validity, in terms of acceptability, was good, but more detailed instructions in the manual will be required to guide therapists on how to explain the purpose of the assessment to clients.

Development of the Activity Card Sort—United Kingdom Version (ACS-UK)

The Activity Card Sort (ACS) is a valid and reliable measure of older adults' participation; however, cultural sensitivity issues are a limitation to its application in the United Kingdom. A content validity study was undertaken to identify culturally relevant activity items to be included in a United Kingdom version of the ACS (ACS-UK). For item generation, United Kingdom time-use studies, research related to other ACS versions, and expert opinions were used. A two-round survey of community-living United Kingdom older adults (aged 65 years and older; round 1, n = 177; round 2, n = 21) was used for item selection, clarifying the wording of activity labels, and agreeing activity domain classification. Ninety-one activities were identified for the ACS-UK and these were compared with items from other ACS versions. The ACS-UK is a culturally relevant measure that can provide useful insight into the participation of older adults for clinical practice and research.

The effectiveness of an augmented cognitive behavioural intervention for post-stroke depression with or without anxiety (PSDA): the Restore4Stroke-PSDA trial

BACKGROUND

Post-Stroke Depression with or without Anxiety (PSDA) is a common disorder in the chronic phase of stroke. Neuropsychiatric problems, such as PSDA, have a negative impact on social reintegration and quality of life. Currently, there is no evidence-based treatment available for reducing PSDA symptoms. In the recent literature on depression in the general population it has been shown that depression complaints can diminish by cognitive behavioural therapy (CBT). In the current study, the effectiveness of augmented, activation-based and individually tailored CBT on the reduction of depression and anxiety will be investigated in patients with PSDA. Additionally, the effects on various secondary outcome measures, such as quality of life, goal attainment and societal participation will be evaluated. This study is embedded in a consortium of 4 interrelated studies on quality of life after stroke (Restore4Stroke).

METHODS/DESIGN

A multi-centre, assessor-blind, randomized controlled trial is conducted. A sample of 106 PSDA patients, as assessed with the Hospital Anxiety and Depression Scale (HADS depression subscale >7), will be recruited and randomly allocated to either an experimental or a control group. The experimental intervention consists of an augmented CBT intervention. The intervention is based on CBT principles of recognizing, registering, and altering negative thoughts and cognitions so that mood, and emotional symptoms are improved. CBT is augmented with direct in-vivo activation offered by occupational or movement therapists. Patients in the control group will receive a computerized cognitive training intervention. Outcomes will be assessed at baseline, immediately post intervention, and at 6 and 12 months follow up.

DISCUSSION

This study is the first randomized clinical trial that evaluates the (maintenance of) effects of augmented CBT on post-stroke depression with or without anxiety symptoms. Together with three other projects, the Restore4Stroke PSDA trial will provide novel information about the (treatment of) emotional problems and quality of life after stroke.

TRIAL REGISTRATION

TRIAL REGISTRATION NUMBER

Dutch Trial Register NTR2999.