The Relationship between Personal and Contextual Factors and Participation Restriction in Mid-Life Caregivers

OBJECTIVES

Mid-life family caregivers (CGs) are at risk for participation restriction, which can worsen quality of care for care recipients (CR) and increase CG burden and poor health. We aimed to identify factors associated with participation restriction in mid-life CGs.

METHODS

This was a cross-sectional study of CGs aged 40-64 years (n = 1100) from the 2015 cohort of the National Study of Caregiving (NSOC)/National Health and Aging Trends Study (NHATS). Multivariate logistic regression was used to evaluate personal and caregiving attributes associated with restricted participation.

RESULTS

Individual items from the negative and Positive aspects of caregiving (PAC) scales were associated with participation restriction. Mid-life caregivers with "frequent changes to caregiving routine" and "no time for self" were more likely to report restricted participation and those feeling "closer to the CR" were less likely to report restricted participation.

DISCUSSION

Interventions to optimize caregiving routines and improve dyadic relationships could decrease participation restriction in mid-life CGs.

A pilot, randomized, feasibility study to improve health self-management behaviors in older adults with multiple chronic conditions and functional limitations: Protocol for the Behavioral Activation and Occupational Therapy Trial (BA+OT)

Background

Approximately 45% of older adults in the U.S. have 2 or more chronic health conditions (e.g., arthritis, hypertension, diabetes) in addition to functional limitations that prevent performance of health self-management activities. Self-management continues to be the gold standard for managing MCC, but functional limitations create difficulty with these activities (e.g., physical activity, symptom monitoring). Restricted self-management accelerates the downward spiral of disability and accumulating chronic conditions which, in turn, increases rates of institutionalization and death by 5-fold. Currently, there are no tested interventions designed to improve independence in health self-management activities in older adults with MCC and functional limitations. Research suggests that older adults are more likely to change behavior with interventions that assist with planning health-promoting daily activities, especially when contending with complex medical regimens and functional limitations. Our team asserts that combining occupational therapy (OT) and behavioral activation (BA) shows promise to improve health self-management in populations with chronic conditions and/or functional limitations. This innovative combination uses the goal setting, scheduling/monitoring activities, and problem-solving components of the BA approach as well as the environmental modification, activity adaptation, and focus on daily routines from OT practice.

Objectives

We will test the effect of this combined approach in a Stage I, randomized controlled pilot feasibility study compared to enhanced usual care. We will recruit 40 older adults with MCC and functional limitation and randomize 20 to the PI- delivered BA-OT protocol. This research will inform modification and larger-scale testing of this novel intervention.

Multimorbidity groups based on numbers of chronic conditions are associated with daily activity

OBJECTIVE

Instrumental activities of daily living (IADL) are important for managing multiple chronic conditions (MCC) and maintaining independence while aging. Using data from the National Health and Aging Trends Study (NHATS), we answered the question: are there differences in ability and performance of IADL among groups of older adults with 0-1 (no MCC), 2-4 (low MCC), and 5+ chronic conditions (multisystem morbidity: MM)?

METHODS

Cross-sectional study using Poisson regression and incidence rate ratios. Participants were 6,019 community-dwelling older adults who regularly take medications. We derived composite variables for ability and performance of IADL; MCC groups were based on count of 11 chronic conditions.

RESULTS

Older adults with MM had lower IADL count for ability (IRR = .81) and performance (IRR = .77), and MM group significantly predicted both ability and performance of IADL (p < .001); 'low MCC' group was not significantly different than 'no MCC' regarding disability.

DISCUSSION

Having MM is statistically and clinically different than having low MCC or no MCC; 5+ chronic conditions may be a meaningful inclusion criterion for interventions to decrease disability and 2-4 chronic conditions may be better for trials to prevent disability. Researchers should measure both ability and performance of daily activity.

The Roles of Busyness and Daily Routine in Medication Management Behaviors Among Older Adults

Busyness (the density of activities) and daily routine (patterns of organizing time) are two understudied factors that likely impact medication-taking behaviors. We examined the association between busyness and routine with medication adherence (MA) in 405 older adults with adequate cognition using multivariable models. The final model included an interaction term between daily routine and busyness. MA scores (measured by the ASK-12, higher scores mean more barriers to adherence) were higher for individuals reporting low and moderate levels of daily routine versus those with high daily routine. MA scores were higher for individuals reporting moderate and high busyness versus those reporting low busyness. The busyness/routine interaction term was significant for MA; among highly busy individuals, those with high daily routine had lower MA scores than those with low routine. A daily routine may be a modifiable factor for improving MA among older adults, particularly among those with busy lives.

Factors Associated With Participation Restriction in Mid-Life Caregivers and Implications for OT Intervention

Date Presented 04/02/2022

Mid-life caregivers are at risk for participation restriction, which contributes to poor health and quality of care for care recipients. We aimed to uncover the predictors of participation restriction in this group. Daughters and caregivers who report frequent changes to routine and no time for self were at highest risk. Feeling close to the care recipient and using respite care were protective. OT interventions can alleviate participation restriction in this at-risk group.

Primary Author and Speaker: Tara C. Klinedinst

Contributing Authors: Heidi Donovan, Grace Cambpell

Depression and polypharmacy are risk factors for activity limitation in type 2 diabetes

OBJECTIVES

Individuals with type 2 diabetes are at risk for deficits in instrumental activities of daily living (IADL: e.g., managing medication, preparing healthy meals). Understanding which demographic and health factors contribute to decreased frequency of IADL performance is especially important to prevent age-related functional decline in type 2 diabetes. This study examined the relationships among demographic and health variables and frequency of IADL performance in adults with type 2 diabetes.

METHODS

For this cross-sectional study, we collected health, demographic, and activity information via self-report and electronic health record review from safety-net primary care patients with type 2 diabetes (n = 93). We used regression models to determine which factors were associated with IADL performance in three subscales (domestic, leisure/work, outdoor) and the overall score.

RESULTS

Depression was associated with decreased frequency of IADL performance for domestic, leisure/work, and outdoor activities. Each additional daily medication was associated with decreased frequency of domestic and outdoor IADL performance.

DISCUSSION

Depression and taking more daily medication were predictors of decreased IADL performance for adults with type 2 diabetes. Our findings suggest regular screening for depression and polypharmacy is important in the primary care of diabetes; especially as these are potentially modifiable risk factors.

Chronic condition clusters and associated disability over time

Objectives

Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (activities of daily living (ADL) and functional mobility (FM)) over time; the aim of this study was to investigate this relationship.

Methods

This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (n = 6179). Using latent class analysis (LCA), we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years.

Results

We identified six chronic condition clusters: Minimal Disease, Cognitive/Affective, Multiple Morbidity, Osteoporosis, Vascular, and Cancer. Chronic condition cluster was related to ADL and FM outcomes, indicating that groups experienced differential disability over time. At time point 4, all chronic condition groups had worse FM than Minimal Disease.

Discussion

The clusters of conditions identified here are plausible when considered clinically and in the context of previous research. All groups with chronic conditions carry risk for disability in FM and ADL; increased screening for disability in primary care could identify early disability and prevent decline.

Exploring Occupational Therapists' Experiences in U.S. Primary Care Settings: A Qualitative Study

IMPORTANCE

Occupational therapy's scope of practice aligns with the goals of comprehensive primary care set forth by the 2010 Patient Protection and Affordable Care Act (Pub. L. 111-148). To successfully integrate occupational therapy into primary care, we must understand occupational therapy practitioners' experiences in this setting.

OBJECTIVE

To explore facilitators of, barriers to, and recommendations for integrating occupational therapy into primary care.

DESIGN

A descriptive qualitative design that incorporated semistructured interviews, member checking sessions, and deductive thematic analysis. Interviews were structured to capture occupational therapists' experiences of and recommendations for practicing in primary care.

SETTING

Primary care.

PARTICIPANTS

A purposive sample of licensed occupational therapists with at least 6 mo primary care experience in the United States.

RESULTS

Seven participants reported 1 to 8 yr of experience in primary care. Four themes emerged that contextualized the experiences of occupational therapists in primary care. The first theme captured the process of gaining entry onto the primary care team. Once structurally embedded on the team, the second and third themes, respectively, captured barriers and facilitators to navigating team-based care and providing patient-centered care. The fourth theme reflected participants' vision and ideas of how to expand reach nationally to promote consistent integration of occupational therapy into primary care. Conclusion and Relevance: Given the important role of an interprofessional primary care team in improving population health, this study is timely in that it explored occupational therapists' experiences in this emerging practice area. What This Article Adds: Occupational therapists in this study used their skills, resources, and networks to become part of a primary care team. They indicated that they contributed to positive outcomes through working with patients on self-management, functional problem solving, and behavior change.

Critical Differences in Instrumental Activities of Daily Living Among Older Adults With Chronic Conditions

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

The aim of this research was to determine whether there are differences in ability and performance of instrumental activities of daily living (IADLs) among groups of older adults with no multiple chronic conditions (MCC), low MCC, or multisystem morbidity (MM). We found that older adults with MM had more IADL impairment in both ability and performance than those with low or no MCC. Our findings also suggest that older adults with MM are able to do more than they actually do.

Primary Author and Speaker: Tara C. Klinedinst

Additional Authors and Speakers: Juleen Rodakowski

Contributing Authors: Lauren Terhorst

The experience of type 2 diabetes: Application of the Model of Human Occupation

Introduction

Integrating type 2 diabetes (T2DM) self-care behaviors into daily life is complex and poorly understood. Occupational therapists, as experts in life context, habits, roles, and routines, can foster new ways of understanding and promoting daily engagement in T2DM self-care. The Model of Human Occupation (MOHO), a conceptual practice model, may have applicability to better understanding the experience of living with T2DM and engaging in necessary self-care behaviors.

Methods

We conducted focus group interviews with individuals with T2DM ( n = 10). We applied the MOHO to understand the experience of living with T2DM and engaging in related self-care behaviors.

Findings

Participants discussed each element of MOHO and how it related to living with and managing type 2 diabetes. Participants identified obtaining skills for self-advocacy with family, individualized/adapted exercise, stable health-promoting environments and routines, and problem-solving skills for disruptions to routine as critical needs for managing T2DM. These intervention strategies are well-aligned with MOHO and occupational therapy practice.

Conclusion

We found that MOHO was a useful tool for exploring the experience and daily management of T2DM.

Health-related quality of life changes after the merging yoga and occupational therapy for Parkinson's disease program: A mixed-methods study

BACKGROUND

To understand changes in health-related quality of life (HRQoL) after the Merging Yoga and Occupational Therapy for Parkinson's Disease (MY-OT for PD) program.

MATERIALS AND METHODS

We used a mixed-methods convergent design and administered the Parkinson's Disease Questionnaire-8 (PDQ-8), a measure of HRQoL, with 17 participants. We considered scores 8 weeks before MY-OT for PD, just before, and upon completion. Additionally, we completed two focus groups following the program with 16 participants to assess qualitative changes in HRQoL.

RESULTS

There were no significant differences in PDQ-8 scores between time points, F(2,32) = 1.60, p = 0.22, partial η² = 0.09. Participants did discuss improvements in all 8 HRQoL domains, frequently regarding mobility and activities of daily living.

CONCLUSION

Results diverged, with quantitative results showing no significant improvement in HRQoL and qualitative results indicating participant perceived improvements in all domains of the PDQ-8. The program should be explored further, and longitudinal follow-up completed.

Fall risk factors for individuals under the age of 65 years with type 2 diabetes mellitus

Introduction

The purpose of this study was to examine self-reported falls and fall risk factors in people with type 2 diabetes mellitus aged under 65 years.

Methods

This study was a cross-sectional analysis of 64 participants at a primary care facility in the western United States of America. The following fall risk factors were examined for differences between groups (fallers vs. non-fallers): age, body mass index, depression, fear of falling, neuropathy, number of medications, sedentary behavior, and visual co-morbidities. Multivariate logistic regression was used to determine relationships with self-reported falls (yes/no recent fall as defined by the participant).

Results

Forty-five percent of participants reported a recent fall. The following fall risk factors produced significant differences between fallers and non-fallers: depression scores ( p = .01), fear of falling ( p < .01), and number of medications currently being taken ( p = .04). Through multivariate logistic regression, the fear of falling score ( p < .01) was the only significant relationship with self-reported falls in the model that included age, body mass index, depression, fear of falling, neuropathy, number of medications, sedentary behavior, and visual co-morbidities.

Conclusion

Psychological fall risk factors such as fear of falling are factors that should be considered early on in a diagnosis of type 2 diabetes mellitus because they may have an effect on falls, as evidenced in this sample of adults with type 2 diabetes mellitus aged under 65 years.

The Relationship between Quality of Life, Activity and Participation among People with Type 2 Diabetes Mellitus

The cross-sectional study investigated the relationship between quality of life, activity, and participation in 93 adults with type 2 diabetes mellitus at a primary care center. Moderately strong correlations were found between quality of life and leisure/work, outdoor and social activities, but not with domestic activities. Leisure/work, outdoor, and social activities accounted for 18% of the variance in the quality of life variables. In a follow-up model, age, depression, and falls efficacy accounted for another 51% of the variance in total quality of life. Findings provide support for the expansion of occupational therapy's role in diabetes self-management, to incorporate leisure, social, and community activities and fall risk management interventions.

The TODAY Project: Qualitative Focus Groups Provide Insight Into Daily Management of Diabetes and Targets for Intervention

Date Presented 4/20/2018

In this qualitative study, patients at a safety net primary care facility shared perspectives on occupations related to the daily management of Type 2 diabetes (T2DM). This research contributes to an understanding of the psychosocial impacts of T2DM management and targeted areas for intervention.

Primary Author and Speaker: Tara C. Klinedinst

Additional Authors and Speakers: Karen E. Atler, Laura A. Grimm, Arlene A. Schmid, Matt P. Malcolm

Relating Activity, Participation, and High Health Care Utilization in Adults With Type 2 Diabetes Mellitus: Occupational Therapy Intervention Targets

Date Presented 4/20/2018

Lower activity and participation levels in daily occupations contribute to overly high health care utilization (HCU) in adults with Type 2 diabetes mellitus (T2DM). Adults with T2DM who are younger, are a member of a minority group, and have many comorbidities are also at increased risk for higher HCU.

Primary Author and Speaker: Matt P. Malcolm

Additional Authors and Speakers: Arlene A. Schmid, Laura A. Grimm, Tara C. Klinedinst, Karen E. Atler

Fall Rates and Risk Factors for Individuals With Type 2 Diabetes Mellitus

Date Presented 4/19/2018

We aimed to identify fall risk factors that contribute to an increased likelihood of self-reported fall rates in a sample of people with Type 2 diabetes. We also sought to detect fall risk factors that were significantly different between self-reported fallers and nonfallers in this sample.

Primary Author and Speaker: Laura A. Grimm

Additional Authors and Speakers: Arlene A. Schmid, Karen E. Atler, Tara C. Klinedinst, Matt P. Malcolm

Relating Activity and Participation Levels to Glycemic Control, Emergency Department Use, and Hospitalizations in Individuals With Type 2 Diabetes

IN BRIEF Participation in domestic, leisure, work, and community-based activities may relate to glycemic control, emergency department use, and hospitalizations in individuals with type 2 diabetes and low socioeconomic status. This study sought to determine how such role-related activity levels relate to A1C, emergency department use, and hospitalizations.