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Kaneko F, Ueno K, Hirasawa R, Saita K, Okamura H. The effects of life review-based collage book making on psychosocial functioning and discrepancy between patients' and hospital staff's perception of daily functioning in long-term hospitalized patients with schizophrenia: A randomized controlled trial. Arch Psychiatr Nurs 2024; 51:183-193. [PMID: 39034077 DOI: 10.1016/j.apnu.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 02/27/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
The purpose of this study was to investigate the psychosocial effects of life review-based collage book making on long-term inpatients with schizophrenia, and to verify the effectiveness of this program in reducing the discrepancy between self-perception and others' evaluation of patients' day-to-day functioning. Participants were randomly assigned to intervention or control group. The intervention group participated in an individual program of life review-based collage book making. At three evaluation points (pre-and post-intervention and at 3-month follow-up) the patients rated their subjective difficulties, and the staff rated the objective severity of the patient's day-to-day functioning, using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J). The Profile of Mood Status-Brief Form (POMS), Recovery Assessment Scale, and Life Skills Profile were used to assess psychosocial functioning, and the changes in scores on the scales were compared between the two groups. In addition, for those with large discrepancy between patient and staff rating scores on the SCoRS-J at baseline, the change in the discrepancy scores were compared between the two groups. As a result, there was a significant group main effect and interaction between the two groups in the changes in the Confusion subscale scores of the POMS, indicating an alleviation of confusion in this program. In addition, for those with large discrepancy scores on the SCoRS-J, there was a significant group main effect and interaction between the two groups in discrepancy scores, indicating that this program can contribute to the reduction of discrepancies in the perceptions, and to the collaborative approach to treatment.
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Affiliation(s)
- Fumiko Kaneko
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kazumi Ueno
- Department of Nursing Faculty of Human Health Sciences, Shunan University, 843-4-2, Gakuendai, Shunan City, Yamaguchi 745-8566, Japan
| | - Rei Hirasawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, 555-36, Kurose-gakuendai, Higashihiroshima, Hiroshima 739-2695, Japan
| | - Kazuya Saita
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hitoshi Okamura
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Sum RKW, Yang Y, Choi SM, Duncan MJ, Li M. Physical literacy-based intervention for older adults: a cluster randomized controlled trial study protocol. Front Sports Act Living 2024; 6:1392270. [PMID: 39086857 PMCID: PMC11288796 DOI: 10.3389/fspor.2024.1392270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
The ageing population creates concerns and challenges worldwide. The large number of older adults (aged over 65) in Hong Kong continues to rise as people live longer. This may result in heavy burdens on public services and problems such as a shortage of medical resources. The purpose of this study is to implement a physical literacy-based intervention among older adults in Hong Kong in order to achieve the goal of health promotion. A two-arm cluster randomized controlled trial will be employed in this proposed study. Ten daycare centers for the older adults in Hong Kong will be invited to participate in this study. The intervention group will receive functional fitness training and mastering physical literacy class twice a week with buddy peer support, and they will be asked to keep a reflective writing journal on a daily basis for 12 weeks in total. Participants will be evaluated at baseline (week 0), post-intervention (week 12), and at 6-week follow-up (week 18). This will consist of objective and self-reported measures covering elements within physical literacy (i.e., physical competence, motivation and confidence, knowledge and understanding) and also physical activity levels on an individual basis. The study intends to introduce a conceptual framework of physical literacy for the older adults through an intervention that allows older people to develop daily behaviour habits, which should promote active ageing for the older adults and greater self-esteem in later life. After this study, participants may share their positive experiences, and encourage their peers in the community to become physically literate in the future. In the long run, due to the feasibility and sustainability of these potential programs, this proposed study has the potential to connect seniors through social engagement and contribute to healthy living. Clinical trial approval from the National Library of Medicine (Reference number: NCT06137859).
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Affiliation(s)
- Raymond Kim Wai Sum
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yijian Yang
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Siu Ming Choi
- Faculty of Education, University of Macau, Taipa, Macao, Macao SAR, China
| | - Michael J. Duncan
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Minghui Li
- Faculty of Physical Education, Ningbo University, Ningbo, China
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Porras-Segovia A, Escobedo-Aedo PJ, Carrillo de Albornoz CM, Guerrero-Jiménez M, Lis L, Molina-Madueño R, Gutiérrez-Rojas L, Alacreu-Crespo A. Writing to Keep on Living: A Systematic Review and Meta-Analysis on Creative Writing Therapy for the Management of Depression and Suicidal Ideation. Curr Psychiatry Rep 2024; 26:359-378. [PMID: 38717657 DOI: 10.1007/s11920-024-01511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review and meta-analysis was to explore the effectiveness of creative writing therapies for the management of depression and suicidal ideation. RECENT FINDINGS Twenty one of the 31 reviewed studies showed that creative writing significantly improved depressive symptoms, while five studies suggested improvement in other symptoms. The results of meta-analyses showed that narrative writing significantly reduced depression compared to those in neutral writing or treatment as usual condition in both post intervention and follow-up. However, the number of studies exploring the effects of creative writing in suicidal ideation was too low to perform a meta-analysis. A structured and well-targeted intervention using creative writing could have beneficial results for the management of depressive symptoms. More studies are needed to explore the potential benefits of creative writing for reducing suicidal ideation.
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Affiliation(s)
- Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.
- Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Madrid, Spain.
| | | | - Carmen Maura Carrillo de Albornoz
- Department of Psychiatry, Virgen de las Nieves University Hospital, Granada, Spain
- Department of Psychiatry, University of Granada, Granada, Spain
| | | | - Laura Lis
- School of Psychology, University of Villanueva, Madrid, Spain
| | - Rosa Molina-Madueño
- Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Luis Gutiérrez-Rojas
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Department of Psychiatry, San Cecilio University Hospital, Granada, Spain
- Department of Psychiatry, University of Granada, Granada, Spain
| | - Adrián Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, Universidad of Zaragoza, Teruel, Spain
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Charise A, Pang C, Khalfan KA. What is Intergenerational Storytelling? Defining the Critical Issues for Aging Research in the Humanities. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:615-637. [PMID: 35462580 PMCID: PMC9759502 DOI: 10.1007/s10912-022-09735-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Intergenerational storytelling (IGS) has recently emerged as an arts- and humanities-focused approach to aging research. Despite growing appeal and applications, however, IGS methods, practices, and foundational concepts remain indistinct. In response to such heterogeneity, our objective was to comprehensively describe the state of IGS in aging research and assess the critical (e.g., conceptual, ethical, and social justice) issues raised by its current practice. Six databases (PsycINFO, MEDLINE, PubMed, Scopus, AgeLine, and Sociological Abstracts) were searched using search terms relating to age, intergenerational, story, and storytelling. Peer-reviewed, English-language studies conducted with participants residing in non-clinical settings were included. One thousand one hundred six (1106) studies were initially retrieved; 70 underwent full review, and 26 fulfilled all inclusion criteria. Most studies characterized IGS as a practice involving older adults (> 50 years old) and conventionally-aged postsecondary/college students (17-19 years old). Typical methodologies included oral and, in more recent literature, digital storytelling. Critical issues included inconsistently reported participant data, vast variations in study design and methods, undefined key concepts, including younger vs. older cohorts, generation, storytelling, and whether IGS comprised an intentional research method or a retrospective outcome. While IGS holds promise as an emerging field of arts- and humanities-based aging research, current limitations include a lack of shared data profiles and comparable study designs, limited cross-cultural representation, and insufficiently intersectional analysis of widespread IGS practices. To encourage more robust standards for future study design, data collection, and researcher reflexivity, we propose seven evidence-based recommendations for evolving IGS as a humanities-based approach to research in aging and intergenerational relations.
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Affiliation(s)
- Andrea Charise
- Department of Health & Society, University of Toronto Scarborough, 1265 Military Trail, c/o Highland Hall Rm. 220, Toronto, ON, M1C 1A4, Canada.
- Graduate Department of English, University of Toronto, Toronto, Canada.
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada.
- The Health Humanities Learning Lab, University of Toronto, Toronto, Canada.
| | - Celeste Pang
- The Health Humanities Learning Lab, University of Toronto, Toronto, Canada
- Research Department, Egale Canada, Toronto, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Canada
| | - Kaamil Ali Khalfan
- The Health Humanities Learning Lab, University of Toronto, Toronto, Canada
- Faculty of Law and Odette School of Business, University of Windsor, Windsor, Canada
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Lee BO, Yao CT, Ramoo V. An Evaluation of Improving Psychosocial Life Satisfaction among Older Adults in Taiwan Day Care Centers Using Life Review Work. J Appl Gerontol 2022; 42:842-851. [PMID: 36437798 DOI: 10.1177/07334648221141408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study examined the effects of life review therapy on the life satisfaction levels of older adults in day care centers in Taiwan. A quasi-experimental design was adopted. A total of 88 adults aged 65 and older were recruited from day care centers through convenience sampling and assigned to two groups based on their level of life satisfaction on Life Satisfaction Index A. The intervention groups participated in a life review therapy for eight weeks in addition to their daily activities. Data were collected at the baseline point and immediately after post-intervention. Generalized estimating equations were used to examine the effect of the intervention on the outcomes. At week eight, the intervention group showed a significantly higher level of life satisfaction than the comparison group. These findings suggest that life review programs may improve general life satisfaction among older adults.
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Affiliation(s)
- Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Taiwan
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Ching-Teng Yao
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Taiwan
- Center for Innovative Research on Aging Society, National Chung Cheng University, Taiwan
| | - Vimala Ramoo
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Factors Associated With Participation in Physical Leisure Activities in Taiwanese Community-Dwelling Older Adults. J Aging Phys Act 2022; 31:430-439. [DOI: 10.1123/japa.2022-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/23/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
This study was to identify factors at the intrapersonal, interpersonal, and community levels that relate to physical leisure participation in Taiwanese community-dwelling older adults and to examine their relative importance. We used a cross-sectional study with purposive sampling (N = 160). Physical leisure participation was quantified as the variety, frequency, and duration of participation. Data were analyzed using a series of hierarchical multiple linear regressions. The results showed that higher variety, frequency, or duration of physical leisure participation was associated with older males and with those who reported having better health, fewer depressive symptoms, and greater social support. Intrapersonal- and interpersonal-level factors play a relatively more important role in predicting physical leisure participation than factors at the community level. Understanding factors that relate to these three levels of participation has the potential to inform interventions that are tailored to individual profiles.
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Pisegna J, Anderson S, Krok-Schoen JL. Occupational Therapy Interventions to Address Depressive and Anxiety Symptoms in the Physical Disability Inpatient Rehabilitation Setting: A Systematic Review. Am J Occup Ther 2022; 76:23166. [PMID: 35037944 DOI: 10.5014/ajot.2022.049068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Depressive and anxiety symptoms across physical disability inpatient rehabilitation (IPR) patient groups are well documented and negatively affect functional recovery. The strategies within the occupational therapy scope of practice to address these symptoms in IPR are unclear. OBJECTIVE To determine what interventions within the occupational therapy scope of practice have been used to address depressive and anxiety symptoms in IPR and to determine intervention efficacy. DATA SOURCES Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus. FINDINGS Five of 8,082 articles met inclusion criteria. Diagnoses included stroke (n = 1), traumatic brain injury (n = 1), spinal cord injury (n = 1), and musculoskeletal conditions (n = 2). Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy. CONCLUSIONS AND RELEVANCE Limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning. What This Article Adds: This systematic review provides an evaluation of the evidence within the occupational therapy scope of practice to address depressive and anxiety symptoms within the physical disability IPR setting. This research can support occupational therapy practitioners to comprehensively address physical and mental health for participation in IPR.
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Affiliation(s)
- Janell Pisegna
- Janell Pisegna, MOT, OTR/L, CSRS, is PhD Candidate, Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus
| | - Sarah Anderson
- Sarah Anderson, OTD, OTR/L, is PhD Candidate, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus
| | - Jessica L Krok-Schoen
- Jessica L. Krok-Schoen, PhD, is Assistant Professor, Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, and Comprehensive Cancer Center, The Ohio State University, Columbus;
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Johnson JK, Carpenter T, Goodhart N, Stewart AL, du Plessis L, Coaston A, Clark K, Lazar A, Chapline J. Exploring the effects of visual and literary arts interventions on psychosocial well-being of diverse older adults: a mixed methods pilot study. Arts Health 2021; 13:263-277. [PMID: 32744951 PMCID: PMC7856091 DOI: 10.1080/17533015.2020.1802603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Engagement in the arts may have health benefits for older adults. Most research has focused on music and dance; less is known about the benefits of other arts interventions. The purpose of this study was to examine the effects of visual (ceramics and collage) and literary arts (storytelling and writing) on well-being. METHODS We used mixed methods to examine the effects of a 12-week visual or literary arts intervention on well-being. Adults age 55 and over from four housing sites were assigned to start an intervention immediately (intervention) or wait 12 weeks (controls). The study included pre/post-test measures of well-being and focus groups about perceived benefits. RESULTS Compared to controls, participants in the ceramics intervention had significant improvements in interest in life and mastery, while no changes were observed after the storytelling intervention. Seven psychosocial benefits were identified . CONCLUSIONS Participation in visual and literary arts for older adults was associated with well-being media.
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Affiliation(s)
- Julene K Johnson
- Institute for Health & Aging, University of California, San Francisco, CA
- Center for Aging in Diverse Communities, University of California, San Francisco, CA
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Anita L Stewart
- Institute for Health & Aging, University of California, San Francisco, CA
- Center for Aging in Diverse Communities, University of California, San Francisco, CA
| | - Lindsay du Plessis
- Institute for Health & Aging, University of California, San Francisco, CA
| | - Angela Coaston
- School of Nursing, University of California, San Francisco, CA
| | - Kristen Clark
- School of Nursing, University of California, San Francisco, CA
| | - Ann Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
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Schelly D, Ohl A, Moronta Y, Nadres R, Snyder E. Comparing life review writing with active control groups: Results of a feasibility study. Aust Occup Ther J 2020; 67:528-536. [PMID: 32820551 DOI: 10.1111/1440-1630.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Life review writing can be used to improve depressive symptoms in well older adults, but it is unclear whether the reminiscing, writing, or socialising is associated with the improvements. This study assessed the feasibility of a controlled trial comparing life review writing with two active control groups designed to isolate the acts of (a) engaging in a meaningful leisure activity and (b) socialising. METHODS Twenty-four participants from a 100-bed assisted living facility were enrolled in the study. Participants ranged in age from 70 to 98 years (M = 83.9, SD = 7.6). Eight 1-hour weekly sessions were held, with participants assigned to one of three groups: (a) life review writing, (b) painting, or (c) coffee from around the world. At baseline, participants completed a demographic and health questionnaire, the Mini-Cog, and the Geriatric Depression Scale Short Form (GDS-15). The GDS-15 was administered again at weeks 4 and 8, along with the health questionnaire at post-test. RESULTS Nearly 25% (N = 24) of the facility's residents attended at least one session, with an average attendance rate of 66.4%, or 5.3 sessions. However, to achieve this participation rate, our original plan to employ random assignment had to be abandoned. The groups were a partial success insofar as we successfully isolated engaging in a meaningful activity in the painting group, but the writing group engaged in less reminiscing than hoped. At post-test, seven participants reported health, mood, and social life benefits. GDS-15 scores fluctuated over time, with no significant improvement from pre- to post-test. CONCLUSION The residents' low willingness to be randomised creates a serious selection bias, but randomising volunteers into different activities runs counter to client-centred therapy. To scrutinise the mechanisms of change of life review writing, we recommend comparing two writing groups: one that reminisces and one that does not.
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Affiliation(s)
- David Schelly
- Occupational Therapy Department, Clarkson University, Potsdam, NY, USA
| | - Alisha Ohl
- Occupational Therapy Department, Clarkson University, Potsdam, NY, USA
| | - Yessica Moronta
- Occupational Therapy Department, Clarkson University, Potsdam, NY, USA
| | - Ramona Nadres
- Occupational Therapy Department, Clarkson University, Potsdam, NY, USA
| | - Eric Snyder
- Occupational Therapy Department, Clarkson University, Potsdam, NY, USA
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Dancewicz EA, Bissett M. Occupational Therapy Interventions and Outcomes Measured in Residential Care: A Scoping Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2020. [DOI: 10.1080/02703181.2020.1719272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Esther April Dancewicz
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Michelle Bissett
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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Hanaoka H, Muraki T, Okamura H. Study of aromas as reminiscence triggers in community-dwelling older adults in Japan. J Rural Med 2019; 14:87-94. [PMID: 31191771 PMCID: PMC6545421 DOI: 10.2185/jrm.2982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022] Open
Abstract
Objective: This study investigates the presence or absence of reminiscence experiences in older adults when using aromas. Focusing on 40 scents familiar to Japanese people, our objective was to determine points of caution for aroma selection and use in reminiscence therapy. Materials and Methods: The participants were 118 community-dwelling older adults aged 65 years and older. They were asked about the experience of recalling the past in response to stimuli of 40 aromas on the Japanese version of the University of Pennsylvania Smell Identification Test (UPSIT-J). In addition, an olfactory visual analog scale (VAS) was used to evaluate olfactory function. Furthermore, a questionnaire-based survey was administered instead of asking participants to actually smell the odorants in the UPSIT-J. Results: At least 70% of the participants experienced recalling the past triggered by 16 aromas including sandalwood and yuzu fruit. Furthermore, 15 of the scents demonstrated a significant association with age, gender, and olfactory function. Conclusion: These results suggest the importance of considering method, age, and gender when selecting olfactory stimuli. In addition, frequently recalled aromas might evoke reminiscence in older adults.
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Affiliation(s)
- Hideaki Hanaoka
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | | | - Hitoshi Okamura
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
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12
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Sagari A, Ikio Y, Imamura N, Deguchi K, Sakai T, Tabira T, Higashi T. Effect of occupation-based interventions in patients with haematopoietic malignancies undergoing chemotherapy: A pilot randomised controlled trial. Hong Kong J Occup Ther 2018; 31:97-105. [PMID: 30643497 PMCID: PMC6322108 DOI: 10.1177/1569186118818680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 11/20/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/OBJECTIVE Chemotherapy for cancer negatively affects activities of daily living and quality of life. This study aimed to validate and compare the efficacy of two different interventions in patients with haematopoietic malignancies undergoing chemotherapy: (1) occupation-based interventions, designed using the Aid for Decision-making in Occupation Choice (ADOC) (an iPAD application) and (2) impairment-based interventions. ADOC helps promote decision-making during activities and participation in occupation-based goal setting. The impairment-based intervention group served as the comparison group and underwent impairment-based interventions focusing on dysfunction. METHODS In this single-blinded pilot randomised controlled trial, 19 participants received an occupation-based intervention (n = 9) or an impairment-based intervention (n = 10). The treatment period comprised two sessions. Recruitment, compliance and outcome completion rates were calculated for the study. Effect sizes were examined for outcomes regarding physical performance, instrumental activities of daily living and quality of life as evaluated by a blinded assessor. RESULTS In this study, 24.8% (28/113) of the eligible patients with haematopoietic malignancies were enrolled, and 67.9% (19/28) of these were retained up to the post-assessment stage. Recruitment (25%) and compliance (68%) rates were satisfactory. The Functional Assessment of Cancer Therapy-General emotional well-being and total scores were significantly higher for the occupation-based intervention group than for the impairment-based intervention group (both p < 0.05; d = 0.54, d = 0.51, respectively). Other outcomes showed no significant differences. CONCLUSION Occupation-based interventions designed using the ADOC application were useful for patients with haematopoietic malignancies.
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Affiliation(s)
| | - Yuta Ikio
- The Japanese Red Cross Society Nagasaki Genbaku Hospital, Japan
| | | | - Kayoko Deguchi
- The Japanese Red Cross Society Nagasaki Genbaku Hospital, Japan
| | - Toko Sakai
- The Japanese Red Cross Society Nagasaki Genbaku Hospital, Japan
| | | | - Toshio Higashi
- Nagasaki University Graduate School of Biomedical Sciences, Japan
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Robinson JT, Murphy-Nugen AB. It makes you keep trying: Life review writing for older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:171-192. [PMID: 29336698 DOI: 10.1080/01634372.2018.1427645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Life review writing produces numerous psychosocial benefits for older adults, who are at risk for isolation and depression. This article shares findings from a study that examined the experiences of older adults participating in a life review writing group. The impact of gender composition on the group dynamic was also explored. Using interpretative phenomenological analysis, this study explored the experiences of six women and one man who participated in a life review writing group. Six unifying themes emerged from the research findings: (1) legacy, (2) connecting with others, (3) reflection, (4) vitality, (5) structure of the group, and (6) gender dynamics. Implications for theory, practice, and research are discussed.
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Affiliation(s)
| | - Amy B Murphy-Nugen
- b Department of Social Work , Western Carolina University , Cullowhee, North Carolina , USA
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14
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Gutman SA, Brown T. A Bibliometric Analysis of the Quantitative Mental Health Literature in Occupational Therapy. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/0164212x.2017.1413479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sharon A. Gutman
- Professor, Rehabilitation and Regenerative Medicine, Columbia University Medical Center, Programs in Occupational Therapy, New York, NY
| | - Ted Brown
- Associate Professor, Faculty of Medicine, Nursing, and Health Sciences, Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University – Peninsula Campus, Frankston, VIC, Australia
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15
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Lan X, Xiao H, Chen Y. Effects of life review interventions on psychosocial outcomes among older adults: A systematic review and meta-analysis. Geriatr Gerontol Int 2017; 17:1344-1357. [PMID: 28124828 DOI: 10.1111/ggi.12947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 07/10/2016] [Accepted: 09/20/2016] [Indexed: 12/01/2022]
Abstract
AIM The present study aimed to evaluate the effects of life review interventions on psychosocial outcomes among older adults. METHODS We searched PubMed, Ovid, CINHAL, Cochrane library, PsycINFO, Springer Link, Oxford Journals Collection, FRMS, CBM, VIP, CNKI, and Wanfang to identify randomized controlled trials and controlled clinical trials that evaluate the effects of life review among older adults. The quality of studies included was evaluated and the relevant information was extracted. Then, a meta-analysis was carried out with RevMan software. RESULTS We identified 15 studies that met the inclusion criteria, and 11 studies were allowed for meta-analysis. The combined results of the meta-analysis showed that life review significantly reduced depression (standardized mean difference 0.57, 95% CI 0.73 to -0.42) and hopelessness (mean difference [MD] 4.01, 95% CI 6.13 to -1.89). There was a significant improvement in well-being (standardized mean difference 0.54, 95% CI 0.01-1.06) and specific memory (MD 1.05, 95% CI 0.07-2.03). However, other study findings did not support its effect in life satisfaction (MD 2.15, 95% CI 0.69- 5.00), self-esteem (MD 0.21, 95% CI 2.09-2.50), the quality of life (standardized mean difference 0.15, 95% CI 0.96-0.66), extended memory (MD 0.03, 95% CI 0.61-0.55), categorical memory (MD 0.48, 95% CI 1.08- 0.12) and no recall (MD 0.30, 95% CI 1.12- 0.52). CONCLUSIONS Life review is a worthwhile intervention for reducing depression and hopelessness, and improving quality of life, well-being and specific memory in older adults. More well-designed trials with a large sample and long-term follow up are necessary to confirm the effects of life review on other psychosocial outcomes. Geriatr Gerontol Int 2017; 17: 1344-1357.
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Affiliation(s)
- Xiuyan Lan
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Ying Chen
- School of Nursing, Fujian Medical University, Fuzhou, China
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Wren R. Effect of Life Review on Quality of Life For Older Adults Living in Nursing Homes. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2016.1268236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rene' Wren
- School of Occupational Therapy, Texas Woman's University, Dallas, Texas, USA
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Chen Y, Xiao H, Yang Y, Lan X. The effects of life review on psycho-spiritual well-being among patients with life-threatening illness: a systematic review and meta-analysis. J Adv Nurs 2016; 73:1539-1554. [DOI: 10.1111/jan.13208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ying Chen
- School of Nursing; Fujian Medical University; Fuzhou China
| | - Huimin Xiao
- School of Nursing; Fujian Medical University; Fuzhou China
| | - Yanqing Yang
- School of Nursing; Fujian Medical University; Fuzhou China
| | - Xiuyan Lan
- School of Nursing; Fujian Medical University; Fuzhou China
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Chen SW, Chippendale T. Factors associated with IADL independence: implications for OT practice. Scand J Occup Ther 2016; 24:109-115. [PMID: 27347768 DOI: 10.1080/11038128.2016.1194464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Globally, the population is aging. Instrumental activities of daily living (IADL) are an important component of independent function and impact the ability of older adults to age in place. Therefore, factors associated with IADL independence warrant further study. OBJECTIVE To explore the association of age, depressive symptoms and leisure participation with IADL independence, and the relative importance of these three factors in predicting IADL independence. METHODS A cross-sectional design using an existing data set was employed. Older adults age 60 and older (n = 98) who resided in senior housing or their own home/apartment were included in the study. A hierarchical multiple regression analysis was employed. RESULTS The second model predicting IADL independence using age, depressive symptoms and level of leisure participation was significant (F(3,96) = 15.57, p < 0.001) and explained 31.00% of the variance in IADL independence compared to the first regression model, which included age alone (R2 adjusted = 18.00%). Age was the strongest of the three predictors, accounting for 11.40% of the variance in IADL independence. Depressive symptoms and participation in leisure activities were also significant predictors, their unique contributions being 7.30 and 4.30%, respectively. CONCLUSION AND SIGNIFICANCE Age, depressive symptoms and leisure participation are all significant predictors of IADL independence among older adults. Therefore, according to our preliminary findings, leisure participation and non-pharmacological interventions for depressive symptoms warrant attention in practice in relation to IADL independence.
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Affiliation(s)
- Szu-Wei Chen
- a Department of Occupational Therapy , New York University , New York , NY , USA
| | - Tracy Chippendale
- a Department of Occupational Therapy , New York University , New York , NY , USA
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Chippendale T, Boltz M. Living Legends: Effectiveness of a Program to Enhance Sense of Purpose and Meaning in Life Among Community-Dwelling Older Adults. Am J Occup Ther 2015; 69:6904270010p1-11. [DOI: 10.5014/ajot.2015.014894] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Living Legends program, which includes life review writing and an intergenerational exchange, compared with life review writing alone, for community-dwelling older adults.
METHOD. This study was a randomized controlled trial with a connected qualitative component. We analyzed quantitative data using independent-samples t tests and written descriptions of program experiences using Collaizi’s qualitative methodology; we then used a triangulation protocol to integrate the qualitative and quantitative data.
RESULTS. For participants in the writing workshop plus intergenerational exchange, sense of purpose and meaning in life increased significantly (p < .0001) compared with those in the writing workshop alone. Qualitative themes revealed additional program benefits.
CONCLUSION. Living Legends enhanced participants’ sense of purpose and meaning in life, a factor known to prevent cognitive loss and disability, compared with life review writing alone.
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Affiliation(s)
- Tracy Chippendale
- Tracy Chippendale, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York;
| | - Marie Boltz
- Marie Boltz, PhD, RN, GNP-BC, is Associate Professor, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA
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Abstract
AbstractObjective:Many patients approaching death experience hopelessness, helplessness, and a depressed mood, and these factors can contribute to a difficult end-of-life (EoL) period. Biography services may assist patients in finding meaning and purpose at this time. The aim of our study was to investigate the lived experience of volunteers involved in a biography service in Melbourne, Australia, using a qualitative methodology.Method:The participants were 10 volunteers who had participated in a biography service within a private palliative care service. Each volunteer was interviewed separately using a study-specific semistructured interview guide. The transcripts of these interviews were then subjected to thematic analysis.Results:Analysis yielded the following themes: motivations for volunteering; dealing with death, dying, and existential issues; psychosocial benefits of volunteering; and benefits and challenges of working with patients and their families. Our results indicated that volunteering gave the volunteers a deeper appreciation of existential issues, and helped them to be more appreciative of their own lives and gain a deeper awareness of the struggles other people experience. They also suggested that volunteers felt that their involvement contributed to their own personal development, and was personally rewarding. Furthermore, the results highlighted that volunteers found that encounters with family members were sometimes challenging. While some were appreciative, others imposed time limits, became overly reliant on the volunteers, and were sometimes offended, hurt, and angered by what was included in the final biography.Significance of Results:It is hoped that the findings of the current study will provide direction for improvements in the biography services that will benefit patients, family members, and volunteers. In particular, our findings highlight the need to provide ongoing support for volunteers to assist them in handling the challenges of volunteering in a palliative care setting.
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D'Amico M. Update on productive aging research in the American Journal of Occupational Therapy, 2013, and overview of research published 2009-2013. Am J Occup Ther 2014; 68:e247-60. [PMID: 25397772 DOI: 10.5014/ajot.2014.013581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In light of the Centennial Vision charge of supporting practice through evidence, this article reviews productive aging research published in the American Journal of Occupational Therapy (AJOT) in 2013 and as a whole from 2009 to 2013. Thirteen such articles were published in 2013, consisting of 4 systematic reviews that identified effective occupational therapy interventions for older adults with low vision; 1 randomized controlled trial that examined changes in occupational therapists' mental health practices with DVD training; and 8 descriptive articles addressing instrument development, practitioner decision making, patient management of medications, and effects of task activities on pain and participation levels. From 2009 to 2013, the quantity and quality of AJOT articles on productive aging increased; 63 articles were published, including 24 effectiveness studies, 14 basic research studies, 15 articles on instrument development and testing, 1 article linking occupational engagement and health, 6 articles on professional education, and 3 articles addressing professional questions.
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Affiliation(s)
- Mariana D'Amico
- Mariana D'Amico, EdD, OTR/L, BCP, is Associate Professor, Department of Occupational Therapy, College of Allied Health Sciences and School of Graduate Studies, Georgia Regents University Augusta, 1120 15th Street, EC2330, Augusta, GA 30912-0700; ,
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Noice T, Noice H, Kramer AF. Participatory arts for older adults: a review of benefits and challenges. THE GERONTOLOGIST 2014; 54:741-53. [PMID: 24336875 PMCID: PMC4229893 DOI: 10.1093/geront/gnt138] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/10/2013] [Indexed: 11/12/2022] Open
Abstract
This article reviews the scientific literature on the enhancement of healthy aging in older adults through active participation in the arts. Methodologies and conclusions are described for studies of dance, expressive writing, music (singing and instrumental), theatre arts, and visual arts including documentation of mental/physical improvements in memory, creativity, problem solving, everyday competence, reaction time, balance/gait, and quality of life. In addition to these gains in measures of successful aging, the article also provides (in a Supplementary Appendix) some selected examples of arts engagement for remedial purposes. Finally, it offers suggestions for expanding inquiry into this underinvestigated corner of aging research.
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Affiliation(s)
- Tony Noice
- Department of Theatre, Elmhurst College, Elmhurst, Illinois.
| | - Helga Noice
- Department of Psychology, Elmhurst College, Elmhurst, Illinois
| | - Arthur F Kramer
- Department of Psychology, University of Illinois at Urbana-Champaign
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Gutman SA, Raphael-Greenfield EI. Five years of mental health research in the American Journal of Occupational Therapy, 2009-2013. Am J Occup Ther 2013; 68:e21-36. [PMID: 24367966 DOI: 10.5014/ajot.2014.010249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the past 5 years, the number of research articles on occupational therapy in mental health published in the American Journal of Occupational Therapy has steadily declined. This article identifies the strengths and limitations of this body of research and provides directions for practitioners and researchers to enhance the profession's role as a valued mental health service provider.
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Affiliation(s)
- Sharon A Gutman
- Sharon A. Gutman, PhD, OTR, FAOTA, is Associate Professor, Programs in Occupational Therapy Research, Columbia University, New York, NY 10032;
| | - Emily I Raphael-Greenfield
- Emily I. Raphael-Greenfield, EdD, OTR, is Assistant Professor, Programs in Occupational Therapy Research, Columbia University, New York, NY
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Chan MF, Leong KSP, Heng BL, Mathew BK, Khan SBAL, Lourdusamy SS, Nagapan M, Woo SF, Chee WY, Ho RCM, Taylor BJ. Reducing depression among community-dwelling older adults using life-story review: a pilot study. Geriatr Nurs 2013; 35:105-10. [PMID: 24246689 DOI: 10.1016/j.gerinurse.2013.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022]
Abstract
A life-story review can serve as an effective intervention to express one's inner feelings and provide emotional catharsis. The research aim was to examine the effects of life-story review on depression levels in community-dwelling older adults in Singapore. This pilot experimental pre-post-follow-up study was conducted from July 2012 to February 2013. Twenty-nine older Malays aged 60 and above, with mild to moderate depression, were randomly allocated to the life-story review (intervention) group (n = 15) or the non life-story review (control) group (n = 14). Depressive symptoms were measured by the Geriatric Depression Scale-15 and collected five times over eight weeks. Generalized estimating equations were used to examine the effects of the intervention on the elders' depression levels, controlled for age, gender, medication use, existence of chronic disease, and diary writing experience. Reductions in depression scores were found in the intervention group from week 1 (Mean ± SD 5.9 ± 2.3) to week 8 (1.9 ± 1.6) compared with the control group (week 1: 5.0 ± 1.3; week 8: 3.5 ± 1.5). At week 8, the intervention group showed a significantly lower level of depression than the control group (χ(2) = 14.61, p < 0.001). This study adds to prior research supporting the use of life story review in improving depression levels in cognitively intact community dwelling older adults.
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Affiliation(s)
- Moon Fai Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Katherine S P Leong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Boon Ling Heng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Blessy Koottappal Mathew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Sher Banu A L Khan
- Malay Studies, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Sumathi Sagayamary Lourdusamy
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Mina Nagapan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Sook Fan Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Wai Yan Chee
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Beverley Joan Taylor
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill, Victoria, Australia
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Spiritual needs of elderly living in residential/nursing homes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:913247. [PMID: 24027598 PMCID: PMC3763582 DOI: 10.1155/2013/913247] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/27/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022]
Abstract
While the research on spiritual needs of patients with chronic and life-threatening diseases increases, there is limited knowledge about psychosocial and spiritual needs of elderly living in residential/nursing homes. We were interested in which needs were of relevance at all, and how these needs are related to life satisfaction and mood states. For that purpose we enrolled 100 elderly living in residential/nursing homes (mean age 84 ± 7 years, 82% women) and provided standardized questionnaires, that is, Spiritual Needs Questionnaire (SpNQ), Brief Multidimensional Life Satisfaction Scale (BMLSS), Quality of Life in Elders with Multimorbidity (FLQM) questionnaire, and a mood states scale (ASTS). Religious needs and Existential needs were of low relevance, while inner peace needs were of some and needs for giving/generativity of highest relevance. Regression analyses revealed that the specific needs were predicted best by religious trust and mood states, particularly tiredness. However, life satisfaction and quality of life were not among the significant predictors. Most had the intention to connect with those who will remember them, although they fear that there is limited interest in their concerns. It remains an open issue how these unmet needs can be adequately supported.
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D’Amico M. Update on Productive Aging Research in the American Journal of Occupational Therapy, 2012. Am J Occup Ther 2013; 67:e77-91. [DOI: 10.5014/ajot.2013.008219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
This article describes a review of articles on productive aging published in the American Journal of Occupational Therapy (AJOT) during 2012 in light of the Centennial Vision charge of supporting practice through evidence. Seventeen AJOT articles published in 2012 specifically addressed productive aging. Of 6 Level I studies, 4 were systematic reviews that identified effective occupational therapy interventions for community-dwelling older adults; 1 randomized controlled trial examined the effectiveness of writing life reviews for residents of senior residences, and 1 meta-analysis investigated the effectiveness of fall-related efficacy and engagement in activity or occupation. Two Level II studies and 2 Level III studies produced support for the effectiveness of individual and group-based occupational therapy interventions. Of 7 descriptive studies addressing a variety of areas, 4 addressed the reliability and validity of assessments. In 2012, AJOT published more and higher quality studies addressing a variety of issues related to productive aging.
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Affiliation(s)
- Mariana D’Amico
- Mariana D’Amico, EdD, OTR/L, BCP, CIMI, is Associate Professor, Department of Occupational Therapy, College of Allied Health Sciences and College of Graduate Studies, Georgia Regents University, 1120 15th Street, EC2330, Augusta, GA 30912-0700;
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