Being part of an unfolding story: togetherness in everyday occupations when ageing

The importance of context-a qualitative study exploring healthcare practitioners' experiences of working with patients at home after a stroke

BACKGROUND

Stroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients' homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients' records.

METHODS

Eight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients' opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.

RESULTS

The analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient's self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.

CONCLUSIONS

Our research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.

Feasibility of a reablement-program in a Swedish municipality

BACKGROUND

While occupational therapists (OT) and physiotherapists (PT) have a central role in reablement, no structured approach for these professions has been described in Sweden.

AIMS/OBJECTIVES

The aim was to explore the feasibility of a reablement program developed to guide OTs and PTs in a Swedish municipality context.

MATERIAL AND METHODS

Eligible participants were OTs and PTs working with reablement. Feasibility was evaluated in terms of how OTs (n = 16) and PTs (n = 15) experienced the application of the program. Data were collected through web surveys during a pilot study over four months.

RESULTS

The program was implemented for 62 clients. Baseline assessments were conducted in 97% of all cases and follow-ups in 77%. The average duration of the program was 8 weeks and includeed 5 home visits and 3 contacts by phone. In 15 cases, a new goal was identified after follow-up. Collaboration was included with other professionals and relatives in 89% and 35% of the cases, respectively. The program was categorized as feasible to some extent in 34 cases and not feasible in 21 cases.

CONCLUSIONS AND SIGNIFICANCE

The program was feasible to some extent. To enhance feasibility, flexibility may be needed in order to tailor assessments according to the client's health status.

Experiences of Active Everyday Life Among Persons with Prodromal Alzheimer’s Disease: A Qualitative Study

Introduction

Identifying strategies to prevent or delay cognitive decline among the rising numbers of elderly is acknowledged as a global public health priority. Research suggests that an active lifestyle in terms of participation in activities has the potential to reduce the risk of later-life cognitive decline. The concept of “active everyday life”, however, needs to be further explored.

Aim

The study aimed to explore and describe the active everyday lives of persons with prodromal Alzheimer’s disease (AD) in terms of quality of participation in activities and perceived restrictions.

Methods

This qualitative study was part of a larger project, the MIND-AD_MINI trial. Nine in-depth interviews were conducted with seven participants (2 males, 5 females; mean age of 72.3) at baseline before the intervention. The data were collected from January to October 2018 and analyzed using the grounded theory approach.

Results

Four categories emerged from the analysis: (i) active body and mind; (ii) doing desired meaningful activities to feel engaged, contented, and satisfied; (iii) doing in the context of being connected to others; (iv) ability in making decisions and taking actions. From these categories, which presented the key elements of an active everyday life, a core category was identified: Living a complete life in flow.

Conclusion

The findings suggest key elements of participation quality that contribute to an active life. The identified elements are important to be considered in rehabilitation to provide opportunities and possibilities for participation to enable and improve the quality of participation among persons with cognitive impairments.

Older adults' experiences of maintaining social participation: Creating opportunities and striving to adapt to changing situations

BACKGROUND

Social participation concerns the possibility of engaging in activities in interaction with others or society at large and contributes to the health and well-being of older adults. In contrast, a lack of social participation is associated with loneliness. It is, therefore, important to understand what strategies older adults use to maintain social participation.

AIM

To explore and describe older adults' experiences of maintaining social participation.

MATERIALS AND METHODS

Nine older adults, aged 69-92 years, participated in interviews that were analysed through qualitative content analysis.

RESULTS

The overall findings reflect how older adults create opportunities for social participation by developing strategies and striving to adapt to changing situations, emphasizing how maintaining social participation is an active process. Preserving social participation requires motivation and an effort to take initiative to cultivate social relations, maintain community bonds, engage in social events and activities and stay connected with society.

CONCLUSIONS AND SIGNIFICANCE

These results may extend our understanding of strategies that older adults use, as well as the challenges they face when striving to adapt to new circumstances. This study may have implications for the practice of how to support older adults' social participation.

Loneliness in assisted living facilities: An exploration of the group process

BACKGROUND

More than one in three older people in assisted living facilities suffer from loneliness that leads to adverse health outcomes. Group work may have the potential to improve residents' quality of life.

AIMS/OBJECTIVES

The purpose of this feasibility study was to thoroughly describe a facilitated group process and compare its effects on cognitively impaired (n = 6) and cognitively intact (n = 7) lonely resident groups in assisted living facilities.

MATERIAL AND METHODS

We used a closed, occupational therapy-oriented group model designed for lonely people. The study used a qualitative, multi-method approach. Material included individual and focus group interviews, observations and the facilitators' field diaries.

RESULTS

Loneliness was reflected in diverse ways in both groups. Meaningful activities in mutual interaction played an important role in empowering the participants and enabling the development of the group process. Group processes had similar, parallel steps, from which the participants seemed to benefit. Surprisingly, the cognitively impaired group progressed towards self-direction more quickly than the cognitively intact group.

CONCLUSIONS

A group process with clearly progressing steps revealed that lonely older people are capable of empowerment and self-direction - despite their frailty and cognitive impairment. Facilitators should be familiar with group processes to enable them to progress effectively.

Design of a Mindfulness Virtual Community: A focus-group analysis

Mental illnesses are on the rise on campuses worldwide. There is a need for a scalable and economically sound innovation to address these mental health challenges. The aim of this study was to explore university students' needs and concerns in relation to an online mental health virtual community. Eight focus groups (N = 72, 55.6% female) were conducted with university students aged 18-47 (mean = 23.38, SD = 5.82) years. Participants were asked about their views in relation to online mental health platform. Three major themes and subthemes emerged: (1) perceived concerns: potential loss of personal encounter and relationships, fear of cyber bullying, engagement challenge, and privacy and distraction; (2) perceived advantages: anonymity and privacy, convenience and flexibility, filling a gap, and togetherness; and (3) desired features: user-centered design, practical trustworthy support, and online moderation. The analysis informed design features for a mindfulness virtual community.

Early Hour, Golden Hour: an Exploration of Slovenian Older People's Meaningful Occupations

People are occupational beings and enabling older people to engage in meaningful occupations contributes to their health and well-being. Experiences of engagement and meaning in an occupation may differ in different socio-cultural contexts. The aim of this study was to explore Slovenian older people's individual experiences of engagement in occupation, with a particular emphasis on their meaningful occupations. The study employed a phenomenological research approach. Semi-structured interviews were conducted with ten Slovenian older adults, living independently in their home environment. Interpretative Phenomenological Analysis was used to approach and analyze the data. The findings highlighted that meaningful occupations and daily rituals represented an important part of the participants' identities. The meanings they attached to their occupations were informed by Slovenian socio-cultural, historical and physical context. A range of people and places were identified as significant in generating and maintaining these meanings. Participants gave particular significance to the role of productive, health-promoting and family-related occupations. The study contributes new occupational science knowledge and the findings support the case for increased recognition of the importance of meaningful occupation for older people.

Strategies of older couples to sustain togetherness

The aim of this study was to explore how elderly couples, who are in need of social services in the community, act and reason over time regarding their everyday togetherness. Data were generated through repeated interviews and participant observations with three older couples. A narrative method was used for data generation and analysis. The findings present four parallel narratives illustrating how the couples, over time, strove to continue living their lives in togetherness despite the many challenges that had emerged. These narratives show the complexity and variety of strategies that the couples adopted to handle different situations of everyday life and the couples' experiences and feelings connected to these situations. The strategies that the couples used resulted, for example, in performing more activities together in another way, using respite care and reorganizing their social interactions. The spousal caregiver had a leading role to manage day-to-day life and to initiate and perform the strategies. Simultaneously, an important reciprocity existed in their relationship that gave meaning to their efforts of sustaining togetherness. These findings give a deeper understanding of the complexity of their situation and of how meaning is created in their everyday life through enacted togetherness. The findings highlight the need for professionals within social services in the community to embrace a couple's whole situation, involving both partners.

Re-imagining occupational wellbeing: Development of an evidence-based framework

BACKGROUND/AIM

Occupational therapists concern themselves with understanding engagement in everyday activity as a mode of facilitating wellbeing. However, there appears to be little consensus within the literature as to how engagement in meaningful activities contributes to wellbeing. Currently, there are no published evidence-based frameworks for wellbeing to support occupational therapy practitioners to address wellbeing with clients. The purpose of the study was to establish an evidence-based contemporary framework, domains and descriptive statements defining occupational wellbeing.

METHODS

A multiphase, exploratory sequential mixed methods design, using both qualitative and quantitative approaches was used. Two phases were identified for data collection. The first phase involved exploration of the domains of occupational wellbeing, through conducting a literature review and two focus groups. The Delphi technique was employed in the second phase to refine and corroborate the domains of occupational wellbeing with an expert panel.

RESULTS

Six new domains of occupational wellbeing were generated in the first phase of the study, namely: Competence, autonomy, contentment and pleasure, identity, hope and belonging. In the second phase, five out of the six domains reached a consensus level of 70% or more. Hope was the only domain not to reach consensus.

CONCLUSION

The framework for occupational wellbeing produced by this study was created using evidence-based, replicable methodology and garnered support from a highly regarded expert key informant group of occupational therapy and occupational science academics. Further exploration to determine whether there is widespread support and applicability for these domains with normative and vulnerable population groups is required.

Altering the boundaries of everyday life in a nursing home context

BACKGROUND

Despite global and local policy frameworks that explicitly aim to privilege participation and active engagement of older adults living in nursing homes, this group often has limited possibilities to engage in occupations and to have influence in their everyday lives.

AIM

To explore how older adults' engagement and influence in an occupation can emerge in everyday life in a nursing home setting.

MATERIAL AND METHODS

A participatory qualitative approach was applied. Older adults living in a nursing home participated in a Book Club that was created collaboratively between researchers, residents, and the nursing home community.

FINDINGS

The analysis identified qualities of altering the boundaries of everyday life and addressing the uncertain conditions for influence and engagement as processes actualized by the residents when engaging in the Book Club. Further analysis identified how these processes involved ordinariness, familiarity, fellowship, and connectedness.

CONCLUSION AND SIGNIFICANCE

Engagement and influence in occupation in a nursing home is possible when enabling partnerships and resourcefulness among the residents. However, such enablement is not guaranteed and needs to be actively upheld by the nursing home community in order to build practices aligned with policy frameworks of participation.

Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement

This study focuses on influence that older adults, living in nursing homes, have over everyday activities. Everyday activities are key to sustain a sense of stability, predictability, and enjoyment in the local world of people's everyday and therefore a critical dimension of the person-centeredness framework applied within gerontology. This narrative ethnographic study aimed to shed light on how influence can be situated contextually, and how it can emerge through activities as well as how it is negotiated in everyday by frail older adults living in a nursing home. Residents, staff members, and significant others from one nursing home in an urban area of Sweden participated in this study. Data were gathered through fieldwork, including participant observation and formal and informal conversations during a period of 6 months. Data were analyzed through a narrative interpretative approach. The findings are presented in narrative form as exemplars. The exemplars-Craquelures as justification, Seeking a place for other life worlds and An almost perfect trip-reveal a gap between the client-centeredness framework and lived experiences regarding older adults' influence in everyday activities. The role of everyday activities in the context of frailty is discussed in terms of ethical and responsive engagement, and implications for health-care practices are considered.

Meanings and experiences associated with computer use of older immigrant adults of lower socioeconomic status: Les sens et les expériences associés à l'utilisation des ordinateurs chez les immigrants âgés ayant un faible statut socioéconomique

BACKGROUND

Immigrant older adults are a substantial demographic composing 12% to 30% of older adults in the United States and Canada, yet no research has addressed the meanings associated with computer use for low-socioeconomic-status and immigrant older adults.

PURPOSE

The study explored the meanings, occupational engagement, and experiences associated with computer use.

METHOD

A mixed-methods approach, qualitative participatory action research (photovoice) and survey (Computer Proficiency Questionnaire), was used. Data collection consisted of narratives, focus groups, and Likert scale responses for nine participants.

FINDINGS

The participants expressed the meanings they associated with computer use as freedom, personal growth, and engagement. Computers promote occupational engagement in social participation, education, and leisure.

IMPLICATIONS

The findings of personal growth may inform occupational therapy interventions using computers to enable adjustment to changes related to aging and wellness. Social participation and education were motivators for computer use, which may inform computer engagement strategies for this population.

Spousal caregivers' experiences of participation in everyday life when living in shifting contexts

BACKGROUND

To promote health and well-being, and to meet the desires of the growing elderly population to age in place, elderly spousal caregivers need adequate support such as respite care services. More knowledge is needed about elderly spousal caregivers' experiences in relation to participation, which is an aspect of health that remains relatively unexplored for this group.

AIM

To explore and describe how elderly spousal caregivers experience and discuss participation in everyday life when living in shifting contexts due to the use of respite care.

METHOD

A grounded theory approach was used during data generation and analysis, which involved repeated focus group interviews with 12 spousal caregivers.

RESULTS

Complexity and ambiguity was understood to imbue participation in everyday life. Being in charge of everyday life was challenging for spousal caregivers, and created a need for personal time. Respite care and home care service gave them time, although when interacting with social contexts other issues arose that influenced their own recovery.

CONCLUSIONS

A holistic 'situation centered' approach that focuses on the elderly couple's life story and needs might capture a wider perspective and enable adequate support that influences their health, well-being, and participation in everyday life.