Influence of Lifestyle Redesign® on Health, Social Participation, Leisure, and Mobility of Older French-Canadians

Effect of Age-Friendly Communities Action Plan on Trajectories of Older Canadians' Depressive Symptoms Between 2018 and 2020: Multilevel Results From the Canadian Longitudinal Study on Aging

As the COVID-19 pandemic impacted mental health, this longitudinal study examined the effect of age-friendly communities (AFC) action plan on older adults' depressive symptoms. Using the CLSA, the CLSA COVID-19 Questionnaire study, survey of Canadian municipalities, and the census, the depressive symptoms trajectories were modeled with multilevel multinomial regressions. Most respondents (66.1%) had non-depressed trajectories, 28.1% experienced a moderate increase in depressive symptoms, and 5.8% had a depressed trajectory. AFC action plans did not have a protective effect on these trajectories. Being a female, greater loneliness, lower income, ≥2 chronic conditions, inferior social participation, weaker sense of belonging, COVID-19 infection, and pandemic stressors predicted a depressed trajectory. Neighborhood's deprivation had a weak protective effect on the declining trajectory. Although AFC action plans provided no benefits during the pandemic, volunteers facilitating resource access and social interactions could limit any increase in depressive symptoms.

[Importance de la nature, des opportunités d'activités, de leur accessibilité et de leur publicisation pour favoriser la santé positive, la participation sociale et l'équité en santé d'Estriens âgés]

Cette étude visait à explorer comment les composantes clés de l'environnement des communautés favorisent les résultantes de santé d'Estriens âgés, plus précisément leur santé positive, leur participation sociale et leur équité en santé. Une étude de cas multiples a été réalisée auprès de cinq communautés estriennes (cas) à l'aide de groupes de discussion focalisée (1/communauté) regroupant un total de 49 participants connaissant bien les communautés respectives, soit 47 aînés, 1 conseillère municipale et 1 technicienne en loisir. En rendant accessible et équitable la réalisation d'activités importantes pour les aînés, la nature, une offre d'activités variée, des moyens de communication efficace et les mesures favorisant l'équité avaient une influence positive sur les résultantes de santé. Des facteurs individuels tels qu'un niveau élevé de scolarité et un statut socioéconomique favorable avaient aussi une influence positive. Ces résultats permettent d'outiller les décideurs souhaitant favoriser un vieillissement actif et en santé.

The Feasibility of Make My Day-A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare

Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.

Multidimensional interventions to increase life-space mobility in older adults ranging from nursing home residents to community-dwelling: a systematic scoping review

BACKGROUND

Life-space mobility (LSM) is an important aspect of older adults' real-life mobility. Studies have shown that restricted LSM is a risk factor for many adverse outcomes such as low quality of life and mortality. Therefore, an increasing number of interventions aim to enhance LSM. However, the intervention approaches differ in terms of their type/content, duration, targeted populations, but also in terms of their outcome measures and assessment tools. Especially the latter impairs the comparability of studies with otherwise similar interventional approaches and thus also the interpretation of their results. Therefore, this systematic scoping review aims to provide an overview of the intervention components, assessment tools, and effectiveness of studies aiming to improve LSM in older adults.

METHODS

A systematic literature search was carried out in PubMed and Web of Science. We considered studies in older adults of any design that included an intervention approach and at least one outcome of LSM.

RESULTS

27 studies were included in the review. These studies analyzed healthy community-dwelling as well as frail older adults in need of care or rehabilitation and nursing home residents with a mean age between 64 and 89. The percentage of female participants ranged from 3 to 100%. The types of interventions were of the following: physical, counseling, multidimensional, miscellaneous. Multidimensional interventions consisting of physical interventions plus any of the following or a combination of counseling/education/motivation/information appear to be most effective in increasing LSM. Older adults with mobility impairments were more responsive to these multidimensional interventions compared to healthy older adults. Most of the studies used the questionnaire-based Life-Space Assessment to quantify LSM.

CONCLUSIONS

This systematic scoping review provides a comprehensive overview of a heterogenous stock of literature investigating LSM-related interventions in older adults. Future meta-analyses are needed to provide a quantitative evaluation of the effectiveness of LSM interventions and recommendations.

Developing and validating the Taiwan version of the meaningful activity participation assessment (T-MAPA) with Rasch analysis

BACKGROUND

Meaningful activity participation has shown good predictability for healthy ageing in older adults, and their participation can be assessed using the Meaningful Activity Participation Assessment (MAPA). However, the MAPA has never been validated in any Taiwanese population. Moreover, different cultures may interpret meaningful activity participation differently. This study thus aimed to cross-culturally adapt the MAPA into a Taiwan version (i.e., the T-MAPA) and to investigate the psychometric properties of the T-MAPA in older adults in Taiwan.

METHODS

This study consisted of 3 phases. First, the original MAPA was cross-culturally adapted in 6 stages, including forward, synthesis of, and back translations, cognitive debriefing, expert review, and pilot testing on 18 older adults. Second, a Rasch-Andrich rating scale model was applied to evaluate the psychometric properties (including category function, unidimensionality, item functioning and targeting, and reliability) of the adapted version in a sample of 146 older adults. Lastly, the convergent validity and test-retest reliability were examined on 120 and 49 older adults, respectively.

RESULTS

After cross-cultural adaptation, the first version of the T-MAPA contained 29 items. Optimal category function was obtained by reducing the response categories of the frequency subscale to 4 and retaining a 5-point rating for the meaningfulness subscale. After the removal of 1 misfit item, a 28-item T-MAPA was generated. This version demonstrated unidimensionality, measurement invariance among different subgroups (regarding sex and education), acceptable item targeting (< 1 logit) and negligible floor and ceiling effects (1.37%; 0.68%), high reliability (person reliability coefficient = 0.86; small standard error < 0.5 with large test information > 4), confirmed convergent validity (absolute r = .49-0.54 with psychological well-being, depressive symptoms, and mental and physical health), and excellent test-retest reliability (intraclass correlation coefficient = 0.94).

CONCLUSION

The cross-culturally adapted 28-item T-MAPA is suitable for application to the older population in Taiwan to measure meaningful activity participation. Future examinations of the T-MAPA in other populations with specific clinical features are warranted to extend its utility in practice.

Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app

Background

Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app.

Objective

The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme.

Methods

Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory.

Results

Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be.

Conclusions

An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.

Increasing occupational participation: A qualitative analysis within the “Occupational Self-Analysis” program

Introduction:

Occupational participation is a key element to increase the quality of life in the population. One of the effective interventions to increase occupational participation is the “Occupational Self-Analysis” program. The aim of this study was to analyze participant’s reported benefits about the “Occupational Self-Analysis” program.

Method:

This is a qualitative study with 26 participants (12 people with intellectual disability, 7 affected by acquired brain injury, and 7 students) who participated in weekly group sessions and one individual session. The outcomes were measured based on participant diaries and focus group transcriptions.

Results:

Two main themes emerged: (1) supports for occupational participation and (2) barriers for occupational participation. The thematic analysis of the categories was based on the Model of Human Occupation to increase applicability of the program in occupational therapy practice.

Conclusions:

The “Occupational Self-Analysis” program allowed participants to increase their knowledge of supports provided for and the barriers against occupational participation.

Occupational Therapy Interventions for the Improvement of the Quality of Life of Healthy Older Adults Living in Nursing Homes: A Systematic Review

Objective

To evaluate current scientific evidence on the effectiveness of occupational therapy interventions for the improvement of the quality of life of healthy adults over 65 years old living in nursing homes.

Data source

PubMed, Web of Science, Dialnet, Scopus, Cochrane, Cinahl and SciELO databases searched between 2012 and 2022.

Study Inclusion and Exclusion Criteria

a) Studies involving occupational therapy interventions in residential settings (nursing homes or community residential settings), b) Studies conducted on a population of healthy adults over 65 years old, c) Studies with a level of evidence 1a-1b to 3a-3b, d) Studies containing the MeSH descriptors in the keyword list.

Data Extraction

For each study included in the review, key information was collected and entered into a data extraction form based on Cochrane recommendations, using Microsoft Excel v.16.16.21 software.

Data Synthesis

Descriptive summary of study characteristics and summarized methodological quality of the studies.

Results

Six of the articles met the inclusion criteria and were categorised into “promotion of active ageing” and “meaningful activities and quality of life”. Overall, the strength of evidence was moderate, and the risk of bias was low.

Conclusion

Occupational therapy intervention programmes structured around the opportunity to choose meaningful activities can improve the perceived quality of life of healthy older adults living in nursing homes.

Optimizing Occupations, Habits, and Routines for Health and Well-Being With Lifestyle Redesign®: A Synthesis and Scoping Review

IMPORTANCE

Lifestyle Redesign® originated as a preventive occupational therapy intervention for healthy older adults, and it was found to be both effective and cost effective in the Well Elderly Studies initiated in the 1990s. Building on that empirical foundation, the scope of Lifestyle Redesign has been greatly expanded as a general intervention framework addressing prevention and chronic condition management in a wide range of populations, settings, and conditions. Yet until now, its full scope, defining characteristics, and supporting evidence have not been clearly and succinctly described, limiting its potential reach and impact.

OBJECTIVE

To outline the definition and key characteristics of Lifestyle Redesign, provide a scoping review of its evidence base and future directions for research, describe its current applications, and make recommendations for its use in clinical practice.

EVIDENCE REVIEW

We searched PubMed and CINAHL, tables of contents of 10 occupational therapy journals, and citations in two seminal Lifestyle Redesign publications to identify articles published in 1997-2020 that described quantitative outcomes (for n ≥ 20) of interventions meeting the defining characteristics of Lifestyle Redesign.

FINDINGS

Our scoping review yielded 12 publications providing supportive evidence for Lifestyle Redesign's positive impact on a range of health and well-being outcomes among both well populations and those with chronic conditions.

CONCLUSIONS AND RELEVANCE

Lifestyle Redesign has the potential to meet a growing need in clinical and community settings for health care services that address prevention, health promotion, and chronic disease management. What This Article Adds: Current evidence supports the use of Lifestyle Redesign to improve health and well-being for a range of client populations. This review outlines its defining characteristics and current applications to improve its implementation in clinical practice and expand related research efforts.

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.

Scoping study of definitions of social participation: update and co-construction of an interdisciplinary consensual definition

Background

considering the importance of social participation for quality of life and active ageing in older adults, it is an important target of social and health professionals’ interventions. A previous review of definitions of social participation in older adults included articles up to 2009; new publications and changes in the social context (e.g. social media and the COVID-19 pandemic) justify continuing this work.

Objective

this paper provides an updated inventory and synthesis of definitions of social participation in older adults. Based on a critical review by content experts and knowledge users, a consensual definition is proposed.

Methods

using a scoping study framework, four databases (MEDLINE, CINAHL, AgeLine, PsycInfo) were searched with relevant keywords. Fifty-four new definitions were identified. Using content analysis, definitions were deconstructed as a function of who, how, what, where, with whom, when, and why dimensions.

Results

social participation definitions mostly focused on people’s involvement in activities providing interactions with others in society or the community. According to this new synthesis and input from content experts and knowledge users, social participation can be defined as a person’s involvement in activities providing interactions with others in community life and in important shared spaces, evolving according to available time and resources, and based on the societal context and what individuals want and is meaningful to them.

Conclusion

a single definition may facilitate the study of active ageing and the contribution of older adults to society, socioeconomic and personal development, benefits for older adults and society, self-actualisation and goal attainment.

Life-Space Mobility and Parkinson's Disease. A Multiple-Methods Study

Background

Life-space mobility (LSM) captures a broad spectrum of mobility in physical and social environments; however, it has not been extensively studied in Parkinson's disease. Using a multiple-methods approach, individual, social and environmental factors that impact LSM were explored in PD.

Methods

Two hundred twenty-seven participants with PD (n = 113) and a comparative group without PD (n = 114) were recruited from the community. Within a cross-sectional survey, LSM (University of Alabama Birmingham Life-Space Assessment, LSA) was compared in the two groups. Using multiple linear regression, socio-demographics, lifestyle behaviors, medical, mobility and social factors were examined to identify factors that explained LSM. A qualitative narrative inquiry was completed to augment the findings from the survey; 10 participants with PD were interviewed regarding facilitators and barriers to mobility.

Results

The mean overall LSA-composite score for the PD group was 64.2 (SD = 25.8) and 70.3 (SD = 23.1) for the community comparative group (mean difference = 6 points, 95%CI:-0.4, 12.5) indicating most participants moved independently beyond their neighborhoods. A higher proportion of the PD group required assistance with mobility than the community comparison group. Not driving, receiving caregiving, lower social participation, and lower monthly family finances were associated with restricted LSM in the PD group. Data from qualitative interviews supported quantitative findings and offered insights into the features of the built environment that facilitate and restrict mobility.

Conclusion

Individual, social and environmental factors are associated with the LSM among persons with PD. Clinicians and policy-makers should include both individual and community-based factors when developing interventions to encourage the LSM of the PD population.

Occupational therapists’ perceptions of the need to enact health promotion in community development through occupational justice

Abstract Introduction Social determinants of health underlie and contribute to health inequalities. Stigma, poverty, and unequal access to health care are examples of social determinants that affect people’s well-being and participation in society. Although occupational therapists use occupation to promote health and well-being, they rarely consider how to address the reduction of health inequalities in their practice. Objective The study aimed to explore how occupational therapists perceive the need to enact health promotion in community development through occupational justice. Method Following critical participatory action research principles, group discussions were conducted by six professionals from across France. Occupational justice frameworks and public health reports were used to prompt a group dialogue over four months. A content analysis of the discussion was conducted, guided by the theory of practice architectures to understand how the therapists’ practices were shaped by discursive, economic, and socio-political circumstances. Results Four themes reflected the professional needs to undertake community development: ‘the professional skills needed to enact the community’s own know-how and self-expertise’, ‘the importance of seeing the ‘whole’ picture and reaching out to other sectors’, ‘the need for occupational justice to understand the complexity of community development’, and ‘the need to move beyond body functions in education’. Conclusion Community development offers unique opportunities to work in the complex context of everyday living. Reasoning informed by occupational justice concepts enables occupational therapists to consider health outcomes caused by social determinants. Occupational therapy education must train students for complex reasoning on how occupational injustices are rooted in everyday social contexts.

Social participation in occupational therapy: Is it possible to establish a consensus?

BACKGROUND

Social participation has been incorporated by occupational therapists in Brazil, and worldwide, as a professional concept to guide practice. The concept has been studied, defined, and constructed from multiple fields of knowledge and can be defined as the social and political involvement of people in social groups and /or public and community spaces. There are different understandings of social participation in occupational therapy and the objective of this study was to explore how Brazilian occupational therapists define social participation in their fields of knowledge.

METHOD

Through application of the Delphi technique, Brazilian occupational therapy academics and professionals who have worked in the state of São Paulo, Brazil, collaboratively responded to an online questionnaire. In the consultation phase, occupational therapists wrote their conceptions about social participation and, in the consensus phase, expressed their opinions and judgements, in order to, in a collective construction, establish a consensus on the definition of social participation.

RESULTS

In the first round of the consensus phase, 38 academics and 27 professionals participated and in the second round, 20 and 14, respectively. Results were analysed quantitatively, through the establishment of degrees of agreement for conceptions arranged in statements. Then, six categories of analysis were built, which identified the multiple ways of understanding social participation: social participation and social interactions, social participation and freedom of movement, social participation as an experience in public and political life, social participation and human activities, social participation and the process of social inclusion, and social participation in the fields of knowledge and practice in occupational therapy.

CONCLUSION

There are theoretical-conceptual differences in the understandings and uses of social participation in occupational therapy that delimit specificity and design the identities of the profession in society. The need to discuss knowledge production, accumulation, and dissemination and practices is debated.

Critical perspectives on implementation of evidence-based practice in occupational therapy – Exemplified by Lifestyle Redesign® in a Danish context

Introduction

Evidence-based practice is an increasing demand in occupational therapy (OT), although multiple barriers can hinder the translation of research knowledge into practice. The article illuminates the transformation of results from a randomised controlled trial into a practice development project with future practice implementation in mind.

Method

A case study was carried out, consisting of a comparison of the US randomised controlled trials (RCTs) Lifestyle Redesign® and the derived Danish practice development project.

Results

The study showed how results from RCTs of Lifestyle Redesign® were transformed into a practice development project with intentions to implement the programme in a Danish context. The modifications of the US RCT into a practice development project in Denmark compromised the study’s scientific execution. The practice development project was used to legitimise the intervention within OT locally by testing an evidence-based intervention, without using associated scientific tools and without considering barriers and facilitators for implementing the project in clinical practice.

Conclusion

Research design compromises in practice development projects may have implications for the internal and external dynamics of professionalisation processes regarding OT and the recognition of OT as a scientific discipline and an autonomous profession, nationally and internationally.

'Weaving lifestyle habits': Complex pathways to health for persons at risk for stroke

BACKGROUND

It is important to understand how healthy lifestyle habits can be developed as they are essential in cardiovascular disease (CVD) prevention. There is limited knowledge regarding whether, and how, engaging occupations (things that people do and occupy themselves with) can promote and help sustain healthy lifestyle habits for persons at risk for CVDs, including stroke.

AIM

The aim was to develop knowledge of how engaging in occupations can contribute to changes in lifestyle habits among persons at risk for stroke.

METHODS

Six adults presenting with stroke risk factors were interviewed on several occasions after participating in an occupation-focused stroke prevention programme. Grounded theory was utilised, and constant comparative methods guided the analysis.

FINDINGS

Changing lifestyle habits was perceived as a complex process, much like weaving a fabric with many parallel and interlacing threads. Literacy of both health and occupations and participation in engaging occupations were important facilitators for promoting healthy lifestyle habits, yet engagement in health-promoting occupations was described as conditioned behaviour.

CONCLUSIONS

CVD prevention programmes can benefit from incorporating engaging occupations to promote healthy lifestyle habits and literacy of health and occupations. However, contextual factors conditioning health and occupations should be considered when developing and implementing sustainable interventions.

Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults.

DESIGN

Single-blind two-arm randomized controlled trial.

SETTING

Participants' homes.

PARTICIPANTS

Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began.

INTERVENTION

Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months.

MEASUREMENTS

Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months.

RESULTS

Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21).

CONCLUSION

Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.