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Lindsay S, Fuentes K, Ragunathan S, Li Y, Ross T. Accessible independent housing for people with disabilities: A scoping review of promising practices, policies and interventions. PLoS One 2024; 19:e0291228. [PMID: 38271462 PMCID: PMC10810508 DOI: 10.1371/journal.pone.0291228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/24/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Accessible housing is imperative to enabling independent living for many people with disabilities; yet, research consistently shows how people with disabilities often lack appropriate accessible housing and are more likely to experience unaffordable, insecure, and/or poor quality housing. Therefore, the aim of this study was to understand promising practices, policies and interventions regarding accessible independent housing for people with disabilities. METHODS We conducted a scoping review that involved searching seven international literature databases that identified 4831 studies, 60 of which met our inclusion criteria. RESULTS The reviewed studies involved 18 countries over a 20-year period. Our review highlighted the following key trends: (1) removing barriers to obtaining accessible housing (e.g., advocacy, builders enhancing housing supply, subsidies and financial incentives); (2) policies influencing accessible housing; (3) interventions to enhance accessible housing (i.e., home modifications, smart homes, mobile applications and other experimental devices); and (4) the impact of accessible independent housing on health and wellbeing. CONCLUSIONS Our findings emphasize the importance of accessible housing for people with disabilities and the urgent need to advance accessible housing options.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
| | - Timothy Ross
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, East York, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Geography & Planning, University of Toronto, Toronto, Canada
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Li J, Wu B, Wang J. Creating a supportive environment for older adults in China --exploring factors associated with the need for home modifications based on a cross-sectional survey in Central China. BMC Geriatr 2023; 23:795. [PMID: 38042787 PMCID: PMC10693095 DOI: 10.1186/s12877-023-04458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 11/04/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND A supportive home environment is critical to the safety and quality of life of older adults. Home modification is an effective way to build a supportive home environment for older adults' aging in place. However, there is a lack of knowledge on older adults' need for home modifications in China. METHODS We conducted a cross-sectional survey in three provinces of China (Hubei, Hunan, and Henan) using stratified and cluster sampling methods in 2021. A total of 5485 older adults aged 60 and over were included. The outcome variables were: need for home modifications, level of need, and type of modification needed. Exposure variables included: demographic and socioeconomic characteristics, as well as health conditions. Logistic and Poisson regressions were applied to examine the needs for home modifications and its associated factors. RESULTS Nearly 30% of the older adults needed home modifications. The most common choice of home modification was the need for handrails at the bedside, toilet, or threshold (31.64%), and paving un-slip tiles or vinyl flooring (17.45%). Age (IRR = 1.01, P < 0.001), education (IRR = 1.11, P < 0.01), and level of assistance (IRR = 2.31, P < 0.001) were more likely to be positively associated with needs for modification. Participants in the age group of 70 to 79 years, with primary school education, and low-level physically dependent had significantly higher needs for modifications than those of advanced age, lower level of education, or higher level of physically dependent (p < 0.01). CONCLUSIONS The overall need for home modifications in China is low. Home modification programs are needed to tailor individuals' needs and provide services to those with the most home modification need.
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Affiliation(s)
- Jiajing Li
- School of Architecture and Urban Planning, Beijing University of Civil Engineering and Architecture, Exhibition Hall Road No. 1, Xicheng District, Beijing, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, 433 1st Ave, New York, NY, USA
| | - Jing Wang
- College of Health and Human Services, University of New Hampshire, Hewitt Hall, 4 Library Way, Durham, NH, USA.
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3
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Ramji R, Rämgård M, Kottorp A. Psychometric properties of the WHOQOL-BREF in citizens from a disadvantaged neighborhood in Southern Sweden. Front Psychol 2023; 14:1118575. [PMID: 37113124 PMCID: PMC10128172 DOI: 10.3389/fpsyg.2023.1118575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
Background Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden. Methods The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study. Results Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved. Conclusion WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.
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Affiliation(s)
- Rathi Ramji
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Valderrama-Ulloa C, Ferrada X, Herrera F. Breaking Down Barriers: Findings from a Literature Review on Housing for People with Disabilities in Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4972. [PMID: 36981880 PMCID: PMC10049237 DOI: 10.3390/ijerph20064972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Accessibility to housing is crucial for people with disabilities as it provides them with equal opportunities and allows them to live independently. A systematic literature review has been conducted to understand the current research on accessibility in housing for people with disabilities in Latin America. The study analysed 56 papers and used co-word analysis to identify common themes and topics within the documents. The results of the analysis showed that Brazil (61%) is the country with the most research on the subject, physical disability, at 36%, is the impairment most analysed, and interventions or analysis for the older people (45%) in their homes is the most researched type of population. The co-word analysis revealed that topics such as policy, regulations, the use of technologies, ergonomics interventions, and architectural criteria or barriers to the daily life of disabled people were frequently discussed in the papers. Although this work shows a substantial and growing increase in research on housing for people with disabilities in Latin America, it also demonstrates the importance of increasing research on other types of impairment, such as visual and cognitive-intellectual disabilities, and including children, caregivers, or even young adults.
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Schmidt LI, Wagner M, Büßecker HA, Franke AA. Who uses technical aids in old age? Exploring the implementation of technology-based home modifications in Europe. Front Public Health 2023; 11:1130177. [PMID: 37064714 PMCID: PMC10099246 DOI: 10.3389/fpubh.2023.1130177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Home modifications and features, e.g., handrails or ramps for people using wheelchairs, should allow residents with functional limitations to maintain social participation, health, and wellbeing for aging in place. However, there is little evidence in relation to the individual characteristics shaping this implementation of technology-based home modifications. Current studies often focus on describing the distribution of certain implementations in households but do not provide information on factors predicting the implementation or detailed and multifaceted data on associations with characteristics of the older user. This article, therefore, examines the use of well-established technological aids and home modifications (e.g., ramps, handrails, automatic doors, bathroom or kitchen modifications, chair lifts, and alerting devices) in the households of older adults in Europe. We refer to Lawton's and Nahemow's concept of personal-environment fit and describe the use of technical aids across 18 countries, analyze associations with individual characteristics and social resources, and compare those associations and variance explanation between older adults in their third age ("young-old", 65-79 years) and older adults in their fourth age ("old-old", 80+). Methods Drawing on representative data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), wave 6, a total of N = 38,553 older adults aged 65-105 years (M = 74.4 years, SD = 7.1; 55% women) were analyzed by performing hierarchical logistic regression analyses. Results Indicators of functioning explained the highest proportion of variance, followed by social resources, and variance explanation was higher for the fourth age than for the third age. In particular, older adults with physical limitations, a larger social network, and those who received care from a child outside the household were more likely to have home modifications installed. Discussion The study provides an overview of associations of diverse variables with assistive devices and modifications in the home and can serve as a starting point for public health activities concerning the heterogeneity of people aged 65 years and older.
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Affiliation(s)
- Laura I. Schmidt
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
- Laura I. Schmidt
| | - Melanie Wagner
- Max Planck Institute for Social Law and Social Policy, Max Planck Society Munich, Munich, Germany
| | | | - Annette A. Franke
- Department of Social Work, Protestant University of Applied Sciences Ludwigsburg, Ludwigsburg, Germany
- *Correspondence: Annette A. Franke
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Effects of a diabetes mellitus-specific care intervention and home environment among older adults following hip fracture surgery. Exp Gerontol 2023; 171:112032. [PMID: 36402416 DOI: 10.1016/j.exger.2022.112032] [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: 09/19/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To explore the impact of home environment on effects of a diabetes mellitus (DM)-specific care model among older adults following hip-fracture surgery. METHODS A secondary analysis using the Home Environmental Barriers Scale assessed home environment (intervention group=81, control group=79) at 1- and 3-months post-discharge. Outcomes of physical functioning were assessed at 1-, 3-, 6-, and 12-months post-discharge. RESULTS The intervention group had better home environmental improvements compared with the control group. Participants were characterized as having good or poor environmental improvements. Those with good improvements and received the intervention had better activities of daily living compared with matched controls. Participants with poor improvements and received the intervention had better scores for hip range of motion and quadriceps muscle strength compared with matched controls. DISCUSSION A DM-specific home rehabilitation for older adults following hip-fracture surgery that includes assessment of the home environment can facilitate complex postoperative functional recovery.
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Gleisner AS, Rose L, Trask C. Towards safety and autonomy in the home bathroom: Identifying challenges, needs and gaps. APPLIED ERGONOMICS 2022; 105:103865. [PMID: 35961247 DOI: 10.1016/j.apergo.2022.103865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
This qualitative study aims to identify challenges, needs and gaps for home care bathroom tasks and gather information that will allow for user-centered, sustainable solutions for home care in the bathroom. Twenty-one interviews were carried out with participants with the perspective of client, health care worker or care organization. The data were analyzed using qualitative content analysis and interpretive description. The findings identify important factors for enabling both independent living for clients and a sustainable work environment for the health care workers. They include adequate space, access to assistive devices and regular risk assessments to recognize changing needs. Enabling independent living is one strategy that can be used to manage the ongoing demographic change as well as the expected future labor shortage in the care sector. Changes can be made in the physical environment (the residential bathroom) in order to facilitate safer task performance for both the clients and the health care workers.
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Affiliation(s)
- AnnaKlara Stenberg Gleisner
- KTH Royal Institute of Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Biomedical Engineering and Health Systems, Division of Ergonomics, Hälsovägen 11C, 141 57, Huddinge, Sweden.
| | - Linda Rose
- KTH Royal Institute of Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Biomedical Engineering and Health Systems, Division of Ergonomics, Hälsovägen 11C, 141 57, Huddinge, Sweden
| | - Catherine Trask
- KTH Royal Institute of Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, Department of Biomedical Engineering and Health Systems, Division of Ergonomics, Hälsovägen 11C, 141 57, Huddinge, Sweden
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8
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Ramadhani WA, Rogers WA. Understanding Home Activity Challenges of Older Adults Aging with Long-Term Mobility Disabilities: Recommendations for Home Environment Design. JOURNAL OF AGING AND ENVIRONMENT 2022; 1. [DOI: 10.1080/26892618.2022.2092929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Widya A. Ramadhani
- School of Architecture, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Wendy A. Rogers
- College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL, USA
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9
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Jagroep W, Cramm JM, Denktaș S, Nieboer AP. Age-friendly neighbourhoods and physical activity of older Surinamese individuals in Rotterdam, the Netherlands. PLoS One 2022; 17:e0261998. [PMID: 35085282 PMCID: PMC8794150 DOI: 10.1371/journal.pone.0261998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Age-friendly neighbourhoods seem to promote physical activity among older individuals. Physical activity is especially important for chronically ill individuals. In the Netherlands, older Surinamese individuals are more likely to have chronic diseases than are their native Dutch counterparts. This study examined relationships of neighbourhood characteristics with physical activity among older Surinamese individuals in Rotterdam, the Netherlands. METHODS Of 2749 potential participants, 697 (25%) community-dwelling older (age ≥ 70 years) Surinamese individuals living in Rotterdam, the Netherlands, completed a questionnaire on personal and neighbourhood characteristics between March and June 2020. Correlation and multilevel regression analyses were performed to identify associations between missing neighbourhood characteristics for ageing in place and physical activity. RESULTS Scores for the neighbourhood domains communication and information (r = -0.099, p ≤ 0.05), community support and health services (r = -0.139, p ≤ 0.001), and respect and social inclusion (r = -0.141, p ≤ 0.001), correlated negatively with participants' PA. In the multilevel analysis, overall missing neighbourhood characteristics to age in place scores were associated negatively with physical activity (p ≤ 0.05). CONCLUSION This study showed the importance of age-friendly neighbourhoods for physical activity among older Surinamese individuals in Rotterdam, the Netherlands. Our findings suggest that the neighbourhood plays an important role in supporting older individuals' leading of physically active lifestyles. Further research is needed to support the development of interventions to create age-friendly neighbourhoods.
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Affiliation(s)
- Warsha Jagroep
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jane M. Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Semiha Denktaș
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Anna P. Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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10
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Beavers DP, Ip EH, Rapp SR, Shumaker SA. Latent Profiles of Home Environmental Modifications Use in the Women’s Health Initiative. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1836110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward H. Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R. Rapp
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sally A. Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Understanding the Wicked Problem of Providing Accessible Housing for the Ageing Population in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031169. [PMID: 33525734 PMCID: PMC7908410 DOI: 10.3390/ijerph18031169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Abstract
While accessible housing is known as important to promote healthy ageing, the societal issue of providing accessible housing for the ageing population bears the characteristics of a “wicked problem”. The aim of this study was to gain a better understanding of crucial variables for decision-making about the provision of accessible housing for the ageing population in Sweden. Materials used for a deductive content analysis were elicited through a research circle involving three researchers and twelve non-academic representatives. Brown and colleagues’ conceptual five-dimension framework to address wicked problems was used for the understanding of crucial variables in decision-making about housing provision. The findings show that such reasoning is dominated by the socioeconomic dimension. Findings in the biophysical dimension reveal well-known challenges pertaining to the definition and interpretation of the concept of accessibility and its operationalization. The dimensions are intertwined in a complex manner, which is essential for effective and efficient decision-making. The findings could make decision-makers aware of the diversity of individual thinking involved when addressing this wicked problem. Acting upon the crucial variables identified in this study could contribute to progressive decision-making and more efficient ways to develop and provide accessible housing to promote health ageing.
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12
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Wu CY, Rodakowski JL, Terhorst L, Karp JF, Fields B, Skidmore ER. A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults. THE GERONTOLOGIST 2020; 60:e52-e65. [PMID: 31002312 DOI: 10.1093/geront/gnz026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Minimizing disability is critical to reduce the costly health care associated with disability and maintain quality of life into old age. We examined the effect sizes of nonpharmacological intervention studies in reducing disability and explored the active ingredients of interventions. RESEARCH DESIGN AND METHODS A scoping review was conducted via PubMed, PsycINFO, and CINAHL databases. Thirty-one randomized controlled trials were included. Eight active ingredients were identified by three experts (exercise, problem-solving, cognitive behavioral therapy, environmental modification, education, goal setting, comprehensive geriatric assessment, and cognitive training). RESULTS The range of Cohen's d was -0.85 to 1.76 across 31 studies (included 33 interventions); 67% studies (n = 22) obtained small-to-negative effect sizes (d = -0.85 to 0.18), accounting for 83% participants across studies. Interventions that incorporated exercise, problem-solving, cognitive behavior therapy, and environmental modification were associated with stronger effect sizes. Interventions that incorporated comprehensive geriatric assessment obtained small effect sizes. DISCUSSION AND IMPLICATIONS Majority of intervention studies found little or no effect in reducing disability for older adults. To optimize the effects of nonpharmacological interventions, we recommend researchers to (i) develop a screening tool for "risk of disability" to inform those who are early on the disability progression, yet not experience any difficulties in activities of daily living and instrumental activities of daily living; (ii) specify the active ingredients embedded in complex interventions to facilitate change in disability; and (iii) select sensitive tools to capture the progression of disability in late life.
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Affiliation(s)
- Chao-Yi Wu
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania
| | - Juleen L Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania.,Department of Health and Community Systems, School of Nursing, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, School of Medicine, Pennsylvania.,Department of Anesthesiology, School of Medicine, Pennsylvania
| | - Beth Fields
- Center for Caregiving Research, Education and Policy, Pennsylvania.,Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, Pennsylvania.,Clinical and Translational Institute, School of Nursing, Pennsylvania.,Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pennsylvania
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Zhang B, Zhou P. An Economic Evaluation Framework for Government-Funded Home Adaptation Schemes: A Quantitative Approach. Healthcare (Basel) 2020; 8:healthcare8030345. [PMID: 32961870 PMCID: PMC7551430 DOI: 10.3390/healthcare8030345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 11/16/2022] Open
Abstract
The ability to live independently plays a crucial role in the mental and psychological wellbeing of the disabled. To achieve this goal, most governments spend a substantial budget on home adaptation projects. It has been observed that schemes with different target clients (residents versus landlords) are different in efficiency and effectiveness. To understand why and how these schemes differ in performance, this paper develops and applies a generic economic evaluation framework for government-funded home adaptation schemes. Based on the individual-level surveys collected in the United Kingdom, an empirical model was formulated to quantify the determinants for various performance indicators, including money costs, time costs and client satisfaction. Robust estimation procedures were applied to deal with the heteroscedasticity and outlier problems in the data. Results showed that a specialized independent living scheme dedicated to disability adaptations (e.g., the Physical Adaptations Grant, PAG) had higher efficiency and effectiveness than general-purpose schemes (e.g., the Disabled Facilities Grant, DFG), because the funds were provided to the landlords who had a stronger motivation to minimize the time cost in the short run and maximize the future rent potential in the long run. A "unified system" approach to adaptations should be a guiding principle for policy development, regardless of who actually delivers the service.
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Affiliation(s)
- Bo Zhang
- School of Economics and Management, Beijing University of Chemical Technology, Beijing 100029, China;
| | - Peng Zhou
- Cardiff Business School, Cardiff University, Cardiff CF10 3EU, UK
- Correspondence: ; Tel.: +44-2920688778
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14
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Thordardottir B, Fänge AM, Chiatti C, Ekstam L. Participation in Everyday Life Before and After a Housing Adaptation. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/26892618.2020.1755141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Björg Thordardottir
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Carlos Chiatti
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Lisa Ekstam
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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15
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Nguyen AT, Somerville EK, Espín-Tello SM, Keglovits M, Stark SL. A Mobile App Directory of Occupational Therapists Who Provide Home Modifications: Development and Preliminary Usability Evaluation. JMIR Rehabil Assist Technol 2020; 7:e14465. [PMID: 32224486 PMCID: PMC7154931 DOI: 10.2196/14465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/21/2019] [Accepted: 01/22/2020] [Indexed: 01/07/2023] Open
Abstract
Background Home modifications provided by occupational therapists (OTs) are effective in improving daily activity performance and reducing fall risk among community-dwelling older adults. However, the prevalence of home modification is low. One reason is the lack of a centralized database of OTs who provide home modifications. Objective This study aimed to develop and test the usability of a mobile app directory of OTs who provide home modifications in the United States. Methods In phase 1, a prototype was developed by identifying OTs who provide home modifications through keyword Web searches. Referral information was confirmed by phone or email. In phase 2, community-dwelling older adults aged older than 65 years and OTs currently working in the United States were purposefully recruited to participate in a single usability test of the mobile app, Home Modifications for Aging and Disability Directory of Referrals (Home Maddirs). Participants completed the System Usability Scale (SUS) and semistructured interview questions. Interview data were coded, and themes were derived using a grounded theory approach. Results In phase 1, referral information for 101 OTs across 49 states was confirmed. In phase 2, 6 OTs (mean clinical experience 4.3 years, SD 1.6 years) and 6 older adults (mean age 72.8 years, SD 5.0 years) participated. The mean SUS score for OTs was 91.7 (SD 8.0; out of 100), indicating good usability. The mean SUS score for older adults was 71.7 (SD 27.1), indicating considerable variability in usability. In addition, the SUS scores indicated that the app is acceptable to OTs and may be acceptable to some older adults. For OTs, self-reported barriers to acceptability and usability included the need for more information on the scope of referral services. For older adults, barriers included high cognitive load, lack of operational skills, and the need to accommodate sensory changes. For both groups, facilitators of acceptability and usability included perceived usefulness, social support, and multiple options to access information. Conclusions Home Maddirs demonstrates good preliminary acceptability and usability to OTs. Older adults’ perceptions regarding acceptability and usability varied considerably, partly based on prior experience using mobile apps. Results will be used to make improvements to this promising new tool for increasing older adults’ access to home modifications.
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Affiliation(s)
- An Thi Nguyen
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Emily Kling Somerville
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | | | - Marian Keglovits
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan Lynn Stark
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Pettersson C, Malmqvist I, Gromark S, Wijk H. Enablers and Barriers in the Physical Environment of Care for Older People in Ordinary Housing: A Scoping Review. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/02763893.2019.1683671] [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)
- Cecilia Pettersson
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Inga Malmqvist
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Sten Gromark
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health & Care Sciences, the Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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17
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Malmgren Fänge A, Carlsson G, Axmon A, Thordardottir B, Chiatti C, Nilsson MH, Ekstam L. Effects of applying a standardized assessment and evaluation protocol in housing adaptation implementation - results from a quasi-experimental study. BMC Public Health 2019; 19:1446. [PMID: 31684916 PMCID: PMC6829845 DOI: 10.1186/s12889-019-7815-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/21/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Standardized, research-based strategies to guide the implementation and evaluate the effects of housing adaptations (HA) on client outcomes are rare. We hypothesized that, compared to ordinary practice, a standardized assessment and evaluation protocol for HA implementation would better maintain or improve client outcomes over 1 year. METHOD Using a cluster design, South Swedish municipalities were recruited to an intervention or control group. Data on activities of daily living, usability of the home, health related quality of life, and participation frequency and satisfaction were collected at home visits 1 month before the HA (baseline; T1), and at 3 (T2), 6 (T3) and 12 (T4) months after. In the intervention group (n = 112) data were collected according to a standardized protocol while in the control group (n = 129) ordinary routines were applied. Changes from baseline to subsequent time points were categorized as no deterioration (i.e. improvement or no change) or deterioration, for each outcome item separately. Differences in "no deterioration" between the groups were assessed using logistic regression. RESULTS Little effect of using the standardized protocol was detected. For activities of daily living, statistically significant differences between the groups were found for toileting (T1-T4; OR 3.14), dressing (T1-T4; OR2.89) and cooking (T1-T3 and T1-T4; OR 3.14). For usability of the home differences were found in personal hygiene (T1-T2; OR 2.32) using a wheelchair (T1-T2 and T1-T3; OR 9.50), picking up the mail (T1-T3; OR 4.06), and in participation, helping others (T1-T3 and T1-T4; OR 2.33 and 3.36). CONCLUSION The applied standardized protocol for HA implementation did not show any convincing effect, possibly due to the complexity of the intervention itself, and the implementation process. A process evaluation might generate in-depth knowledge about the reasons behind the findings. TRIAL REGISTRATION ClinicalTrials.gov . NCT01960582.
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Affiliation(s)
- A. Malmgren Fänge
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
| | - G. Carlsson
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
| | - A. Axmon
- Division of Occupational and Environmental Medicine, EPI@LUND (Epidemiology, Population studies, and Infrastructures at Lund University), Lund University, SE-221 00 Lund, Sweden
| | - B. Thordardottir
- Faculty of Health Sciences, OsloMet - OsloMetropolitan University, NO-0130, Oslo, Norway
| | - C. Chiatti
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
| | - M. H. Nilsson
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - L. Ekstam
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
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18
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Whitehead PJ, Golding‐Day MR. The lived experience of bathing adaptations in the homes of older adults and their carers (BATH-OUT): A qualitative interview study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1534-1543. [PMID: 31373420 PMCID: PMC6851978 DOI: 10.1111/hsc.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
The onset of disability in bathing may be followed by disability in other daily activities for older adults. A bathing adaptation usually involves the removal of a bath or inaccessible shower and replacement with a level, easy access shower. The purpose is to remove the physical environmental barriers and restore older adults' ability to bathe safely and/or independently. The aim of this study was to explore the views and experiences of older adults and their carers who had received a bathing adaptation in order to examine how the adaptation had affected them and identify mechanisms of impact and outcomes from their perspectives. The study was nested within a feasibility Randomised Controlled Trial (RCT) (BATH-OUT) conducted within one local authority housing adaptations service in England. Semi-structured interviews were completed between 21 December 2016 and 19 August 2017 with 21 older adults and five carer participants of the feasibility RCT. Interview participants were purposively sampled on living arrangement and gender. Interviews were audio-recorded, transcribed verbatim and analysed in seven stages using framework analysis. Findings were presented thematically. Five themes were identified: ease of use; feeling safe; feeling clean; independence, choice and control; and confidence and quality of life. The removal of the physical barriers in the bathroom led to older adults re-mastering the activity of bathing, having an improved sense of physical functioning which gave a sense of 'freedom'. This appeared to impact a range of areas contributing to a wider sense of increased confidence consistent with constructs underpinning social care-related quality of life. We suggest that future research should examine housing adaptations from a person-environment fit approach, and that timely restoration of bathing ability is especially important as it can affect confidence and perceived competence in other areas of daily living.
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Affiliation(s)
- Phillip J. Whitehead
- Department of Social Work, Education and Community WellbeingNorthumbria University at NewcastleNewcastle upon TyneUK
| | - Miriam R. Golding‐Day
- Division of Rehabilitation, Ageing and WellbeingUniversity of NottinghamNottinghamUK
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19
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De-Rosende-Celeiro I, Torres G, Seoane-Bouzas M, Ávila A. Exploring the use of assistive products to promote functional independence in self-care activities in the bathroom. PLoS One 2019; 14:e0215002. [PMID: 30958846 PMCID: PMC6453482 DOI: 10.1371/journal.pone.0215002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Abstract
In homes, problems in daily functioning of older people often occur in the bathroom, especially in the transfers to the toilet and/or shower/bath. Assistive products have the potential to maximise functional independence (i.e. performance without assistance from another person) in everyday activities; however, more research is needed to better understand the impact of this technology on independence in the transfers in the bathroom. Additionally, little is known about the role of the environmental factors in the process of implementing bathroom adaptations. Therefore, this cross-sectional study aimed to examine the relationship between the use of assistive products and independence in the transfers in the bathroom. The secondary objective was to determine the role of the environmental factors in predicting the implementation of bathroom adaptations. 193 community-dwelling older adults with disabilities in the basic activities of daily life, who requested public long-term care services in Spain, were included. Data was collected in the participant´s homes using a standardised assessment procedure. There was no significant association between the number of categories of assistive products used in the toilet transfer and the independent performance of this task. In a multivariate model, the number of categories of assistive products used in the transfer to shower/bath was positively associated with the independent performance of this transfer (OR = 2.59, 95%CI = 1.48–4.53; p = 0.001). A multivariate analysis revealed that social functioning was significantly associated with the implementation of a bathroom adaptation; social risk was lower in participants who made an adaptation (OR = 0.76, 95%CI = 0.63–0.93; p = 0.006). Assistive products may play an important role in promoting independence in the bathroom. Assistive product needs should be addressed when planning community-based interventions aimed at improving daily life. Moreover, social functioning had a strong influence on the installation of bathroom adaptations, suggesting the importance of paying special attention to social factors in the home adaptations planning process.
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Affiliation(s)
| | - Gabriel Torres
- Department of Physical and Sports Education, University of A Coruña, A Coruña, Spain
| | | | - Adriana Ávila
- Department of Health Sciences, University of A Coruña, A Coruña, Spain
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20
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Luther A, Chiatti C, Ekstam L, Thordardottir B, Fänge AM. Identifying and validating housing adaptation client profiles - a mixed methods study. Disabil Rehabil 2019; 42:2027-2034. [PMID: 30731046 DOI: 10.1080/09638288.2018.1550530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: An increasing number of people will live with disabilities in their homes and consequently, the need for home-based interventions will increase. Housing adaptations (HAs) are modifications to the physical home environment with the purpose to enhance independence for a heterogeneous group of people. Increasing the knowledge of the characteristics of HA clients by exploring their heterogeneity, could facilitate the planning of interventions and allocation of resources. The purpose of this article was to identify and validate HA client profiles.Materials and methods: This cross-sectional study applied a mixed methods design to identify profiles of HA clients through cluster analysis confirmed by qualitative interview data. The sample consists of 241 HA clients in Sweden with a mean age of 75.1 years.Results: A classification into five groups emerged as the one best describing the heterogeneity of characteristics among this sample of clients. Five client profiles were outlined based on their age and level of disability, and the variation between the profiles was confirmed through the qualitative interview data.Conclusions: The identified client profiles are a step towards a better understanding of how home-based interventions could be delivered more effectively to groups of HA clients, based on their different characteristics.Implications for rehabilitationHousing adaptations are structural modifications to the physical home environment with the purpose to enhance independence for people with disabilities.People applying for housing adaptations are a heterogeneous group with different needs.This study outlines five client profiles which can guide professionals on how to differentiate home-based interventions and follow-up processes among housing adaptation clients.
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Affiliation(s)
- Anna Luther
- Department of Geriatrics, Skåne University Hospital, Malmö, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carlos Chiatti
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Lisa Ekstam
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Björg Thordardottir
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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21
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Lim YM, Kim H, Cha YJ. Effects of environmental modification on activities of daily living, social participation and quality of life in the older adults: a meta-analysis of randomized controlled trials. Disabil Rehabil Assist Technol 2018; 15:132-140. [PMID: 30409070 DOI: 10.1080/17483107.2018.1533595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This study aims to provide evidence of the benefits and effects of environmental modification intervention on activities of daily living, quality of life and social participation in older adults.Methods: This study searched and used randomized controlled trial research studies from the databases of MEDLINE, CINAHL and the Cochrane Library. A systematic review and meta-analysis were conducted using the Jadad scale, risk of bias and the patient, intervention, comparison, outcome (PICO) process. The domains of impact considered in this meta-analysis were activities of daily living, quality of life and social participation. The analysis was completed with the Review Manager software 5.3.Results: Jadad scores of collected studies were 3-4 in seven studies and 2 in one study, which means that most studies had high levels of quality. This study comprised of 733 subjects in the experimental group and 672 subjects in the control group. The effect size of environmental interventions on basic activities of daily living, instrumental activities of daily living and overall activities of daily living were 0.37, 0.65 and 0.47, respectively. Meanwhile, the environmental intervention was neither effective on quality of life nor social participation.Conclusions: Environmental modifications are effective in facilitating the daily life activities of older adults. This kind of intervention is shown to be useful for enhancing life performance. In order to confirm intervention effects on the quality of life and social participation of older adults, studies should conduct environmental modifications interventions that take into account contexts such as individual characteristics, lifestyle and physical activities.Implications for rehabilitationEnvironmental modifications are effective in improving older adults' performance of daily activities (ADL).Appropriate environmental modification interventions should be considered before the quality of life (QoL) and levels of social participation of older adults decline.
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Affiliation(s)
- Young Myoung Lim
- 1Department of Occupational Therapy, Graduate School of Konyang University, Daejeon, Korea
| | - Hee Kim
- 2Department of Occupational Therapy, Konyang University - Daejeon Medical Campus, Bo-gun-hak-kwan, Daejeon, Korea
| | - Yu Jin Cha
- 3Department of Occupational Therapy, Semyung University, Jecheon, Korea
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Maggi P, de Almeida Mello J, Delye S, Cès S, Macq J, Gosset C, Declercq A. Fall determinants and home modifications by occupational therapists to prevent falls: Facteurs déterminants des chutes et modifications du domicile effectuées par les ergothérapeutes pour prévenir les chutes. The Canadian Journal of Occupational Therapy 2018; 85:79-87. [PMID: 29506411 DOI: 10.1177/0008417417714284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls. PURPOSE This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls. METHOD We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls. FINDINGS The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls. IMPLICATIONS Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.
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23
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Hedman A, Kottorp A, Almkvist O, Nygård L. Challenge levels of everyday technologies as perceived over five years by older adults with mild cognitive impairment. Int Psychogeriatr 2018; 30:1447-1454. [PMID: 29615145 PMCID: PMC6317289 DOI: 10.1017/s1041610218000285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 01/17/2023]
Abstract
ABSTRACTBackground:In clinical practice, efficient and valid functional markers are needed to detect subtle cognitive and functional decline in mild cognitive impairment (MCI). This prospective study explored whether changes in perceived challenge of certain everyday technologies (ETs) can be used to detect signs of functional change in MCI. METHODS Baseline and five-year data from 37 older adults (mean age 67.5 years) with MCI regarding their perceived ability to use ET were used to generate Rasch-based ET item measures reflecting the relative challenge of 46 ETs. Actual differential item functioning in relation to time was analyzed based on these item measures. Data collection took place in 2008-2014. RESULTS Seven (15%) of the ETs included were perceived to be significantly more challenging to use at year five compared to at baseline, while 39 ETs (85%) were perceived to be equally challenging to use, despite the fact that the participants' perceived ability to use ET had decreased. Common characteristics among the ETs that became more challenging to use could not be identified. The dropout rate was 43%, which limits the power of the study. CONCLUSIONS Changes in the perceived challenge of ETs seem to capture functional change in persons with cognitive decline. Both easier and more challenging ETs typically used at home and in society need to be addressed to capture this functional change because significant changes occurred among ETs of all challenge levels and within all types of ETs.
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Affiliation(s)
- Annicka Hedman
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Anders Kottorp
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Ove Almkvist
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Louise Nygård
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
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Renda M, Lape JE. Feasibility and Effectiveness of Telehealth Occupational Therapy Home Modification Interventions. Int J Telerehabil 2018; 10:3-14. [PMID: 30147839 PMCID: PMC6095682 DOI: 10.5195/ijt.2018.6244] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite the effectiveness of occupational therapy home modification interventions, persons with disabilities may not receive them due to service delivery costs, limited number of therapists, and expansive geographic service areas. The need for occupational therapy home modification interventions will increase with the rising U.S. aging population, incidence of chronic illness, and shift toward community-based care. This study examined the feasibility of telehealth occupational therapy home modification interventions using participant owned smart phones, tablets, or computers. A pretest posttest design (n=4) demonstrated improvement in home safety and perception of performance of daily activities. Participants reported satisfaction with the mode of intervention citing ease of use and reduction in client and caregiver burden. Two key implementation challenges were (1) inconsistent quality of synchronous audio and video and (2) limited funding for home modification interventions. A large-scale telehealth occupational therapy home modification interventions pilot study is warranted.
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Affiliation(s)
- Marnie Renda
- CHATHAM UNIVERSITY, PITTSBURGH, PA, USA
- REBUILD INDEPENDENCE LLC, CINCINNATI, OH, USA
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25
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Nielsen LM, Maribo T, Kirkegaard H, Petersen KS, Oestergaard LG. Development of a complex intervention aimed at reducing the risk of readmission of elderly patients discharged from the emergency department using the intervention mapping protocol. BMC Health Serv Res 2018; 18:588. [PMID: 30055597 PMCID: PMC6064169 DOI: 10.1186/s12913-018-3391-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Limitations in performing daily activities and a incoherent discharge are risk factors for readmission of elderly patients after discharge from the emergency department. This paper describes the development and design of a complex intervention whose aim was to reduce the risk of readmission of elderly patients discharged from the emergency department. Methods The intervention was described using the Intervention Mapping approach. In step 1, a needs assessment was conducted to analyse causes of readmission. In steps 2 and 3, expected improvements in terms of intervention outcomes, performance objectives and change objectives were specified and linked to selected theory- and evidence-based methods. In step 4, the specific intervention components were developed; and in step 5, an implementation plan was described. Finally, in step 6, a plan for evaluating the effectiveness of the intervention was described. The intervention was informed by input from a literature search, informal interviews and an expert steering group. Results A three-phased theory- and evidence-based intervention was developed. The intervention consisted of 1) assessment of performance of daily activities, 2) defining a rehabilitation plan and 3) a follow-up home visit the day after discharge with focus on enhancing the patients’ performance of daily activities. Conclusion The intervention mapping protocol was found to be a useful method to describe and systemize this theory- and evidence-based intervention. Electronic supplementary material The online version of this article (10.1186/s12913-018-3391-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark. .,Department of Occupational Therapy, VIA University College, Aarhus, Denmark.
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region , Aarhus, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR) Department of Clinical Medicin, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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26
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de Lange L, Coyle E, Todd H, Williams C. Evidence-based practice guidelines for prescribing home modifications for clients with bariatric care needs. Aust Occup Ther J 2018; 65:107-114. [PMID: 29314054 DOI: 10.1111/1440-1630.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Home modifications maintain people's functional independence and safety. No literature exists to guide the prescription of home modifications for clients with bariatric care needs. With Australia's increasing obesity rate, more evidence is needed to support home modification prescribers. This study aimed to map Australian home modification prescribing practices for clients with bariatric care needs and to establish and evaluate a clinical resource for this prescription process. METHODS The study included two phases. Phase 1 conducted a cross-sectional survey of therapists practicing in Australia, and Australian industry partners who prescribe or install home modifications for clients with bariatric care needs. Phase 2 included design, implementation and evaluation of a clinical resource. Data were analysed with means and frequencies; multivariable regression analysis was used to explore prescribing habits. RESULTS Therapists surveyed (n = 347) reported 11 different bariatric weight definitions. Less than 3% constantly or regularly prescribed home modifications for these clients; rails were most commonly prescribed. Many therapists (n = 171, 58%) 'never' or 'rarely' knew rail load capacity. Therapists' knowledge of rail load capacity was associated with previous experience prescribing home modifications (P = 0.009); rail manufacturer's advice (P = 0.016) and not using advice from builders (P = 0.001). Clinical resources were used by 11% (n = 26) of therapists to support their prescription, and industry sporadically relied on therapists to specify modification design requirements (n = 5, 45%). Post-implementation of a clinical resource increased consensus regarding understanding of the term bariatric and increased consultation with builders and manufacturers. CONCLUSION There was a lack of consistency in bariatric terminology, uncertainty of rail load capacities and minimal use of clinical practice guidelines. Additional resources will assist with consistency in prescribing practices to maximise occupational performance for clients with bariatric care needs.
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Affiliation(s)
- Laura de Lange
- Domiciliary Care Service, Peninsula Health, Frankston, Victoria, Australia
| | - Emma Coyle
- Domiciliary Care Service, Peninsula Health, Frankston, Victoria, Australia
| | - Helen Todd
- Domiciliary Care Service, Peninsula Health, Frankston, Victoria, Australia
| | - Cylie Williams
- Peninsula Health, Frankston, Victoria, Australia.,Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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27
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Greiman L, Fleming SP, Ward B, Myers A, Ravesloot C. Life Starts at Home: Bathing, Exertion and Participation for People With Mobility Impairment. Arch Phys Med Rehabil 2018; 99:1289-1294. [PMID: 29305848 DOI: 10.1016/j.apmr.2017.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/13/2017] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the relationship between perceived exertion while bathing/dressing/grooming and associations with social-recreational activities outside the home for individuals with mobility impairment (MI). DESIGN A 2-study approach was used to examine data from the American Time Use Survey (ATUS) and primary data from the Health and Home Survey (HHS). The relationship between bathing/dressing/grooming and engagement in social-recreational activities was explored, as well as the role that exertion in the bathroom may play in participation in these activities. SETTING General community setting. PARTICIPANTS For the ATUS survey, participants (n=6002) included individuals who reported an MI. For the HHS, 2 mail-based recruitment methods were used to recruit a sample of individuals with MI (n=170) across 3 geographically diverse U.S. communities. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation in social and recreational activities. RESULTS People with MI (relative to those without MI) were less likely to report spending any time bathing/dressing/grooming on a given day, but spent more time when they did. People with MI reported higher exertion while bathing/dressing/grooming than people without. People with MI were less likely to leave the house or engage in social-recreational activities on days where they did not engage in bathing activities. People who reported greater exertion in the bathroom engaged in fewer social-recreational activities. CONCLUSIONS Exertion in the bathroom may present a barrier to participation, indicating a relationship between exertion in the bathroom and social-recreational participation. Research that examines the impact of home modifications on exertion and participation is needed.
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Affiliation(s)
- Lillie Greiman
- University of Montana Rural Institute for Inclusive Communities, Missoula, MT.
| | | | - Bryce Ward
- University of Montana, Bureau of Business and Economic Research, Missoula, MT
| | - Andrew Myers
- University of Montana Rural Institute for Inclusive Communities, Missoula, MT
| | - Craig Ravesloot
- University of Montana Rural Institute for Inclusive Communities, Missoula, MT
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Falls and Fear of Falling among Persons Who Receive Housing Adaptations-Results from a Quasi-Experimental Study in Sweden. Healthcare (Basel) 2017; 5:healthcare5040066. [PMID: 28961158 PMCID: PMC5746700 DOI: 10.3390/healthcare5040066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 11/23/2022] Open
Abstract
While health might deteriorate through the ageing and disablement process, the impacts of disability can be reduced by adapting the environment. This study aimed to investigate the effects of applying a standardized research-based strategy to housing adaptation as compared to ordinary practice with respect to falls and fear of falling. Another aim was to investigate the overall effects of housing adaptations on fall-related outcomes over time. In total, 196 clients were included at baseline, with follow-up at 3 and 6 months after the housing adaptation was implemented. The only significant difference between the two approaches was identified with respect to fear of falling at 3 months after the housing adaptation, but not after 6 months. The number of clients reporting actual falls increased over time in both sites, whereas the number of reported near-falls decreased most in the intervention site, but without significant differences. Thus, the patterns of differences between the sites are inconsistent, as are the patterns of change in fall-related outcomes. An overall conclusion is that if the goal is to improve fall-related outcomes, housing adaptation should be complemented with other interventions preventing falls and explicitly address the clients’ activity limitations. In addition, longer follow-up times are necessary.
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29
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Home Features and Assistive Technology for the Home-Bound Elderly in a Thai Suburban Community by Applying the International Classification of Functioning, Disability, and Health. J Aging Res 2017; 2017:2865960. [PMID: 28656108 PMCID: PMC5471586 DOI: 10.1155/2017/2865960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/30/2017] [Accepted: 05/09/2017] [Indexed: 11/17/2022] Open
Abstract
The ageing population is having an impact worldwide and has created a serious challenge in Thailand's healthcare systems, whereby healthcare practitioners play a major role in promoting independent interaction of their client's abilities, as well as environmental factors. The purpose of this study was to survey features of the home and assistive technology (AT) for the home-bound elderly in the community of Chiang Mai, Thailand. Home evaluation included features inside and outside the home, and AT was based on the International Classification of Functioning, Disability, and Health (ICF) concept. Methods included observation and an interview that were used by the researcher for evaluation. The study found that every home had at least one hazardous home feature such as inappropriate width of the door, high door threshold, tall stair steps, no bedside rail, and inappropriate height of the toilet pan. AT was found in houses as general products and technology for personal use in daily living and for personal indoor and outdoor mobility as well as transportation. Therefore, home features and AT can afford the home-bound elderly independent living within the community. Perspective AT according to the ICF concept could provide a common language for ageing in place benefits.
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Yu J, Rosenberg MW. "No place like home": Aging in post-reform Beijing. Health Place 2017; 46:192-200. [PMID: 28551567 DOI: 10.1016/j.healthplace.2017.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
This study shows the Western theorization and interpretation of aging, place and health are not well suited to a non-western case. The current generation of older Chinese has experienced the transition from a planned economy to a socialist market economy. Urban changes have taken place in various ways. This study explains the spatio-temporal processes of older people with their changing places by conducting in-depth interviews with 47 older people living at home in Beijing. Their generational consciousness and old place identities are deeply rooted in pre-reform Collectivism and shaped by socialist ideologies of the past. The representation of the old identity among older people is circumscribed by their living situations and selectively manifested. In most cases, there are limited mechanisms formed to recreate positive place meanings and reintegrate older people and place. The processes reflect the growing social inequality and changing cultural values in a society in transition. Growing social inequality and changing cultural values have a great impact on older people's health and well-being.
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Affiliation(s)
- Jie Yu
- Department of Health Ethics and Society, Maastricht University, The Netherlands.
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Stark S, Keglovits M, Arbesman M, Lieberman D. Effect of Home Modification Interventions on the Participation of Community-Dwelling Adults With Health Conditions: A Systematic Review. Am J Occup Ther 2017; 71:7102290010p1-7102290010p11. [PMID: 28218595 DOI: 10.5014/ajot.2017.018887] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review investigated the role of home modification interventions to improve participation outcomes for community-living adults and older adults. METHOD Thirty-six articles met the inclusion criteria. The majority of the studies investigated older adult populations and used occupational therapists as interventionists. RESULTS Strong evidence was found for home modification interventions to improve function for people with a variety of health conditions and for both single and multicomponent interventions that included home modifications to reduce the rate and risk of falls among older adults. Moderate evidence was found for improved caregiving for people with dementia. CONCLUSION Comprehensive, higher intensity interventions demonstrated greater efficacy to improve occupational performance. Emerging evidence was also found for the role of occupational therapy in providing effective home modification interventions. Implications for occupational therapy practice, education, and research are discussed.
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Affiliation(s)
- Susan Stark
- Susan Stark, PhD, OTR/L, FAOTA, is Assistant Professor of Occupational Therapy, Neurology, and Social Work, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO;
| | - Marian Keglovits
- Marian Keglovits, OTD, MSCI, OTR/L, is Occupational Therapist, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, is Methodology Consultant, Evidence-Based Practice Project, American Occupational Therapy Association, Bethesda, MD; President, Arbesideas, Inc., Williamsville, NY; and Adjunct Associate Professor, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Deborah Lieberman
- Deborah Lieberman, MSHA, OTR/L, FAOTA, is Director, Evidence-Based Practice Project, and Staff Liaison to the Commission on Practice, American Occupational Therapy Association, Bethesda, MD
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Granbom M, Taei A, Ekstam L. Cohabitants’ perspective on housing adaptations: a piece of the puzzle. Scand J Caring Sci 2017; 31:805-813. [DOI: 10.1111/scs.12400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Lisa Ekstam
- Department of Health Sciences; Lund University; Lund Sweden
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Pettersson C, Slaug B, Granbom M, Kylberg M, Iwarsson S. Housing accessibility for senior citizens in Sweden: Estimation of the effects of targeted elimination of environmental barriers. Scand J Occup Ther 2017; 25:407-418. [PMID: 28114837 DOI: 10.1080/11038128.2017.1280078] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To estimate the effects of targeted elimination of environmental barriers (EB) in the ordinary housing stock in Sweden, and to explore the estimated effects on accessibility at a population level in relation to (a) residents with different functional profiles, (b) different housing types and (c) building periods. METHOD Data on dwellings from existing Swedish research databases were utilized. EB and accessibility were assessed by means of the Housing Enabler instrument. In simulations of EB removal, five items that correspond to the most common housing adaptations were selected. The simulations were applied to four functional profiles of different complexity. RESULT EB known to be commonly removed by housing adaptations exist in large proportions of the existing ordinary housing stock. Estimated targeted elimination of selected barriers would have the largest accessibility effects for the more complex functional profiles. The effects would be consistently larger for one-family houses, and for all types of dwellings built before 1960. CONCLUSIONS The elimination of the EB most commonly addressed by housing adaptations could result in a reduction of the housing accessibility problems that community-living older people are facing. For society to solve the housing situation for the ageing population well-informed and efficient upgrading of ordinary housing is imperative.
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Affiliation(s)
| | - Björn Slaug
- a Department of Health Sciences , Lund University , Lund , Sweden
| | - Marianne Granbom
- a Department of Health Sciences , Lund University , Lund , Sweden
| | - Marianne Kylberg
- a Department of Health Sciences , Lund University , Lund , Sweden
| | - Susanne Iwarsson
- a Department of Health Sciences , Lund University , Lund , Sweden
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Labbé D, Jutras S, Coulombe S. Perceptions on well-being at home of families with people with disabilities: A psycho-environmental perspective. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2017. [DOI: 10.1016/j.erap.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ekstam L, Fänge AM, Carlsson G. Negotiating Control: From Recognizing a Need to Making a Decision to Apply for a Housing Adaptation. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/02763893.2016.1224788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lisa Ekstam
- Department of Health Sciences, Lund University, Lund, Sweden
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Meucci MR, Gozalo P, Dosa D, Allen SM. Variation in the Presence of Simple Home Modifications of Older Americans: Findings from the National Health and Aging Trends Study. J Am Geriatr Soc 2016; 64:2081-2087. [PMID: 27550315 DOI: 10.1111/jgs.14252] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the association between sociodemographic and economic factors and the presence of simple home modifications (HMs) among older adults in the United States. DESIGN Cross-sectional. SETTING National Health and Aging Trends Study (2011, Round 1). PARTICIPANTS Community-dwelling Medicare enrollees aged 65 and older (N = 6,628). MEASUREMENTS The primary dependent variable was the reported presence or absence of simple HMs (grab bars in the shower or near the toilet, shower seats, raised toilet seats). RESULTS Of the individuals sampled, 60.7% reported having at least one HM of interest. Black (odds ratio (OR) = 0.79, 95% confidence interval (CI) = 0.68-0.91) and Hispanic (OR = 0.60, 95% CI = 0.45-0.78) respondents were less likely than white, non-Hispanic respondents to have HMs. Those with more education (high school graduate: OR = 1.20, 95% CI = 1.01-1.42; >high school: OR = 1.36, 95% CI = 1.14-1.62) and larger social networks (≥4 people; OR = 1.46, 95% CI = 1.12-1.89) were more likely to have at least one HM, whereas being divorced (OR = 0.57, 95% CI = 0.43-0.74) was associated with lower likelihood. Income (OR = 1.01, 95% CI = 0.97-1.05), Medicaid enrollment (OR = 0.98, 95% CI = 0.77-1.25), and living alone (OR = 1.02, 95% CI = 0.85-1.23) were not significantly associated with the presence of HMs. CONCLUSION Minorities, individuals with less education, and those with less social support are less likely to have HMs. Awareness of these disparities and the shortcomings of the HM delivery system is important to clinicians and policy-makers who seek to prevent falls and facilitate aging in place for all older Americans.
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Affiliation(s)
- Marissa R Meucci
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.
| | - Pedro Gozalo
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - David Dosa
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.,Department of Medicine, Warren Albert Medical School, Brown University, Providence, Rhode Island.,Providence Veterans Administration Medical Center, Health Services Research Program, Providence, Rhode Island
| | - Susan M Allen
- Department of Health Services Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island.,Providence Veterans Administration Medical Center, Health Services Research Program, Providence, Rhode Island
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Cho HY, MacLachlan M, Clarke M, Mannan H. Accessible Home Environments for People with Functional Limitations: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E826. [PMID: 27548194 PMCID: PMC4997512 DOI: 10.3390/ijerph13080826] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 11/17/2022]
Abstract
The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.
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Affiliation(s)
- Hea Young Cho
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Malcolm MacLachlan
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.
- School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland.
- Centre for Rehabilitation Studies, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch 7602, South Africa.
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc 77111, Czech Republic.
| | - Michael Clarke
- Northern Ireland Network for Trials Methodology Research, Centre for Public Health, Queen's University Belfast, Belfast BT126BA, UK.
| | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
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Zhang L, Yan T, You L, Li K, Gao Y. Social Isolation and Physical Barriers in the Houses of Stroke Survivors in Rural China. Arch Phys Med Rehabil 2016; 97:2054-2060. [PMID: 27485365 DOI: 10.1016/j.apmr.2016.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the home barriers and social isolation of stroke survivors in the rural areas of China and to explore which home barriers are associated with social isolation. DESIGN Cross-sectional survey. SETTING Structured interviews and observation in the participants' homes. PARTICIPANTS Community-dwelling stroke survivors in the rural areas of China (N=818). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical barriers in rural homes were surveyed using a home fall hazards assessment. Social isolation was identified if ≥2 of the following indicators were observed: low frequency of getting out of the home, lacking leisure activities, and living alone in the previous 3 months. RESULTS The prevalence rates of 18 among 30 home barriers were >20%, and the highest was 93% (lack of handrails in the bathroom). The prevalence of social isolation was 30%. Three home barriers were independently related to social isolation. These were a distant toilet (odds ratio [OR], 2.363; 95% confidence interval [CI], 1.527-3.658; P<.001), unsuitable seating (OR, 1.571; 95% CI, 1.026-2.404; P=.038), and inaccessible light switches (OR, 1.572; 95% CI, 1.064-2.324; P=.023). CONCLUSIONS Many barriers exist in the houses of stroke survivors in rural China. Some of them are related to social isolation. Eliminating or decreasing home barriers could be a feasible and effective approach to reducing social isolation.
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Affiliation(s)
- Lifang Zhang
- School of Nursing, Youjiang Medical College for Nationalities, Baise, China; School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tiebin Yan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Liming You
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yan Gao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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Thordardottir B, Ekstam L, Chiatti C, Fänge AM. Factors associated with participation frequency and satisfaction among people applying for a housing adaptation grant. Scand J Occup Ther 2016; 23:347-56. [PMID: 26853519 DOI: 10.3109/11038128.2016.1139622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People applying for a housing adaptation (HA) grant are at great risk of participation restrictions due to declining capacity and environmental barriers. AIM To investigate the association of person-, environment-, and activity-related factors with participation frequency and satisfaction among people applying for a housing adaptation grant. MATERIAL AND METHODS Baseline cross-sectional data were collected during home visits (n = 128). The association between person-, environment-, and activity-related factors and participation frequency and satisfaction was analysed using logistic regressions. RESULTS The main result is that frequency of participation outside the home is strongly associated with dependence in activities of daily living (ADL) and cognitive impairments, while satisfaction with participation outside the home is strongly associated with self-reported health. Moreover, aspects of usability in the home were associated with frequency of participation outside the home and satisfaction with participation in the home and outside the home alone. CONCLUSION Dependence in ADL, cognitive impairments, self-rated health, and aspects of usability are important factors contributing to participation frequency and satisfaction among people applying for a housing adaptation grant, particularly outside the home. SIGNIFICANCE Our findings indicate that more attention should be directed towards activity-related factors to facilitate participation among HA applicants, inside and outside the home.
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Affiliation(s)
- Björg Thordardottir
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
| | - Lisa Ekstam
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden
| | - Carlos Chiatti
- a Department of Health Sciences, Faculty of Medicine , Lund University , Sweden ;,b Scientific Direction , Italian National Research Centre on Ageing (INRCA) , Italy
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Thordardottir B, Chiatti C, Ekstam L, Malmgren Fänge A. Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden--Relationship to Participation and Self-Rated Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010091. [PMID: 26729145 PMCID: PMC4730482 DOI: 10.3390/ijerph13010091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 01/14/2023]
Abstract
The aim of the paper was to explore the heterogeneity among housing adaptation clients. Cluster analysis was performed using baseline data from applicants in three Swedish municipalities. The analysis identified six main groups: “adults at risk of disability”, “young old with disabilities”, “well-functioning older adults”, “frail older adults”, “frail older with moderate cognitive impairments” and “resilient oldest old”. The clusters differed significantly in terms of participation frequency and satisfaction in and outside the home as well as in terms of self-rated health. The identification of clusters in a heterogeneous sample served the purpose of finding groups with different characteristics, including participation and self-rated health which could be used to facilitate targeted home-based interventions. The findings indicate that housing adaptions should take person/environment/activity specific characteristics into consideration so that they may fully serve the purpose of facilitating independent living, as well as enhancing participation and health.
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Affiliation(s)
- Björg Thordardottir
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
| | - Carlos Chiatti
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
- Italian National Research Center on Aging, Via S. Margherita 5, Ancona 60124, Italy.
| | - Lisa Ekstam
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, Lund 221 00, Sweden.
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Hedman A, Nygård L, Malinowsky C, Almkvist O, Kottorp A. Changing everyday activities and technology use in mild cognitive impairment. Br J Occup Ther 2015. [DOI: 10.1177/0308022615586800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Knowledge of the conditions under which older adults facing cognitive decline engage in everyday activities is of major importance for occupational therapists in designing supportive interventions. This study aimed to investigate perceived activity involvement over time and its longitudinal relationship to perceived ability to use everyday technology in older adults with mild cognitive impairment. Method Thirty-seven older adults with mild cognitive impairment at inclusion were assessed over 4 years. Overall and item-specific activity involvement were analyzed using mixed-linear-effect modeling and differential item functioning. Furthermore, overall activity involvement and ability in everyday technology use were correlated. Results Overall activity involvement decreased significantly over time. When adjusting for declining ability in the sample, actual differential item functioning indicated descending involvement in seven of 15 activities, while eight activities were stable. All leisure activities descended. The positive correlations between activity involvement and ability in everyday technology use became stronger over time. Conclusion Variations across activities and time-points suggest that occupational therapists should repeatedly monitor the increasingly associated aspects of activity involvement and ability to use everyday technology in persons with cognitive decline.
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Affiliation(s)
- Annicka Hedman
- PhD Lecturer, Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Louise Nygård
- Professor of Occupational Therapy, Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Camilla Malinowsky
- PhD Lecturer, Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Ove Almkvist
- Associate Professor, Division of Translational Alzheimer Neurobiology, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Professor, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Anders Kottorp
- Associate Professor, Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Professor, Department of Occupational Therapy, University of Illinois, Chicago, United States
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Jepson P, Sands G, Beswick AD, Davis ET, Blom AW, Sackley CM. A feasibility randomised controlled trial of pre-operative occupational therapy to optimise recovery for patients undergoing primary total hip replacement for osteoarthritis (PROOF-THR). Clin Rehabil 2015; 30:156-66. [PMID: 25795459 DOI: 10.1177/0269215515576811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/18/2015] [Indexed: 01/24/2023]
Abstract
Objective: To assess the feasibility of a pre-operative occupational therapy intervention for patients undergoing primary total hip replacement. Design: Single blinded feasibility randomised controlled trial, with data collection prior to the intervention, and at 4, 12, and 26 weeks following surgery. Setting: Recruitment from two NHS orthopaedic outpatient centres in the West Midlands, UK. Subjects: Patients awaiting primary total hip replacement due to osteoarthritis were recruited. Following pre-operative assessment, patients were individually randomised to intervention or control by a computer-generated block randomisation algorithm stratified by age and centre. Interventions: The intervention group received a pre-surgery home visit by an occupational therapist who discussed expectations, assessed home safety, and provided appropriate adaptive equipment. The control group received treatment as usual. Outcomes: The study assessed the feasibility of recruitment procedures, delivery of the intervention, appropriateness of outcome measures and data collection methods. Health related quality of life and resource use were recorded at 4, 12 and 26 weeks. Results: Forty-four participants were recruited, 21 were randomised to the occupational therapy intervention and 23 to usual care. Analysis of 26 week data included 18 participants in the intervention group and 21 in the control. The intervention was delivered successfully with no withdrawals or crossovers; 5/44 were lost to follow-up with further missing data for participation and resource use. Conclusions: The feasibility study provided the information required to conduct a definitive trial. Burden of assessment would need to be addressed. A total of 219 patients would be required in an efficacy trial.
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Affiliation(s)
- Paul Jepson
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK
| | - Gina Sands
- CLAHRC-EM, School of Medicine, University of Nottingham, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - Edward T Davis
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Birmingham, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
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Ekstam L, Carlsson G, Chiatti C, Nilsson MH, Malmgren Fänge A. A research-based strategy for managing housing adaptations: study protocol for a quasi-experimental trial. BMC Health Serv Res 2014; 14:602. [PMID: 25432718 PMCID: PMC4256922 DOI: 10.1186/s12913-014-0602-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 11/14/2014] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The primary aim of this paper is to describe the design of a project evaluating the effects of using a research-based strategy for managing housing adaptations (HAs). The evaluation targets clients' perspectives in terms of activity, participation, usability, fear of falling, fall incidence, use of mobility devices, and health-related quality of life, and determines the societal effects of HAs in terms of costs. Additional aims of the project are to explore and describe this strategy in relation to experiences and expectations (a) among clients and cohabitants and (b) occupational therapists in ordinary practice. METHODS/DESIGN This study is a quasi-experimental trial applying a multiphase design, combining quantitative and qualitative data. At the experimental sites, the occupational therapists (OTs) apply the intervention, i.e. a standardized research-based strategy for HA case management. At the control site, the occupational therapists are following their regular routine in relation to HA. Three municipalities in south Sweden will be included based on their population, their geographical dispersion, and their similar organizational structures for HA administration. Identical data on outcomes is being collected at all the sites at the same four time points: before the HA and then 3, 6, and 12 months after the HA. The data-collection methods are semi-structured qualitative interviews, observations, clinical assessments, and certificates related to each client's HA. DISCUSSION The intervention in this study has been developed and tested through many years of research and in collaboration with practitioners. This process includes methodological development and testing research aimed at identifying the most important outcomes and research targeting current HA case-management procedures in Swedish municipalities. When the study is completed, the results will be used for further optimization of the practice strategy for HA, in close collaboration with the data-collecting OTs. TRIAL REGISTRATION No: NCT01960582.
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The ideal neighbourhood for ageing in place as perceived by frail and non-frail community-dwelling older people. AGEING & SOCIETY 2014. [DOI: 10.1017/s0144686x14000622] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTDue to demographic changes and a widely supported policy of ageing in place, the number of community-dwelling older people will increase immensely. Thus, supportive neighbourhoods enabling older people to age in place successfully are required. Using Q-methodology, we examined older people's perceptions of the comparative importance of neighbourhood characteristics for ageing in place. Based on the World Health Organization's Global Age-friendly Cities guide, we developed 26 statements about physical and social neighbourhood characteristics. Thirty-two older people in Rotterdam, half of whom were frail, rank-ordered these statements. Q-factor analysis revealed three distinct viewpoints each among frail and non-frail older people. Comparisons within and between groups are discussed. Although both frail and non-frail older people strongly desired a neighbourhood enabling them to age in place, they have divergent views on such a neighbourhood. Older people's dependence on the neighbourhood seems to be dynamic, affected by changing social and physical conditions and levels of frailty.
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Lerdal A, Kottorp A, Gay CL, Lee KA. Lee Fatigue And Energy Scales: exploring aspects of validity in a sample of women with HIV using an application of a Rasch model. Psychiatry Res 2013; 205:241-6. [PMID: 22985544 PMCID: PMC3540121 DOI: 10.1016/j.psychres.2012.08.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/12/2012] [Accepted: 08/26/2012] [Indexed: 01/14/2023]
Abstract
This study examines the psychometric properties of the Lee Fatigue and Energy Scales (visual analog version) using a Rasch model application. The relationship between fatigue and energy is also described for a convenience sample of 102 women with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who completed the Lee Fatigue and Energy Scales in the morning and evening. Both scales were assessed for internal scale validity, unidimensionality, and uniform differential item functioning in relation to morning and evening ratings. Analyses confirmed that both the Fatigue and Energy Scales demonstrated evidence of internal scale validity and unidimensionality. Mean fatigue measures were also higher in the evening than in the morning and mean energy measures were higher in the morning than in the evening (both p<0.001), indicating that time of day is an important consideration. Fatigue and energy measures were moderately correlated with each other in the morning but not in the evening. The concepts of energy and fatigue were inversely related, but not polar opposites in this sample. Fatigue and energy may therefore be distinct constructs that should not be used interchangeably, either in measurement or when interpreting outcomes for research or clinical purposes.
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Affiliation(s)
| | - Anders Kottorp
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Caryl L. Gay
- Lovisenberg Diakonale Hospital, Oslo, Norway,Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Kathryn A. Lee
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
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Aplin T, de Jonge D, Gustafsson L. Understanding the dimensions of home that impact on home modification decision making. Aust Occup Ther J 2013; 60:101-9. [PMID: 23551003 DOI: 10.1111/1440-1630.12022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIM The home environment is a multidimensional and personally meaningful place, and the complexity of this environment often impacts on the home modification process and outcomes. Home modifications can appear as a straightforward solution to safety and occupational performance concerns; nevertheless, clients sometimes reject modifications or are unsatisfied with the completed works. To understand this phenomenon, this study aimed to determine what aspects of the home environment impact home modification decision making. METHOD In this qualitative descriptive study, 42 in-depth interviews using a semi-structured questionnaire were undertaken and analysed using a template analysis. The interviews explored the experience of the home modification process, including concerns and the decisions made about the modifications. FINDINGS Four dimensions of the home environment were commonly found to affect decision making namely, the personal, societal, physical and temporal dimensions of home as well as social and occupational dimensions. CONCLUSIONS An understanding of the dimensions of home that impact decision making provides occupational therapists with a greater appreciation of the experience of home and allows them to enhance the effectiveness and acceptance of home modifications.
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Affiliation(s)
- Tammy Aplin
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia.
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Sheffield C, Smith CA, Becker M. Evaluation of an agency-based occupational therapy intervention to facilitate aging in place. THE GERONTOLOGIST 2012; 53:907-18. [PMID: 23213082 DOI: 10.1093/geront/gns145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The United States faces a growing population of older adults and accompanying functional disabilities, coupled with constrained public resources and diminishing informal supports. A variety of interventions that aim to improve client outcomes have been studied, but to date, there is limited translational research that examines the efficacy of moving such interventions from clinical trials to agency settings. METHODS A randomized controlled trial was conducted to evaluate a restorative occupational therapy intervention relative to "usual care" among community-dwelling older adults. The intervention included a detailed assessment from a person-environment perspective and provision of adaptive equipment and home modifications where appropriate. The intervention (n = 31) and control groups (n = 29) were evaluated at 3 months and assessed for changes in functional status, home safety, falls, health-related quality of life (HRQoL; EQ5D), depression, social support, and fear of falling; a 4 subgroup analysis also examined outcomes by waiting list status. An informal economic evaluation compared the intervention to usual care. RESULTS Findings indicated improvements in home safety (p < .0005, b = -15.87), HRQoL (p = .03, b = 0.08), and fear of falling (p < .05, b = 2.22). Findings did not show improvement in functional status or reduction in actual falls. The intervention resulted in a 39% reduction in recommended hours of personal care, which if implemented, could result in significant cost savings. IMPLICATIONS The study adds to the growing literature of occupational therapy interventions for older adults, and the findings support the concept that restorative approaches can be successfully implemented in public agencies.
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Affiliation(s)
- Chava Sheffield
- *Address correspondence to Mary Becker, Howard County Office on Aging, 6751 Columbia Gateway Drive, Columbia, MD 21046. E-mail:
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Fänge AM, Lindberg K, Iwarsson S. Housing adaptations from the perspectives of Swedish occupational therapists. Scand J Occup Ther 2012; 20:228-40. [PMID: 23095046 DOI: 10.3109/11038128.2012.737368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to investigate how occupational therapists in Sweden administer housing adaptation cases, how they perceive the housing adaptation process, and which improvements they consider necessary. METHODS A total of 1 679 occupational therapists employed by the county councils or the local authorities (and involved in housing adaptations) participated in a web-based survey. The survey targeted issues related to referral and needs identification, assessment, certification, case progress feedback, and evaluation. RESULTS Less than half of the occupational therapists systematized the assessment prior to intervention and very few conducted any evaluation afterwards. Feedback from workmen or grant managers to the occupational therapists on each case's adaptation progress was often asked for but rarely given. The majority of the participants were satisfied with the housing adaptation process in general, while at the same time they indicated a need for further improvements in the process. Differences between occupational therapists related to employer and year of graduation were found on the majority of the targeted issues. CONCLUSIONS To conclude, to a very large extent housing adaptations seem to be based on non-standardized procedures for assessment, and only a few of them are evaluated systematically.
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Kottorp A, Ekstam L, Petersson Lie I. Differences in awareness between persons with left and right hemispheric stroke. Scand J Occup Ther 2012; 20:37-44. [DOI: 10.3109/11038128.2012.688864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation. Crit Care Med 2012; 40:1088-97. [PMID: 22080631 DOI: 10.1097/ccm.0b013e3182373115] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. METHODS This was a single-site, feasibility, pilot, randomized trial of 21 general medical/surgical intensive care unit survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation), whereas intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months), with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. RESULTS Patients tolerated the program with only one adverse event reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test (for planning and strategic thinking) vs. controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5 [4.0-8.5]; adjusted p < .01). Intervention group patients also reported better performance (i.e., lower score) on one of the most frequently used measures of functional status (Functional Activities Questionnaire at 3 months vs. controls, 1.0 [0.0 -3.0] vs. 8.0 [6.0-11.8], adjusted p = .04). CONCLUSIONS A multicomponent rehabilitation program for intensive care unit survivors combining cognitive, physical, and functional training appears feasible and possibly effective in improving cognitive performance and functional outcomes in just 3 months. Future investigations with a larger sample size should be conducted to build on this pilot feasibility program and to confirm these results, as well as to elucidate the elements of rehabilitation contributing most to improved outcomes.
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