Systematic review of occupational engagement and health outcomes among community-dwelling older adults

The impact of caregiving on the roles and valued activities of stroke carers: A systematic review of qualitative studies

OBJECTIVE

To understand the experiences of informal carers and the impact of role and activity changes on their health and wellbeing.

METHODS

A systematic search of CINHAL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted. Studies were eligible if they included informal stroke carers (≥18 years), used a qualitative methodology, explored the roles and valued activities of stroke carers, and were published in English. The 10-item Critical Appraisal Skills Programme checklist for qualitative studies was used to assess methodological quality. The results of the included studies were thematically synthesised.

RESULTS

A total of 36 qualitative studies were included and four overarching themes were identified: (1) Life adjustment; (2) Changing role and identity; (3) Changing activities: From meaningful to purposeful; and (4) Understanding and supporting carers.

CONCLUSION

The sudden nature of stroke requires major readjustment in the carers life that has implications on their relationships, roles, and activities, subsequently impacting on their health and wellbeing. Health professionals and researchers should collaborate with stroke carers to identify their valued activities and implement realistic strategies to maintain these activities. Future interventions designed for carers should implement education about the importance of participating in valued activities and strategies to maintain these activities.

Characteristics of Occupational Therapy Interventions to Promote Healthy Aging: Protocol for a Scoping Review

BACKGROUND

Healthy aging is a pressing public health priority. Focusing on what people do every day may be a meaningful approach to lifestyle change, suggesting a need for occupation therapy interventions to promote healthy aging. A preliminary database search was conducted, and no current or underway systematic or scoping reviews on the topic were identified. Developing an overview of studies of occupational therapy interventions to promote healthy aging is a necessary first step to understanding the existing knowledge and increasing the impact of future interventions. This scoping review will build on previously conducted reviews.

OBJECTIVE

This scoping review will identify the following: (1) what occupational therapy interventions exist for promoting healthy aging in community-dwelling adults? and (2) what are the intervention characteristics, their evaluated outcome, and the impact observed?

METHODS

This protocol was reviewed by 2 occupational therapists as part of a patient and public involvement consultation. The review will consider all studies and publications of occupational therapy focused on promoting healthy aging in community-dwelling adults who are aged 18 years and older. Databases to be searched are AMED, CINAHL, Cochrane Library, Embase, JBI EBP database, MEDLINE, OAlster, PsycINFO, PsycArticles, ProQuest Dissertations & Theses, ProQuest nursing and allied health source, PubMed, and Science Direct. Studies published in any language will be included. Titles and abstracts will be screened against the inclusion criteria using Covidence (Veritas Health Innovation). Potentially relevant studies will be retrieved in full and assessed against the inclusion criteria. No date limiters will be used. Study selection will be completed by 2 independent reviewers. Data will be extracted using a data extraction tool, including descriptive characteristics of the participants including age, sex, and socioeconomic status. Data will be charted using the TIDieR (Template for Intervention Description and Replication) checklist in alignment with the review objectives. The scoping review will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement.

RESULTS

The research began in October 2023, and the results are expected to be published in 2024.

CONCLUSIONS

This scoping review will produce valuable information about occupation-based interventions to promote healthy aging to support the development of an occupational therapy intervention.

TRIAL REGISTRATION

Open Science Framework 5k36d; https://osf.io/5k36d/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55198.

Occupation-Based Interventions to Improve Occupational Performance Among Older Adults Living in Long-Term Care: A Systematic Review

IMPORTANCE

Evidence for the positive effects of occupation-based interventions on occupational performance is increasing; however, little is known about the impacts of occupation-based interventions on older adults living in long-term care.

OBJECTIVE

To consolidate the evidence on the effectiveness of occupation-based interventions for improving occupational performance among older adults living in long-term care.

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, SCOPUS, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from journal-database inception to February 2023.

STUDY SELECTION AND DATA COLLECTION

This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles were peer-reviewed studies published in English that evaluated occupation-based interventions for older adults living in long-term care and used validated tools to measure occupational performance.

FINDINGS

Seventeen articles, with 2,974 participants, were identified. The reviewed studies included 6 Level 1b randomized controlled trials, 5 Level 2b studies of various study designs, and 5 Level 3b studies with quasi-experimental designs. Across studies, heterogeneous measures were used to assess occupational performance. All studies implemented client-centered, occupation-based interventions designed and/or delivered by occupational therapists. Interventions were tailored to residents' goals, interests, or abilities to improve occupational performance and participation, and inconsistent effects were reported.

CONCLUSIONS AND RELEVANCE

Moderate evidence supports the use of occupation-based interventions tailored to individual residents and incorporation of physical activities for improving the occupational performance of older adults living in long-term care. Currently, evidence for care partner involvement and multilevel occupation-based interventions is limited. Plain-Language Summary: This study adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care. High-quality randomized controlled trials with longer term follow-up and assessment of clinically meaningful outcomes are critical for developing the evidence base in this practice setting.

Occupation-centred practice and supervision: Exploring senior occupational therapists' perspectives

INTRODUCTION

Occupation-centred practice is core to contemporary occupational therapy; however, knowledge and implementation of occupation in practice vary. New graduate occupational therapists find implementing occupation-centred practice challenging, partly due to the influence of senior occupational therapists. However, little is known about senior therapists' views, knowledge, and use of occupation-centred practice and the impact this has on new graduates. The aims of this study were to explore senior occupational therapists' perspectives on and use of occupation-centred practice and the extent to which they influence the occupation-centred practice of the new graduates they supervise.

METHODS

Interpretative phenomenology was used as the research design. Ten senior occupational therapists in Australia were purposively recruited to participate in semi-structured interviews, which we transcribed. Interpretative Phenomenological Analysis (IPA) was used to analyse the data and develop themes.

FINDINGS

Five themes were discovered from the data: together, but apart; a link between knowledge and identity; navigating different cultures; making up for what is missing; and good supervisors. The themes revealed participants' varied knowledge and use of occupation-centred practice, the influence of practice context, and the way supervision impacted on the practice of new graduates.

CONCLUSION

Senior occupational therapists valued occupation-centred practice, but their understanding and implementation of it varied. Participants acknowledged that they held great power to influence new graduates' use of occupation-centred practice through supervision. Consequently, if occupation is not central to supervision, this could perpetuate the ongoing challenges of delivering contemporary practice.

Which Occupations Did People Engage in during Lockdown? A European Cross-Sectional Descriptive Survey by Generation

Objective

The primary objective was to describe the occupations people engaged in more frequently during lockdown than before the coronavirus disease 2019 pandemic as a function of generation. The secondary objectives were to (i) describe the levels of importance, performance, and satisfaction for these occupations and (ii) identify factors affecting the levels of importance, performance, and satisfaction.

Method

We conducted an online, cross-sectional survey of young adults (YAs, aged 18-39), middle-aged adults (MAs, aged 40-59), and older adults (OAs, aged 60 or over).

Results

2534 participants (YAs: 47%, MAs: 33%, and OAs: 20%) cited 4500 occupations. The occupations in which people most engaged were leisure occupations (67%), followed by productive occupations (31%) and then self-care (2%) occupations. YAs gave a median (interquartile range) importance score of 8 (6; 9) to leisure, 8 (7; 10) to productivity, and 8 (7; 10) to self-care. MAs gave a median importance score of 8 (6; 10) to leisure, 8 (7; 10) to productivity, and 8 (7; 10) to self-care. OAs gave a median importance score of 8 (7; 10) to leisure, 8 (7; 9) to productivity, and 9 (8; 10) to self-care. In a pre-/postlockdown comparison, the changes in performance scores among YAs were +5 (3; 6) for leisure, +4 (2; 5) for productivity, and +4 (3; 6) for self-care. Among MAs, these changes were, respectively, +4 (3; 6), +3 (2; 5), and +4.5 (3; 6). Among OAs, these changes were, respectively, +3 (1; 5) for leisure, +3 (2; 5) for productivity, and +2 (0; 4) for self-care. The changes in satisfaction scores among YAs were +3 (0; 5) for leisure, +3 (0; 5) for productivity, and +3 (1; 6) for self-care. Among MAs, these changes were, respectively, +3 (0; 5), +2 (0; 4), and +5 (0; 6). Among OAs, these changes were, respectively, +2 (0; 4), +2 (0; 4), and +2 (0; 4).

Conclusions

Lockdown led to stronger engagements in quiet leisure and alternative forms of socialization. Occupational therapists may have a role in helping community-dwelling people to balance and structure their new daily routine.

Subjective Well-Being and Related Factors among Independent, Healthy, Community-Dwelling Older Adults in Japan

(1) Background: Subjective well-being (SWB) is internationally recognized as an important health-related factor for most age groups and is particularly influential for life quality and expectancy in independent, healthy, community-dwelling older adults. However, the physical function and community participation correlates of SWB in independent living older adults in super-aging societies and other influencing factors remain underexplored. (2) Methods: A total of 926 independent, healthy, community-dwelling older adults aged 65 years and above registered in Yokohama, Japan, were included. Respondents' mean age was 78.1 years (standard deviation = 6.7), and 74.0% were women. The dependent variable was SWB. The independent variables were respondents' demographic characteristics, physical factors (visual, hearing, and cognitive functions, and mobility), and community and social factors (participation in community groups, social networks, and community commitment. (3) Results: The mean (standard deviation) WHO-5 score was 16.3 (5.1). Significant factors associated with WHO-5 score were visual function (odds ratio [OR]: 0.708; 95% confidence interval [CI]: 0.352-0.690), hearing function (OR: 0.615; CI: 0.431-0.878), community groups (OR: 1.310; CI: 1.003-1.059), community commitments (OR: 1.180; CI: 1.132-1.231), and social networks (OR: 1.525; CI: 1.142-2.037) adjusted for the effects of demographic factors. (4) Conclusions: These findings are important because factors associated with SWB are likely to contribute to individual well-being and longevity and to developing a healthy super-aged society.

Prevalence and factors associated with anxiety and depression among community-dwelling older adults in Hunan, China: a cross-sectional study

BACKGROUND

Older adults' psychological health is a public health issue that cannot be ignored, especially when these psychological health problems and related factors change across different social backgrounds because of rapid changes in traditions and family structures and the epidemic responses after the outbreak of COVID-19 in China. The aim of our study is to determine the prevalence of anxiety and depression and their associated factors among community-dwelling older adults in China.

METHODS

A cross-sectional study was conducted from March to May 2021 with 1173 participants aged 65 years or above from three communities in Hunan Province, China who were selected using convenience sampling. A structured questionnaire including sociodemographic characteristics, clinical characteristics, the Social Support Rating Scale (SSRS), the 7-Item Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire-9 Item (PHQ-9) was used to collect relevant demographic and clinical data and to measure social support status, anxiety symptoms, and depressive symptoms, respectively. Bivariate analyses were conducted to explore the difference in anxiety and depression based on samples' different characteristics. The multivariable logistic regression analysis was performed to test for significant predictors of anxiety and depression.

RESULTS

The prevalence of anxiety and depression were 32.74% and 37.34%, respectively. Multivariable logistic regression analysis revealed that being female, being unemployed before retirement age, lacking physical activity, having physical pain, and having three or more comorbidities were significant predictors for anxiety. Subjective social support and support utilization were significant protective factors. Regarding depression, religion, lacking physical activity, having physical pain, having three or more comorbidities were found to be significant predictors. Support utilization was a significant protective factor.

CONCLUSIONS

The study group showed a high prevalence of anxiety and depression. Gender, employment status, physical activity, physical pain, comorbidities, and social support were associated with psychological health problems of older adults. These findings suggest that governments should focus on the psychological health problems of older adults by raising community awareness of issues related to older adults' psychological health. They should also screen for anxiety and depression among high-risk groups and encourage individuals to seek supportive counseling.

Life Domains and Lifestyle of Older Adults Living in a Nursing Home: A Pilot Study

Although the preventive occupational therapy intervention program Lifestyle Redesign® has proven to be effective in maintaining and improving the health and quality of life of older adults, a similar program has not yet been culturally adapted to the Spanish population. As a preliminary step in developing a lifestyle intervention tailored to healthy Spanish older adults living in a nursing home (Lifestyle Choice; originally in Spanish "Elección de Estilo de Vida"), we aimed to identify and describe the life domains of this population and determine overlap with content areas addressed in the Lifestyle Redesign® program. An observational cross-sectional study was carried out using quantitative methods, including 30 healthy older adult residents in the "Virgen del Prado" nursing home in Talavera de la Reina (Toledo), based on the development of a questionnaire and a survey. Six life domains were identified: self-care, sleep and rest, mobility, personal safety, health maintenance, spirituality, and free time usage. The results of this study reveal important overlaps with content areas of Lifestyle Redesign®, suggesting that it may be feasible to develop a lifestyle intervention ("Elección de Estilo de Vida") tailored to the sociocultural features of the healthy Spanish population over 65 years old living in nursing homes.

Occupational engagement: some assumptions to inform occupational therapy

Abstract Occupational engagement has been conflated with other concepts, such as participation, active occupational performance, and therapeutic engagement. This critical review will discuss occupational engagement as a unique concept that describes a form of involvement in doing that does not require performance and foregrounds the subjective-affective and cognitive experiences of doing. We present some attributes of occupational engagement and the implications for the lack of clarity of this concept within the literature. The difference between occupational engagement and therapeutic engagement is discussed by comparing the foundational tenets of the Model of Human Occupation (MOHO) and the Canadian Model of Occupational Performance and Engagement (CMOP-E). Through one illustrative narrative, we discuss how occupational engagement can be understood as a phenomenon that is not performance-dependent and has different levels of engagement. To conclude, we point out some assumptions about occupational engagement that can inform occupational therapy research and practice.

Lifestyle Redesign® with independent living older adults in countries other than the USA

BACKGROUND

Health promotion services need to be developed to respond to the needs of an ageing population. Lifestyle Redesign^® (LR^®) is an occupational therapy intervention that has been addressed as cost-effective in the USA.

AIMS/OBJECTIVES

This scoping review aimed to identify how the LR^® has been implemented and what the results have been with older adults living independently in countries other than the USA.

MATERIAL AND METHODS

Sixteen studies were included. Quantitative results were interpreted through the numeric data and qualitative results through inductive thematic analysis.

RESULTS

The delivery of the LR^® shared both similarities and differences with the original LR^®, and the variations concerned interventions length, facilitators, and the outcome measures used. In the quantitative results, there was often a positive trend in intervention groups' health-related quality of life, mental health, and occupational performance; in qualitative results, there was improvement in self-esteem and possibilities in building new communities.

CONCLUSIONS AND SIGNIFICANCE

The original LR^® was often transferrable into cultural settings other than the USA and many positive outcomes in the health and well-being of older adults were addressed. However, to understand the feasibility and effectiveness of the LR^®, scientific research and publications need to be enhanced.

How do older women perceive the occupations and activities within their maternal role? Findings from an exploratory survey

BACKGROUND

Participation in meaningful everyday occupations and life-roles is crucial to the health and wellbeing of older adults. However, little is known regarding meaningful life-roles of older women. Although the maternal-role remains meaningful to women throughout their life, previous literature focused on earlier stages of motherhood.

AIMS

To describe the occupations and perceptions within the maternal-role of older women.

MATERIALS AND METHOD

An online survey was distributed via social media. It included closed and open-ended questions regarding the engagement and relatedness of occupations to the maternal-role; and the perceptions of older women towards their maternal-role. Quantitative data was analyzed using descriptive statistics, and thematic analysis was used to analyze data from open-ended questions.

RESULTS

The survey was answered by 317 community-dwelling older mothers (aged 65-87). High frequency of engagement and relatedness of occupations to the maternal-role were found. Most participants perceived the maternal-role as a never-ending and evolving life role. Seven categories, describing both 'doing' and 'being' aspects of the maternal-role, were identified.

CONCLUSION

The maternal-role is meaningful to older women. It continues to develop over time, and includes new occupations which have not been central at earlier stages of motherhood.

SIGNIFICANCE

These findings have significant implications for healthcare professionals striving to promote healthy aging by enhancing the participation of older women in meaningful occupations. Further research is needed to broaden the understanding of the unique characteristics of the maternal-role at older age.

Interventions to promote independent participation among community-dwelling middle-aged adults with long-term physical disabilities: a systematic review

PURPOSE

People aging with long-term physical disabilities (PAwLTPD) are aging at an accelerated rate beginning in middle-age. They face age-related challenges in conjunction with their existing disabilities; thus, maintaining independence as they age is often difficult. The aim of this systematic review was to examine the effectiveness of rehabilitation interventions for middle-aged PAwLTPD to participate independently in the home and community.

MATERIALS AND METHODS

We searched four databases - MEDLINE, CINAHL, Web of Science, and EMBASE - for studies published from January 2005 to December 2020. Information from included studies was extracted using a critical appraisal form. Studies were categorized based on common themes, assigned level of evidence, and assessed for risk of bias.

RESULTS

Fourteen articles were included. Common themes derived were fall risk reduction, functional capacity, community mobility, and function within the home. The strongest evidence supports wheelchair skills training programs (WSTPs) among manual wheelchair users and targeted paretic limb exercise post-stroke. Moderate evidence supports exercise and multicomponent interventions for those with multiple sclerosis, adaptive strategy training and WSTPs to improve satisfaction with mobility for power wheelchair users, and home modifications/assistive technology for mobility-impaired individuals.

CONCLUSION

Interventions with strong and moderate evidence should be routinely offered for middle-aged PAwLTPD. Future research should focus on developing evidence-based interventions for middle-aged PAwLTPD.IMPLICATIONS FOR REHABILITATIONMiddle-aged PAwLTPD face the same aging-related challenges as people without disabilities but will experience additional difficulties due to compounding effects of long-term health conditions and aging.Current effective interventions to promote participation for middle-aged PAwLTPD have been measured over a wide range of outcomes, and many interventions should be used by clinicians on a case-by-case basis.Wheelchair skills training was found to have the strongest evidence and is recommended for use with middle-aged PAwLTPD who use manual and power wheelchairs.

The experiences of older adult members of a combined lunch club and assisted shopping group and the perceived value in their occupational lives: A qualitative study

Background and Aims

Health and social care policies are increasingly focusing on community interventions for older adults with service providers diversifying services to widen their reach. As a result, new concepts are under-researched, and it can be challenging to draw parallels with existing interventions. Evidence of the value of community interventions is often limited and conflicting and few researchers have considered the service-user perspective. This qualitative research explores the experiences of members of a combined lunch club and assisted shopping group based in North-East England to understand the perceived value in their lives from an occupational perspective.

Methods

Six older adult members were recruited through convenience sampling to participate in individual semistructured interviews January-March 2020. Interview data was subject to thematic analysis using an inductive approach and three key themes were constructed to represent the data.

Results

Themes identified were: "Togetherness: promoting social belonging"; "Meaningful engagement for older adults" and "Independence and staying active in later life." Findings indicated largely positive experiences with themes depicting influences that motivate engagement and perceived benefits.

Conclusion

Participants particularly valued the opportunity for social engagement, as well as independence through supporting continued engagement with shopping in later life. In conclusion, successful community interventions for older adults need to be meaningful and purposeful.

Role of Occupational Therapy in Pain Management

This new position statement from the American Occupational Therapy Association (AOTA) describes occupational therapy's role in pain management. AOTA asserts that occupational therapy practitioners are distinctly prepared to work independently and to contribute to interprofessional teams in the treatment of pain. Practitioners strive to ensure active engagement in meaningful occupations for clients at risk for and affected by pain.

Role of Occupational Therapy in Pain Management

The American Occupational Therapy Association (AOTA) asserts that occupational therapists and occupational therapy assistants, collectively referred to as occupational therapy practitioners (AOTA, 2020b), are distinctly prepared to work independently and to contribute to interprofessional teams in the treatment of pain. Occupational therapy practitioners work to ensure active engagement in meaningful occupations for "persons, groups, or populations (i.e., the client)" (AOTA, 2020b, p. 1) at risk for and affected by pain.

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.

Cocreation from Emerging Opportunities: Occupational Therapists’ Perspectives on Supporting Older Persons, in Japan

Introduction

Practices of occupational therapists, particularly those supporting older persons with physical impairments, remain overly focused on remediating impairments, and implementation of occupation-centered practices remains fraught with difficulties. In Japan, this issue exists across the continuum from acute care to rehabilitation settings and into the community. This is despite the existence of international models and frameworks that place occupation at the core of the profession. Accordingly, there is a need to better understand how occupational therapists respond to the call for occupation-centered practices across the said continuum of care with this population. The aim of this study was at exploring and understanding occupational therapists' experiences of supporting the resumption of occupations among older persons with physical impairments, in Japan.

Methods

Embedded in a constructivist world view, this was a qualitative focus group study. Four focus groups (two in urban areas and one each in rural and semirural areas), consisting of seven or eight occupational therapists with at least three years of relevant practice experience, convened twice to narrate and explore their support of older persons. All were participating voluntarily with confidentiality of their participation being guaranteed by the researchers. They met for a third time to verify emerging analytic results. Data were analysed using a reflective thematic analysis.

Results

Identified were three themes, namely, calling forth powers of occupations, imagining client's future, and cocreating plots, which we synthesized into recurring cocreations from emerging opportunities. Discussion. Supporting the resumption of occupations among older persons with physical impairments hinges on repeated processes of identifying possibilities for occupation, followed by actions to bring these (e.g., images of clients' future) into reality. Occupations' healing properties (i.e., occupations' powers) can be used to assist clients in experiencing health and well-being. The results suggest a reframing of occupational therapy practices as recurring processes of recognizing opportunities for occupation, followed by actions whereby these possibilities are turned into reality. Occupational therapy effectiveness might be enhanced when goals and methods are repeatedly and creatively aligned with the evolving plots cocreated between the client, therapist, and stakeholders.

Feasibility of Lifestyle Redesign® for community-dwelling older adults with and without disabilities: Results from an exploratory descriptive qualitative clinical research design

INTRODUCTION

Although Lifestyle Redesign® has been shown to be effective in improving older adults' health and well-being, little is known about the feasibility of implementing this programme to develop meaningful and health-promoting routines of community-dwelling older adults in Canada. This study thus aimed to explore the feasibility of implementing a culturally-adapted 6-month version of Lifestyle Redesign® with community-dwelling older French-Canadians with and without disabilities.

METHODS

An exploratory descriptive qualitative clinical research design was used with 17 older adults living at home or in a seniors' residence, divided into two groups participating in Lifestyle Redesign®. Semi-structured interviews were conducted with participants and the occupational therapist who delivered the programme and recorded clinical notes.

FINDINGS

Participants were aged between 65 and 90; they were mainly women (n = 11; 64.7%), and seven (41.2%) had disabilities. The intervention was tailored to the participants' needs, interests, and capacities in each group (e.g. modules selected, number of individual sessions, and assistance of volunteer). Over the 6-month period, older adults participated in an average of about 25 group sessions with the occupational therapist and in four or five outings with their group (e.g. restaurant, market, and museum) and attended between 5 and 11 individual sessions with the occupational therapist. The most common reasons for missing group sessions were being ill, working, or having another appointment. Personal facilitators and barriers to participation in the intervention were mainly related to abilities, needs, spiritual life, and health. Environmental facilitators were mostly the regularity of the sessions, group, and external support, including human resources to deliver the intervention, whereas barriers were the residence's time restrictions and staff's attitudes, cost of some activities targeted in the programme, and transportation problems.

CONCLUSION

Lifestyle Redesign® is a feasible preventive occupational therapy intervention for community-dwelling older French-Canadians. These findings will guide future studies including large-scale clinical trials.

Healthy ageing through participation in community situated activities: A scoping review of assessment instruments to support occupational therapy practice

Introduction

The occupational therapy profession has an essential role to play in healthy ageing that includes enabling participation, a construct that according to The International Classification of Functioning, Disability and Health (ICF), incorporates an environmental context. Environmental barriers and enablers of participation in community‐situated activities for people over the age of 65 have been identified. To support practice, occupational therapists require assessments with demonstrated content validity including comprehensive coverage of the construct. The purpose of this scoping review study was to investigate what instruments are available to assess community participation for people over the age of 65 that included environmental factors.

Methods

A scoping review of the literature was conducted, utilising the Joanna Briggs Institute (JBI) scoping review methodology. The evidence source was review articles and inclusion criteria were that they reviewed instruments to assess participation that could be used for people over the age of 65. Items extracted from included instruments were evaluated against a preset list of community‐participation and environment categories that had been developed from the ICF.

Results

Twenty‐three review studies met inclusion criteria and from these 240 instruments were extracted. Twenty instruments were retained after exclusions and from these, 540 instrument items were extracted. Of these, 280 (47%) were coded as community‐participation, and only 20 (3.4%) as environment items. Fourteen of the instruments included no environment items.

Conclusions

No instrument was identified that comprehensively assessed community participation including the related environmental factors. Such an instrument is required to enable occupational therapy practitioners to support healthy ageing. The development of such an instrument will strengthen the profession's capacity to develop new ways of delivering services to older adults in line with emerging ways that aged care will be delivered and to advance its essential role in healthy ageing.

The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites

Background

Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia.

Objective

The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia.

Methods

We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to “older adults,” “dementia,” and “institutional care” and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis.

Results

Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use.

Conclusions

This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets.

Shared Site Intergenerational Programs: A National Profile

Shared site intergenerational programs deliver ongoing services and shared programming to youth and older adults in a single setting. With the potential to benefit youth, older adults, families, and communities, they attract growing attention from practitioners, researchers, funders, and policy makers. Using national survey data we profile characteristics of 95 shared sites. Responding programs connected over 25,000 youth and older persons in 2017. The most common models consisted of adult day services and early childhood programs (i.e., preschool or childcare), though unique models offered diverse opportunities. Current priorities and challenges can be addressed with systematic data collection and access to resources, including incentives in the 2020 reauthorized Older Americans Act.

The Contribution of Frailty to Participation of Older Adults

Background: Participation, which is involvement in life situations, is an important indicator of human health and well-being of older adults. Frailty is known to be related to difficulties in activities of daily living (ADL) but the association with participation restriction has not been sufficiently researched. Therefore, we aimed to (1) to assess the correlations between frailty, ADL, and participation; and (2) to identify the contribution of frailty to explaining the participation restriction of older adults. Methods: A cross-sectional study included home visits to community-dwelling older adults aged 75 and older. The Reintegration to Normal Living Index (RNL-I) assessed participation, PRISMA-7 assessed frailty, and the Functional Independence Measure and IADL questionnaire assessed the basic and instrumental ADL. Cognition, which may explain participation, was also assessed (The Montreal Cognitive Assessment) and demographic information was collected. Results: Older adults (N = 121, 60 women), aged 75 to 91 years (mean (SD)—79.6 (3.1)), were included. Older adults demonstrated full to restricted participation (RNL-I-mean (SD)—78.2 (18.0)/100). Frailty was identified in 39 (32%) older adults (mean (SD) PRISMA-7—2.9 (1.4)/7points). A negative moderate significant correlation was found between participation and frailty (r = −0.634, p < 0.001). The variance of participation was significantly explained by frailty, 31.5%, and basic ADL, 5.6% (after controlling for age and cognition); the total model explained 44.6% (F = 23.29, p < 0.001). Conclusions: Frailty is significantly associated with participation restriction. Since participation has many health benefits, understanding which factors are associated to participation is central to developing interventions for older adults. These findings may help health professionals in the future develop interventions for maintaining and promoting the participation of older adults.

A Scoping Review of the Maternal Role at Older Age; Perceptions and Occupations

Motherhood is a meaningful life role among adult women. Occupations within the maternal role of younger mothers have been well documented, but less is known regarding the maternal-role at older age. This review aimed to describe the occupations, activities, and perceptions that older women ascribe to their maternal role. In the future, this information may promote health and wellbeing of older women. A systematic search of peer reviewed articles, that included healthy, community-dwelling mothers, 60 years of age or older, was conducted. Maternal-role occupations and perceptions of older mothers were identified and classified according to the Occupational Therapy Practice Framework (OTPF). Fourteen articles, representing 3102 older mothers, were included. The identified occupations and activities within the maternal role were from two categories: Instrumental Activities of Daily Living (IADL) (such as assistance with daily chores) and social participation (such as sharing holiday rituals). Three themes reflecting maternal-role perceptions were identified: providing support; relationship with children; and motherhood as a never-ending role. Maternal occupations were identified in only a few articles and from only two categories, IADL and social participation. These findings together with the perception that motherhood is a ‘never-ending’ role suggests that further research is needed to better characterize the maternal role of older women from an occupational perspective.

Promoting outdoor recreation among older adults in Sweden - a theoretical and empirical foundation for the development of an intervention

BACKGROUND

Disengagement from outdoor recreation may diminish the positive benefits on health and well-being in old age. The purpose of this study is to present a contextual, theoretical, and empirical rationale for an intervention, aiming to promote continued engagement in outdoor recreation for older adults in a Swedish context.

METHODS

The paper includes a contextualization of outdoor recreation in Sweden, a presentation of evidence on health benefits related to engagement in outdoor recreation, together with theoretical frameworks that may guide future intervention designs. To add empirical knowledge, a mixed methods approach was applied, including an empirical data collection based on a quantitative survey (n = 266) and individual semi-structured interviews with older adults (n = 12). Survey data were presented with descriptive statistics. Associations between disengagement from previously performed activities and age and gender was analyzed with Chi2 tests. Transcripts and handwritten notes from the interviews were analyzed qualitatively to identify key themes, as well as patterns and disparities among respondents.

RESULTS

Outdoor recreation was rated as important/very important by 90% of respondents of the survey. The interviews highlighted that engagement in outdoor recreation aided respondents to keep fit but had also relevance in terms of identity, experiences, and daily routines. Outdoor recreation close to the place of residence was most common and walking was the most frequently reported activity. While 80% considered their health to be good/very good, disability and long-term diseases were common and during the previous year, more than half of all respondents had disengaged from activities previously performed. Reasons for disengagement were mainly related to health decline or that activities were too demanding but also due to social loss. The interviews indicated that continued engagement was important but challenging, and that disengagement could be considered as a loss or accepted due to changing circumstances.

CONCLUSIONS

In the design of an intervention aiming to promote engagement in outdoor recreation for older adults, the following features are proposed to be considered: person-centeredness, promoting functioning, addressing self-ageism, providing environmental support, promoting subjective mobility needs and adaptation to find new ways to engage in outdoor recreation.

Association between Occupational Dysfunction and Social Isolation in Japanese Older Adults: A Cross-Sectional Study

We clarified the relationship between occupational dysfunction and social isolation among community-dwelling adults. We used a self-administered questionnaire with a cross-sectional study for 2879 independently living older adults in Kasama City, Japan. Participants responded to a self-reported questionnaire in November 2019. Occupational dysfunction and social isolation were assessed. The participants were classified into two groups: healthy occupational function group, and occupational dysfunction group. To examine the relationship between occupational dysfunction and social isolation, we performed a logistic regression analysis with social isolation as a dependent variable and occupational dysfunction as an independent variable. In the crude model, the occupational dysfunction group had a higher risk of social isolation than the healthy occupational function group (odds ratio (OR) = 2.04; 95% confidence interval (CI), 1.63–2.55; p < 0.001). In the adjusted model, the occupational dysfunction group had a higher risk of social isolation than the healthy occupational function group (OR = 1.51; 95% CI, 1.17–1.94; p = 0.001). The results showed that occupational dysfunction was significantly associated with social isolation. These results can be used in constructing a support method for social isolation from a new perspective.

Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

The Effectiveness of Community Occupational Therapy Interventions: A Scoping Review

Background: This review aims to evaluate the level of scientific evidence for the effectiveness of Community Occupational Therapy interventions. Methods: A systematic review was used to analyze and synthesize the studies collected. The databases of Cochrane, OTseeker, OTCATS, Web of Science, Scielo and Scopus were used in order to collect articles published between 2007 and 2020. PRISMA recommendations were followed. Results: A total of 12 articles comprised part of the study (7 randomized controlled studies, 4 systematic reviews and 1 meta-analysis). The main areas of practice were geriatric gerontology (22.1%) and mental health (19.7%), which were statistically significant (χ²; p < 0.005) compared to the rest. Regarding the studies analyzed, all of them had scores of >7 on the PEDro and AMSTAR scales. Conclusions: Research on Community Occupational Therapy constitutes a consolidated line of research but the objectives and areas of research were limited. Descriptive qualitative methodology predominated and studies on the effectiveness of Community Occupational Therapy interventions showed a medium–low level of evidence.

The perceptions of adult psychiatric inpatients with major depressive disorder towards occupational therapy activity-based groups

Background

Occupational therapists have been using group therapy as their preferred treatment modality in mental healthcare since the origin of the profession. In private mental healthcare units, major depressive disorder (MDD) is the most common psychiatric disease. Occupational therapists use individual and group therapy to treat adult inpatients with MDD. Little is known about the perceptions and experiences of adult inpatients with MDD regarding occupational therapy activity-based groups.

Aim

To describe the perceptions and experiences of adult psychiatric inpatients with MDD towards occupational therapy activity-based groups. This article reports on the perceptions of adult psychiatric inpatients with MDD, which formed part of a larger study.

Setting

The study took place at two private general hospitals in Gauteng province, South Africa, each with a psychiatric ward.

Methods

The researcher used a qualitative explorative descriptive design. Accessible participants were selected using convenience sampling. Only consenting participants took part in the study. Data were collected during focus group discussions. Data were thematically analysed.

Results

Participants’ perceptions could be placed into one of four themes: (1) experience improved mood, (2) learned coping skills, (3) regained self-esteem and (4) becoming part of the solution to face life challenges.

Conclusion

Activities that are unique to occupational therapy profession can benefit inpatients with MDD. This supports the profession’s historical beliefs, assumptions and foundations regarding therapeutic use of activities. According to these inpatients, group activities improved their overall mental health.

Membership, Neighborhood Social Identification, Well-Being, and Health for the Elderly in Chile

The world’s elderly population is growing, and in Chile they represent 16.2% of the total population. In Chile, old age is marked by retirement, with a dramatic decrease in income that brings precariousness. Older adults are economically, socially, and psychologically vulnerable populations. This condition increases their likelihood of disengaging from their usual social environment, facilitating their isolation, sadness, and discomfort. From the perspective of social identity, well-being (WB) can be explained by two principles: social groups’ importance for health and people’s psychological identification with those groups. This study analyzes the relationships between belonging to the neighborhood and extra-neighborhood groups and neighborhood social identification with WB. Urban or rural location and gender are measured, and the sample is 1,475 older Chilean adults of both sexes. The results show that the majority are not members of social groups (52%), and the remaining 48% are members of one or two groups or organizations (42.65%). Only 4.47% belong to three groups or organizations. Those who belong to groups obtain higher scores, emotional–mental WB, and positive emotions than older adults who do not belong to any organization. Urban and rural older adults have the same level of WB. Membership in close social organizations (neighborhood councils) or distant ones (clubs for the elderly and religious groups) causes different WB associations. Membership in neighborhood councils reduces gender differences in self-assessment of health. This result supports the idea that participation in heterogeneous groups with a shared sense of belonging to the neighborhood is associated with higher WB and lower perceived loneliness. Social identification with the neighborhood, rather than belonging to the group, had the most widespread impact on WB and health indicators. The variable social identification with the neighborhood was consistently associated with indicators of hedonic WB.

Age trajectories of disability in instrumental activities of daily living and disability-free life expectancy among middle-aged and older adults in Taiwan: an 11-year longitudinal study

BACKGROUND

This study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults.

METHODS

We included 3118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996-2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages.

RESULTS

We identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63), diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6 and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5 and 27.2% of remaining life.

CONCLUSIONS

Early-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.

Occupational therapy, loneliness and social isolation: a thematic review of the literature

Background/Aims

Loneliness and social isolation are thought to have a negative impact on health and wellbeing. There is little literature that provides an explicit focus on loneliness and social isolation in occupational therapy practice. The aim of this study was to explore themes related to loneliness and social isolation in occupational therapy-related literature and consider the implications for practice.

Methods

CINAHL, Medline, Pub Med, AMed, PsycINFO, TRIP Database, and Science direct and Web of science databases were used to identify articles pertaining to occupational therapy, loneliness and social isolation.

Results

A total of 20 articles were included and three themes were identified: loneliness and social isolation are detrimental to health and wellbeing; factors associated with increased loneliness and social isolation; factors that protect against the impact of loneliness and social isolation.

Conclusions

Loneliness and social isolation have a significant impact on the health and wellbeing of the people occupational therapists work with. Occupational therapy practice should include the recognition and assessment of loneliness and social isolation, and interventions to help reduce any impacts on health and wellbeing.

The value of powered mobility scooters from the perspective of elderly spouses of the users - a qualitative study

PURPOSE

To explore spouses' experiences of the value of mobility scooters prescribed to their partner.

MATERIAL AND METHODS

A descriptive design with a qualitative approach was used. Thirteen spouses (11 females) aged 65-86 years participated. Semi-structured interviews were conducted when the spouse's partner had had the mobility scooter for 4-6 months. The interviews were analysed using qualitative content analysis.

RESULTS

The interviews showed primarily that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They reported that they could engage in activities of their own choice to a greater extent. The prescription of a mobility scooter to their partner had also yielded a sense of freedom related to shared activities. On the other hand, the spouses described some of the scooter's limitations. Three categories emerged: a sense of freedom related to the spouse's own activities, a sense of freedom related to shared activities and a somewhat restricted freedom.

CONCLUSION

Prescription of a powered mobility scooter was of value to the users' spouses because it facilitated independent and shared activities and participation in the community. The value was mainly expressed as a sense of freedom when doing things on their own or together with their partner. Spouses are key persons in the rehabilitation of people with mobility restrictions. Their views on the assistive device may influence the rehabilitation process. Knowledge of spouses' experiences is thus crucial, as this may influence the future rehabilitation outcome.IMPLICATIONS FOR REHABILITATIONA powered mobility scooter prescribed to one partner eases everyday life and increases activity and participation for the spouse, which in turn may further improve the quality of life for the scooter user.The spouses' perspectives on their partners' mobility scooter use could be helpful in developing the design of the mobility device and in the prescription process.A mobility scooter has an added value by giving a sense of freedom and freedom to choose for the spouse as well as the scooter user.

Appliquer un procédé argumentaire pour revendiquer une attribution des services en ergothérapie basée sur l’habilitation aux occupations

Problématique : L’attribution actuelle des services en ergothérapie en CLSC permet difficilement aux ergothérapeutes d’intervenir selon leur expertise première d’habilitation aux occupations. Pour revendiquer cette situation, les professionnels sont appelés à agir comme agent de changement et idéalement avoir recours à un procédé argumentaire. Objectif : Appliquer un procédé argumentaire à une situation professionnelle problématique en ergothérapie, soit revendiquer une attribution des services en ergothérapie en CLSC basée sur l’habilitation aux occupations. Méthode : Le procédé argumentaire est basé sur le cadre argumentaire Convictions-Réel-Actions-Fondements (CRAF) nécessitant une recherche d’arguments provenant d’une recension critique des écrits. Résultats : Les études recensées font valoir des arguments basés sur les valeurs et les fondements théoriques de la profession. Les arguments issus des résultats probants proviennent d’études dont le niveau d’évidence scientifique est élevé. Ils montrent que des interventions basées sur l’habilitation aux occupations ont des retombées sur la participation et le fonctionnement dans les occupations, le bien-être et la santé physique et mentale, la perception d’efficacité personnelle, la satisfaction de vie, les interactions sociales, l’apprentissage de connaissances et l’espérance de vie. Discussion : L’habilitation aux occupations dans une approche de prévention et de promotion de la santé est efficace et rentable, et ce, pour une clientèle plus vaste que celle actuellement desservie. Les ergothérapeutes, désireux d’être agent de changement dans leur milieu, pourraient reproduire le procédé argumentaire pour l’appliquer à une situation clinique problématique.

Identity, civic engagement, and altruism: a phenomenological exploration of activity engagement in older adults

BACKGROUND

Older adults' health and quality of life, proxies for aging well, are tied to activity engagement. Recent research indicates studying the perspective of older adults through their personal stories is key to understanding the phenomenon of occupational engagement as experienced day-to-day.

AIM

To uncover the lived experience of older adults within their natural settings to better understand the phenomenon of activity engagement. This new knowledge informs programming options suited to older adults' wants and needs.

MATERIALS/METHODS

Ten community-dwelling older adults (5 female, 5 male mean 79 years) were studied. Researchers performed phenomenological interpretive analysis (IPA) with multiple coders and member cheques to triangulate findings.

RESULTS

Daily activities revolved around three themes: 1) Perspectives of self-identity are viewed as consistent throughout the lifespan; 2) Civic engagement is beneficial for social support and self-efficacy; and 3) Philosophical outlook influences activity choices and outlooks centred on altruism are critical to continued activity engagement. Seven of the ten participants expressed an overall positive outlook on aging. Three participants described a negative outlook on aging, expressed more difficulty with activity engagement, but reported desire to help others.

CONCLUSIONS AND SIGNIFICANCE

These themes provide a basis for programming to increase activity engagement with older adults in the community.

The influence of occupation on wellbeing, as experienced by the elderly: a systematic review

OBJECTIVE

The objective of this review was to synthesize knowledge regarding which types of occupations the elderly perceive as important to and supporting their overall wellbeing.

INTRODUCTION

Being active is an important part of managing the daily challenges of advanced old age. Occupational therapy and occupational science are based on the premise that a person's occupations are intertwined with their health and are thus needed for them to experience a meaningful life and improve their wellbeing.

INCLUSION CRITERIA

This review, which included independently living elderly people aged 65 and over living in Europe, the USA, Canada and Australia, sought to uncover if the elderly see any specific types of occupations as enhancing their wellbeing. This review included qualitative studies with designs including, but not limited to, phenomenology, grounded theory, ethnography and action research.

METHODS

A three-step search strategy using Joanna Briggs Institute methodology was utilized. Both published and unpublished studies were searched. The following databases were searched for studies up to 2017: CINAHL, Nursing and Allied Health Source, Web of Science, PubMed and OpenGrey. Using the JBI Critical Appraisal Checklist for Qualitative Research, two independent reviewers assessed whether each study had the methodological quality required to be included in the review. Any disagreements were resolved through discussion with a third reviewer. The standardized JBI data extraction tool for interpretive and critical research was used to extract data from the included studies. JBI tools were used to pool the qualitative research findings. The findings were then aggregated through a process of rating according to quality, and categorized according to similarity in meaning, which generated a set of statements for each category. These categories were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings useful as a basis for evidence-based practice.

RESULTS

All three of the included studies utilized qualitative interviews and followed a phenomenological approach. The studies included only participants aged 85 and over. Thirty-five findings were extracted and grouped into four categories, which were synthesized into two meta-syntheses: 1) The importance of "doing" alone - to feel good, I have to be the master of my own life; and 2) Old habits never die - a structured day is a good day. Based on the dependability and credibility of the three studies, the ranking was high (see Summary of Findings).

CONCLUSIONS

The present review shows that two factors enhance elderly people's wellbeing: first, variation and independence in undertaking activities; second, having a choice between the occupations and a structure of activities that make up daily life. The two factors are influenced by a balance between having activities alone and with others. This review is not intended to identify specific occupations that enhance elderly people's wellbeing, but rather to indicate which types of occupations enhance the wellbeing of the elderly, and provide value and meaning to their daily lives.Both the dependability and the credibility of the studies have been rated as moderate.

Scoping review: occupational therapy interventions in primary care

This is the second article in a series of two about occupational therapy and primary care. The first article (see PH&RD….) described the position of the profession in primary care across Europe and the scope of the profession. In this article the broad scope of the profession is illustrated with various examples of occupational therapy interventions. The interventions are identified by means of a literature search. A questionnaire (the questionnaire is available by mailing the author) was sent out to experts across Europe which resulted in both relevant literature and evidence-based examples. The evidence level of these examples differs from expert opinion (5), case series (4), case-controlled studies (3), cohort studies (2) and randomized-control trial (1). The article ends with recommendations in four areas how to develop, establish or strengthen the profession in primary care.

Older women's engagement in community occupations: Considerations of lifespan and place

Background: To reach the promise of age-friendly communities, more complete understandings of how participation in community occupations occurs, in place and over time, is needed.Aim: To explore older Canadian women's engagement in community occupations as it occurs over the lifespan and in context.Materials and methods: Data from three selected participants were drawn from an exploration of older adults' social connectedness in neighbourhoods, which involved an ethnographic approach involving narrative interviews, go-along interviews, and activity tracking and follow-up interviews. A transactional lens oriented analysis, considering occupation in place, over time. Analysis involved identifying key storylines and themes and drew on conceptualizations of transition and continuity.Results: The participants' stories revolved around two themes: continuity within leisure over time and social engagement as a work in progress. The participants demonstrated differing patterns of achieving continuity within leisure and worked to maintain social engagement in the face of continually evolving social networks.Conclusions and significance: Findings enhance understandings of transition, continuity and the transactions between person and place that shape leisure and social engagement over time. Occupational therapists can consider community occupations from a transactional lens within services and policy to better support older women's participation and inclusion in neighbourhoods.

Working mechanisms of dyadic, psychosocial, activating interventions for people with dementia and informal caregivers: a qualitative study

Background

People living with dementia (PWD) and their informal caregivers often report difficulties in maintaining their usual activities. Several dyadic, psychosocial, activating interventions were developed to create insight into how to cope with limitations in a practical way and to increase skills for maintaining personal activities. Effects of these interventions varied so far. More knowledge on the working mechanisms of activating interventions might help to increase their impact. This study will provide more insights into the working mechanisms of three dyadic, psychosocial, activating interventions as the participating PWD, caregivers, and coaches perceived them during the interventions.

Participants and methods

We used a qualitative design with semi-structured interviews of 34 dyads that included 27 PWD, 34 caregivers, and 19 coaches. The data were analyzed with the constant comparative method.

Results

Many PWD and caregivers found capacity-building approaches beneficial. We identified “empowerment” as the core theme. Three working mechanisms explained why the interventions were perceived as having a beneficial impact: 1) enabling activities without providing false hope; 2) exploring the most important personal activity needs of the PWD and caregivers; and 3) a solution-focused approach to adapt, test, and practice activities. An individualized approach contributed to positive change.

Conclusion

For the overarching working mechanism empowerment, expertise in the field of dementia and psychological skills of coaches seem to be important. Assessing the needs, capacities, and limitations of both the PWD and the caregivers to take part in activities seems to be key, as well as the communication about it and the skills to teach a solution-focused approach. Studies on the impact of psychosocial and activating interventions might benefit from considering outcome measures directed at empowerment, along with aspects such as hope and belief in one’s own capacities versus traditional outcome measures as mood, burden, or quality of life.

Association between cognitive function and life-space mobility in older adults: results from the FRéLE longitudinal study

BACKGROUND

Cross-sectional and longitudinal studies show conflicting results regarding the association between cognition and life-space mobility, and little is known regarding the mediators and moderators of the association. The aim of this study was to investigate the association between cognition and life-space mobility in older adults, as well as the intervening variables modifying the relationship.

METHODS

Community-dwelling older adults aged 65 years and older (N = 1643) were assessed at three time points over a period of 2 years. Growth mixture models with mediation and moderation analysis were utilised to investigate association between cognitive function and life-space mobility. The potential mediators and moderators were depressive symptoms, locus of control, gait speed and grip strength. Analysis was controlled for age, sex, education, annual income, number of chronic illnesses, and living site.

RESULTS

The direct association between initial scores of cognitive function and life-space was mediated by initial scores of depressive symptoms and gait speed, and moderated by initial scores of grip strength. No direct association between change in cognitive function and change in life-space mobility was found; the scores were mediated by change in depressive symptoms.

CONCLUSIONS

We conclude that the relationship between change in cognitive function and life-space mobility in older adults is not well-defined over an observation period of 2 years.

Opportunities for Occupational Therapy to Serve as a Catalyst for Culture Change in Nursing Facilities

Ensuring that older adults are receiving quality and effective rehabilitation and skilled nursing services must be a priority to society and to the health care system, but health care policies and systems driving reimbursement continue to challenge the delivery of services. A review of the literature indicates significant problems among residents of skilled nursing facilities (SNFs) that could be alleviated by meaningful occupational therapy. Research and practice in the occupational therapy community should focus on this large area of practice. Advocacy by individual practitioners-challenging themselves and others to provide more patient-centered care-can lead to changes that benefit clients, facilities, and payment systems as well as contribute to career satisfaction of occupational therapy practitioners. Occupational therapy can and should serve as catalyst for culture change in SNFs by providing meaningful interventions and opportunities that support engagement and health.

Occupational therapy practice and patient/client participation in religious occupations: a scoping review protocol

REVIEW OBJECTIVE

The objective of this scoping review is to identify and map information on how occupational therapists address their clients' perceived and experienced barriers to participation in religious occupations as part of the occupational therapy intervention.Specifically the review questions are.

The relationship between time spent in volunteering activities and quality of life in adults over the age of 50 years: A systematic review

Introduction

Increased attention has focused on the importance of time spent by ageing adults in volunteering. The aim of this systematic review was to analyse literature exploring the relationship between time spent volunteering and quality of life for adults over the age of 50 years.

Method

Electronic searches of nine databases located relevant articles involving adults over the age of 50 in volunteering activities that included psychological, physical and social quality of life domains. The quality of the selected articles was assessed and data extracted using preferred reporting items for systematic reviews and meta-analyses.

Results

Of the 65 articles retrieved, 22 were reviewed and eight included in the final review. Studies included one randomised controlled trial, one cross-sectional and six longitudinal studies. Levels of time spent volunteering by participants within the studies varied considerably. Articles retrieved reported positive quality of life outcomes including increases in life satisfaction, self-esteem and social support and a slowed functional decline.

Conclusion

Volunteering is identified as an important occupation for adults over the age of 50, although the relationship between time spent volunteering and the impact on quality of life outcomes is still not fully understood. Future research is required to better understand the impact of time spent volunteering on quality of life.

Burden and Quality of Life of Family Caregivers of Stroke Patients

The purpose of this study was to identify the level of burden and quality of life of family caregivers of stroke patients and to investigate the correlation between burden, quality of life (including physical, social, psychological, and environmental domains), age of caregivers, and the care period. A descriptive correlational cross-sectional study was performed, with a convenience sample of family caregivers (n = 30) of stroke patients in São Paulo, Brazil. Data were collected using a questionnaire on participants' characteristics, the Zarit Burden Interview Scale (ZBIS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument. A descriptive analysis was performed, and correlations between variables were analyzed using Pearson's product-moment correlation coefficient. The average burden score on the ZBIS was 29.6, representing a moderate burden, and the average overall quality of life score on the WHOQOL-BREF was 62.06%, which indicates moderate quality of life. A significant weak negative correlation was observed between burden and environmental domains (r = -0.470; p =.009), quality of life (r = -0.414; p =.023), and physical domains (r = -0.394; p =.031). No significant correlations were found between burden and quality of life, and variables in the psychological and social domains, age of caregivers, or care period. Caregivers for stroke patients presented with moderate levels of burden and reduction in quality of life. Levels of burden correlated negatively with environmental domains, quality of life levels, and physical domains; however, these correlations were weak, indicating the possible interference of other factors.

Teaching a Person with Memory Impairment Smartphone Use for Emergencies during Outdoors Walking: Case Report

Safety issues arise during the performance of activities as dementia advances. Occupational therapists collaborate with dementia clients and their caregivers to find solutions and strategies to prolong safe activity participation. Additionally, occupational therapists teach through demonstration showing engagement in specific activities may no longer be safe. We present the case of a 70-year-old male with mild dementia. His caregiver believes he needs to use a smartphone for safety during outdoors walking; the client's enjoyed and valued occupation. This case report illustrates smartphone use may be difficult to learn for a person with mild dementia. It highlights the need for the caregiver and person with dementia to receive education together for best understanding. New technologies for community mobility such as outdoors walking are considered.