Evolution of psychological distress with age and its determinants in later life: evidence from 17-wave social survey data in Japan.

BACKGROUND: Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied. METHODS: We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0-24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD. RESULTS: Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0-47.3%), 13.7% (95% CI: 8.2-19.3%), and 10.5% (95% CI: 8.0-13.0%), respectively; consequently increasing PD between 50 and 75 years. CONCLUSION: The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.

Exploring the challenges of social participation during COVID-19 in Saudi Arabia through an occupational therapy lens.

Aim: To measure the social participation of people in Saudi Arabia during the COVID-19 pandemic. Subject and methods: A cross-sectional survey was conducted among people in Saudi Arabia to measure their participation in social activities during the COVID-19 pandemic. A validated questionnaire of Social Participation Scale was used to collect data from five main regions in Saudi Arabia through social media platforms. Means, frequencies, and percentages were calculated through descriptive analysis. Mean scores and standard deviation of social participation of participants were also presented. Results: The total number of participants was 1,560 including Saudi (87.3%) and non-Saudi (12.7%) nationals. Most participants (60.2%) were female. The age of participants ranged between 16 and 24 years old. Around 62.1% of participants were married, 63.2% were educated, 48.4 were employed and 82% were from the Eastern region. Around 72% of participants earned <10,000 riyals per month compared to those (27.3%) who earned <5,000 riyals per month. A total 72.7% of the participants have been diagnosed by COVID-19. The mean score of social participation was 47.81 (SD = 0.27). Most participants (62.7%) reported that social participation was severely restricted. Around 68.2% of the participants were quarantined at the facilities. Conclusion: The social participation of people in Saudi Arabia had been severely restricted during the COVID-19 pandemic. An early assessment of people's social participation would help to identify their problems and needs, to help them improve their participation in social activities and thus increase their overall quality of life.

Predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities in Saudi Arabia: An observational study.

To examine predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities, a cross-sectional design was used. Participants were primary caregivers of children with developmental disabilities. Caregivers completed a demographic form about the child and the family, and the Arabic version of Patient-Reported Outcomes Measurement Information System-Profile 29 (PROMIS-29 v2.0). Descriptive statistics were used to report on demographic data, 1-sample Z tests to compare PROMIS domain scores with the general population, and multiple linear regression analyses to identify predictors of each domain. Participants were 111 primary caregivers, mostly mothers (65.8%). Caregivers reported higher levels of anxiety, depression, fatigue, sleep disturbance, and pain interference, and lower levels of physical function and social participation compared to the general population, P < .05. The regression models for predicting the HRQoL accounted for 12.3% of the variance in the physical function domain (P = .016), 13.9% in the anxiety domain (P = .009), 24.7% in the ability to engage in social activities and roles (P < .001), and 11.4% in the pain interference domain (P = .02). In these models, the severity of the child's disability and/or the child's age were common significant predictors. Specifically, child's age was the only significant predictor in 2 domains, the anxiety domain (ß = -.29, P < .01) and ability to participate in social activities and roles domain (ß = .42, P < .05). The severity of the child's disability was the only significant predictor in the physical function domain (ß = -.52, P < .01). Both the severity of the child's disability and the child's age were significant predictors in the pain interference model (ß = .40, P < .05), and (ß = -.23, P < .05), respectively. However, the models did not significantly predict depression, fatigue, or sleep disturbance, P > .05. HRQoL is a complex construct and is influenced by multiple child and family factors. Implications of the study emphasize the importance of regular HRQoL screening for caregivers, the development of efficient referral systems for support services, and the exploration of respite care options.

The transformation of 20-year social participation policies of older people in China: Network analysis and text analysis.

BACKGROUND: Social participation of older adults is a crucial component of China's aged care services and an important strategy for actively addressing the aging population. Analyzing policy texts on older people's social participation can inform future policy formulation and the development of relevant programs. OBJECTIVES: This study aims to quantitatively analyze the transformation of China's social participation policies for older people from 1999 to 2023, employing institutional network analysis and policy text analysis. METHOD: A two-dimensional policy analysis framework was constructed based on the perspective of "policy tools and social participation stages." Using Rost Content Mining 6.0 and Nvivo 11.0 Plus software, 55 national-level policy texts were coded. Structural analysis of policy-issuing subjects and topic words was conducted to visualize the findings. RESULTS: The analysis revealed that the policy-issuing subjects demonstrated strong authority but weak coordination, with a lack of communication and cooperation across subjects. The use of policy tools was imbalanced, with an over-reliance on supply-type tools and insufficient use of demand-type tools. Additionally, the lack of effective policy tools to support various social participation stages has limited policy implementation. CONCLUSION: With technological advancement and changing needs of the elderly population, there is a need for a more systematic and forward-looking top-level design of elderly social participation policies: accelerating the systematization and precision of technological elements in policies for elderly social participation, integrating social organizations via technological platforms to mobilize diverse stakeholder engagement, and addressing the digital divide between the elderly and new technologies is imperative.

A qualitative study of a Sporting Memories program in South Australia: belonging, participation, and social connection.

Background: Older people can experience health and social challenges such as loneliness, depression, and lack of social connectedness. There is need for programs and approaches that address the growing incidence of social isolation and loneliness for older people. One initiative that aims to address these challenges is the Sporting Memories program. This program was developed in the United Kingdom and licensed to South Australia in 2019. The program is currently delivered across six community locations. Methods: The aim of this study was to explore participants perspectives of the Sporting Memories program in South Australia. Underpinned by qualitative research, three focus groups were conducted, led by an experienced interviewer. Focus groups occurred at three of the six locations, including a day respite center, assisted living center and a government community center. The data were analyzed thematically by the research team. Results: There were 16 participants over 65 years old, including four women and 12 men. Three key themes were developed: "free to talk about anything," "not feeling left out" and "a chance to share and learn." Collectively, participants reflected on how they built social connections, felt safe and included and learnt more about each other. Conclusion: The Sporting Memories program provides a group program for older people to come together and develop new friendships. The use of sports as a means of reminiscence was considered relatable for the participants who reported social benefits and plans to keep attending. They valued learning through the program which was enhanced by having a facilitator who was knowledgeable about sport.

Active social engagement and health among older adults: assessing differences by cancer survivorship status.

INTRODUCTION: The number of older adults who are cancer survivors is rapidly growing. Evidence is needed to inform interventions to support successful aging among older adults (including older adult cancer survivors). Active engagement with life, that is, spending time with family and/or close friends, may be related to health outcomes, but this concept remains understudied. METHODS: We used survey data to assess active engagement among older adults (ages 50 + years) from seven mid-Atlantic US states (n = 2,914), and geocoded their residence to collect collected measures of community availability of social interaction. Outcomes were physical and mental health-related quality of life (HRQoL), assessed with the SF-12. We used multivariable, multilevel linear regression to evaluate relationships between social interactions (i.e., "active engagement with life," or visiting with family and/or friends at least once per week and having at least three close friends, and community-level availability, measured with census tract-level park land and walkability and with county-level availability of social associations) and HRQoL. Finally, we explored differences in these relationships by recent cancer survivorship. RESULTS: Overall, 1,518 (52.3%) participants were actively engaged. Active engagement was associated with higher physical HRQoL (estimate = 0.94, standard error [SE] = 0.46, p = .04) and mental HRQoL (estimate = 2.10, SE = 0.46, p < .001). The relationship between active engagement and physical HRQoL was stronger for recent cancer survivors (estimate = 4.95, SE = 1.84, p < .01) than for the general population (estimate = 1.10, SE = 0.43, p = .01). Community-level availability of social interaction was not associated with HRQoL. CONCLUSION: Our analysis demonstrated promising associations between active engagement with life and HRQoL among older adults, with large benefits for older cancer survivors. Additional research is needed on how active engagement is associated with better HRQoL, which can inform future policies and programs to optimize the aging process in the US.

Enjoying the golden years: social participation and life satisfaction among Chinese older adults.

Introduction: Older adults commonly face the risk of social isolation, which poses a significant threat to their quality of life. This study explores the association between social participation and life satisfaction among older Chinese adults. Methods: Data were sourced from the 2018 China Health and Retirement Longitudinal Study. Regression analysis and mediation analysis were employed to examine the relationship between social participation and life satisfaction, with a focus on the roles of loneliness and self-rated health. Results: The results indicate that social participation is significantly positively associated with older adults' life satisfaction. Furthermore, the positive association is more pronounced with increased diversity in social activities. Mediation analysis reveals that reductions in feelings of loneliness and improvements in health levels mediate the relationship between social participation and life satisfaction. Further analysis showed that social participation had a greater positive association among rural older adults and those lacking family companionship. Discussion: This study provides evidence for enhancing life satisfaction among older adults and highlights the importance of diversity in social participation.

Mechanism of the impacts of older adults social participation on their health.

Purpose: Against the background of population aging challenges in China, focusing on health, security, and social participation as core elements of positive aging, this study aims to formulate strategies for promoting the health of the older adults and reveal the pathways and trends of social participation in promoting health. Method: The study analyzed 1,015 randomly selected older adults individuals living at home in Beijing using household survey questionnaires. Drawing on group dynamics theory and structural equation modeling, the study proposed hypotheses regarding the relationships between social participation, group cohesion, and health status. Results: First, the triangular path model of social participation, group cohesion, and health status among the older adults was established. The direct path coefficient of social participation on health status was 0.15, that of social participation on group cohesion was 0.56, and that of group cohesion on health status was 0.32. The indirect path coefficient of social participation on health status through group cohesion was calculated at 0.56 × 0.32 = 0.18. Second, of the older adults age groups-younger, middle, and older-social participation's direct path effects on health status were present only in the older age group. Social participation's indirect path effects on health status through group cohesion were relatively high in all three groups, with a slight increase in the older age group. Conclusion: First, just the older adults participation in social activities serves as a benign stimulus to physical and mental health. Additionally, group cohesion formed through interaction with others during social activities encourages self-improvement behaviors, indirectly promoting health. In fact, indirect pathways of health promotion through group cohesion are stronger than direct pathways, highlighting the importance of group cohesion during social participation. Second, participation in activities alone can provide only sufficient benign stimuli for the older adults aged 80 and above, with the direct path effect of social participation on health beginning to appear only with increasing age. With age, selectivity of interaction with others decreases, and dependence increases; social participation's indirect path effect on health through group cohesion continues to grow slightly.

Participation and environment measure - children and youth: PEM-CY Brazil measurements properties.

BACKGROUND: Participation of children with disabilities is an indicator of social inclusion, health, and well-being, and its evaluation needs to be included in the clinical practice of rehabilitation professionals. OBJECTIVES: To investigate the measurement properties of the Participation and Environment Measure - Children and Youth Brazilian version (PEM-CY Brazil). METHODS: We used the PEM-CY to evaluate participation and environment of children with and without disabilities in the home, school, and community settings. Based on COSMIN guidelines, we analyzed two measurement properties: internal consistency for all domains using Cronbach's alpha; and construct (known-groups) validity, i.e., the degree to which instrument scores identify differences between groups. T-tests, Mann-Whitney, or Chi-square tests compared children with and without disabilities. RESULTS: 101 Brazilian children (mean age=9.31 years) with (n = 62) and without (n = 39) disabilities were included. Internal consistency ranged from appropriate (0.70) to excellent (0.95) for all domains in all settings, except for Resources in the environment of the home setting (0.53). Regarding construct validity, PEM-CY participation scores were significantly different between groups in most domains. Children with disabilities were significantly less involved and participated in a smaller number of activities in all settings, in comparison to those without disabilities. The PEM-CY scores in all settings of the environment were significantly higher in the group of children without disabilities. CONCLUSION: Preliminary support was provided for the internal consistency and construct (known-groups) validity of the PEM-CY Brazil to measure participation and the environment in the Brazilian context. The PEM-CY can therefore be used by rehabilitation professionals in Brazil.

Social participation of women with breast cancer compared to the general population 5 years after primary surgery-what role do medical data and cancer-related complaints play?

PURPOSE: This study analyzes levels of social participation in patients with breast cancer on average 5 years following primary surgery as compared to women in the general population. In addition, the role of breast cancer-related complaints and medical data as possible influencing factors on levels of patients' social participation is investigated. METHODS: A total of n = 454 patients after primary surgery (t0) were recruited for a third follow-up study, and n = 372 completed this survey (t3), corresponding to a response rate of 82.2%. For measuring breast cancer-related complaints, participants completed a written questionnaire. Social participation was measured by a questionnaire on different leisure activities that was taken from the Socio-Economic Panel Study. Medical information was extracted from medical reports at t0. A principal component analysis was carried out to identify different dimensions of social participation. Chi2-tests and logistic regression analyses were applied to analyze social participation as compared to the general population and the role of possible medical and diagnosis-related influencing factors thereby. RESULTS: Compared to the general population, patients show lower levels of social participation in the domains "socio-cultural participation" and "participation in institutions," while no significant differences for "social participation in the private sphere" and "social participation via social media" were found. Psychological symptoms, pain, and a history of mastectomy were most strongly associated with restrictions in social participation. CONCLUSIONS: Our study suggests that social withdrawal may happen due to disease-related symptoms, preventing some breast cancer patients from participating fully in society. Cancer-related follow-ups should address this issue and support patients' reintegration into society through appropriate therapeutic interventions.

Locked-in syndrome: A qualitative study of a life story.

INTRODUCTION: Locked-in syndrome (LIS) is characterized by tetraplegia, anarthria, paralysis of cranial nerves, and facial musculature, with the preservation of consciousness and cognitive abilities, as well as vertical eye movements and eyelid movements, hearing, and breathing. Three types of LIS are distinguished: classic, incomplete, and total. The aim of the present study was to describe the life history of a person with LIS, as well as the wife's experience and perspective of this life history. METHODS: A qualitative life history study was conducted with two participants: a 54-year-old man diagnosed with LIS and his 50-year-old wife. Data were collected through interviews and autobiographical documents submitted by the participants and analyzed following Braun and Clarke's method of inductive thematic analysis. RESULTS: Five main themes were identified: (1) how to understand and overcome the new situation; (2) the process of care and rehabilitation; (3) communication; (4) writing as a way of helping oneself and others; and (5) personal autonomy and social participation. CONCLUSION: The participants valued the support of their friends and family in the acceptance stage of the new situation, giving special importance to the communication skills and medical attention received after diagnosis.

Participation Questionnaire for Preschoolers With Autism Spectrum Disorder: Item Development.

Occupational therapists need to comprehensively assess the participation of children with autism spectrum disorder (ASD) in daily activities and evaluate the effectiveness of relevant interventions. Several participation measurement tools have been developed for children with ASD, but these tools require expert involvement, which is a barrier to large-scale surveys. To address these concerns, a caregiver-administered questionnaire-the Participation Questionnaire for Preschoolers (PQP)-was developed. However, this tool could be improved due to its narrow age range of 48-72 months and because the item development process does not reflect the perspectives of children and caregivers. Therefore, we expanded the PQP's target age range to 36-83 months and developed new items that reflect the perspectives of professionals and caregivers. Interviews were conducted with eight experts in supporting children with ASD and 11 caregivers of children with ASD. The interviews were transcribed, and a content analysis was performed. The number of questions was reduced from 51 to 36, and the order of items was changed for clarity. Two of the eight subdomains were removed to clarify the conceptual difference between activity and participation. The updated version of the PQP has two unique features: (1) it can be administered without expert involvement, and (2) it includes items specific to the challenges faced by children with ASD. Future development of the scale and validation of its measurement properties are needed.

Heterogeneity of social participation in patients three months after total knee arthroplasty: a latent profile analysis.

BACKGROUND: Social participation is an important index of rehabilitation and social reintegration in patients after total knee arthroplasty (TKA). However, most existing studies focus on improving patients' functioning and activities, with only a few examining the social participation among patients after TKA. Therefore, the study aims to investigate the heterogeneity of social participation in patients three months after TKA and analyze subgroup influencing factors, to promote functional exercise and postoperative follow-up in specific patients. METHODS: This cross-sectional study recruited 255 patients who underwent TKA in a Tertiary Hospital in Jinan City, China, from March to July 2022. Three months after having undergone TKA, participants' data were collected using the Numeric Pain Rating Scale, the Chinese version of the Tampa Scale of Kinesiophobia, the 10-item Kessler Psychological Distress Scale, Hospital for Special Surgery Knee-rating Scale, and Impact on Participation and Autonomy Questionnaire. Latent profile analysis was used to identify categories of patients' social participation. Multiple logistic regression analysis was used to analyze the influencing factors of the different subgroups. RESULTS: Three months after TKA, the patients were divided into three subgroups: low social participation group (17.9%), moderate social participation group (40.8%), and high social participation group (41.3%). The vast majority of patients who underwent TKA exhibited moderate-to-high level of social participation. The multiple logistic regression analysis results showed that age, degree of pain, knee function, and kinesiophobia were the influencing factors of the potential profiles of social participation in patients three months after TKA (p < 0.05). CONCLUSION: These results support a distinct categorical feature of social participation among patients three months after undergoing TKA. Medical staff need to provide targeted guidance according to the potential classification characteristics of social participation to improve the level of social participation and promote rehabilitation of patients.

Patient-Reported Variables Affecting Self-Perceived Overall Recovery Among People With Subacute Stroke.

IMPORTANCE: Patients' perception of overall recovery is a critical outcome for stroke rehabilitation. However, the perception of overall recovery cannot be obtained using multidimensional measures, because satisfaction in most domains of life does not guarantee satisfaction in overall recovery. A single overall recovery score seems a straightforward measure. However, the clinical implications of overall scores are restricted, because factors affecting patients' overall recovery are unclear, which can be prioritized to optimize the effectiveness of rehabilitation. OBJECTIVE: To examine patient-reported variables affecting overall recovery scores in patients with differing stroke severity. DESIGN: The 59 items of the Stroke Impact Scale 3.0 were selected using regression analysis with a forward selection to explain the overall recovery score (0% = no recovery; 100% = full recovery). Stroke severity was determined with the National Institutes of Health Stroke Scale. SETTING: Hospitals. PARTICIPANTS: Data of 950 patients collected 90 days after stroke. RESULTS: The models explained about 55% of the variance of the overall recovery scores with five to nine variables, but merely 16% of the variance was explained for patients with moderate stroke. As stroke severity increased, the number of identified variables decreased. Most identified variables were related to social participation and self-care activities (e.g., ability to help others, control the bowels, and dress the torso). Differences in the remaining variables depended on stroke severity. CONCLUSIONS AND RELEVANCE: Patients' priorities differ depending on stroke severity. The identified variables may be set as treatment goals to optimize patients' self-perceived overall recovery. Plain-Language Summary: How patients perceive their overall recovery after a stroke is a critical outcome for their stroke rehabilitation. This study demonstrated that patients with different stroke severity may have different priorities that influence their self-perceived levels of overall recovery. The variables identified in this study may help occupational therapy practitioners identify meaningful goals to optimize patients' self-perceived overall recovery.

Association between the level of social participation and depressive symptoms among older Japanese adults: a cross-sectional survey.

BACKGROUND: Social participation is recommended for older adults to remain actively involved in daily life. Social participation is a broad concept, ranging from 'interacting with others without doing a specific activity with them' to 'actively contributing to society.' However, previous studies have not taken into account the components of social participation. Depressive symptoms are significant outcomes in older adults. Social participation mitigates these risks owing to its association with reduced mortality and enhanced quality of life. This study aimed to examine the association between the level of social participation and depressive symptoms in community-dwelling older adults. METHODS: We included 17 040 individuals aged ≥65 years. Social participation was categorised into Level 3, interacting with others without doing a specific activity with them; Level 4, engaging in an activity with others; Level 5, helping others; and Level 6, contributing to society, based on a previous study by Levasseur et al. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. Logistic regression models were used to examine the association between the level of social participation and depressive symptoms. RESULTS: Overall, 15 069 older adults met the inclusion criteria. A higher level of social participation was associated with lower odds ratios (ORs) for depressive symptoms (Level 6 = OR: 0.43, 95% confidence interval (CI): 0.37-0.50; Level 5 = OR: 0.50, 95% CI: 0.41-0.60; and Level 4 = OR: 0.60, 95% CI: 0.52-0.69). Subgroup analyses based on age and sex yielded similar results across all participants. CONCLUSIONS: Among older adults in Japan, a higher level of social participation was associated with lower rates of depressive symptoms. The relationship between depressive symptoms and the levels of social participation may help develop measures to reduce or prevent depressive symptoms in older adults.

Impact of the COVID-19 pandemic on psychosocial health in rheumatic patients: A longitudinal study.

AIM: To describe the impact of the COVID-19 on the psychosocial health of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and systemic lupus erythematosus (SLE). DESIGN: Longitudinal observational study of a series of patients with rheumatic disease. METHODS: The main outcome measure was impairment of the ability to participate in social activities, as measured using the PROMIS-APS instrument Short Form-8a. We evaluated social activities in various settings and performed a multivariate analysis to study the association between worsening of social participation during the COVID-19 pandemic and implicated factors. RESULTS: One hundred and twenty-five patients had completed the prospective follow-up: 40 with AR (32%), 42 with SpA (33.6%), and 43 with SLE (34.4%). Overall, poorer mean PROMIS scores were recorded after the COVID-19 pandemic for: satisfaction with social roles (p=0.029), depression (p=0.039), and ability to participate in social activities (p=0.024). The factors associated with ability to participate in social activities after the COVID-19 pandemic were older age (ß=-0.215; p=0.012), diagnosis of SLE (ß=-0.203; p=0.015), depression (ß=-0.295; p=0.003) and satisfaction with social roles (ß=0.211; p=0.037). CONCLUSION: The ability to participate in social activities after the COVID-19 pandemic is affected in patients with rheumatic disease, especially in SLE.

Factor structure of FUNDES-Child-SE measuring the participation and independence of children with disabilities.

BACKGROUND: FUNDES-Child-SE is a proxy rating questionnaire for measuring participation and independence in children with disabilities in a Swedish context. It includes the components of frequency of attendance, engagement and independence. The original, Taiwanese FUNDES-Child 7.0, has previously been found to have a four-factor structure for frequency of participation and a two-factor structure for independence. The aim of this study was to test the factor structure in FUNDES-Child-SE. The factor structure is an important part of construct validity. METHODS: Caregivers of 163 children with disabilities aged 6-18 years participated in this cross-sectional study. Exploratory factor analysis was used to find the factor structure for Engagement. Confirmatory factor analysis was used to test the factor structure for all three components. RESULTS: The proposed factor structure for frequency of participation (daily living participation frequency, mobility participation frequency, learning participation frequency and community participation frequency) and independence (daily living independence and social participation independence) fit with data from FUNDES-Child-SE after excluding three to five items and adding two to five covariances of residuals. In the engagement component, two factors, named engagement in informal activities and engagement in formal activities, were found. After excluding one item and adding 10 covariances of residuals, the factor structure had an acceptable fit to data. CONCLUSIONS: Differences in components' factor structure indicate that attendance and engagement are separate aspects of participation. Before using numeric scores from FUNDES-Child-SE in clinical settings, responsiveness and interpretability should be evaluated.

Mexican American Intergenerational Research: Transformative Model of Occupational Therapy.

Thirty-seven interviews of Mexican American women who crossed the border into the United States during the era of the Mexican Revolution of 1910 were analyzed using constructivist grounded theory methods. The intent is to expand the occupational therapy profession's occupational consciousness and cultivate cultural humility. Four themes emerged from the data: suffering, work, yearning for an education, and compassion for others. The findings suggest that environmental barriers such as hierarchy (patriarchy and discrimination) and physical barriers (limited access to built environments, lack of nonexploitative work opportunities, and hostile educational institutions) prevented occupational participation. Small acts of resistance through everyday living (finding joy, playing, self-sufficiency, and community organizing) were identified as facilitators of occupational participation. The research findings challenge proposed assumptions found within the occupational therapy literature: (1) humans and occupations exist as separate from their environments, and (2) work, productivity, and leisure contribute positively to health. The Transformative Model of Occupational Therapy is introduced as a decolonized framework that inextricably links individual health to community and global health. The model centers play, social participation, work, and education as occupations that contribute to the common good. These occupations are kept in equilibrium within the Four Pillars of Culture (self-determination, compassion, sustainability, and language) or the cultural values identified and derived from the stories.

Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline.

OBJECTIVES: Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity. METHODS: We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness. RESULTS: The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone. CONCLUSIONS: The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.

Health-related quality of life and participation after inpatient rehabilitation of sepsis survivors with severe sequelae: a cohort study.

OBJECTIVE: To describe health-related quality of life and participation after rehabilitation of severely affected sepsis survivors. DESIGN: Cohort study. SUBJECTS/PATIENTS: Patients with severe sequelae after sepsis treated in a multidisciplinary rehabilitation pathway were included. METHODS: Patient characteristics at the time of diagnosis, and the outcome 3 months after discharge from rehabilitation are described. At that time, health-related quality of life, social participation, and the rate of living at home were measured. RESULTS: Of the 498 patients enrolled, 100 severely impaired patients were transferred for a multidisciplinary rehabilitation approach. Fifty-five of them were followed up at 3 months. Descriptive and inference statistics showed that 69% were living at home with or without care. Health-related quality of life and participation scores were 0.64 ± 0.32 for the EQ-5D utility index and 54.98 ± 24.97 for the Reintegration of Normal Living Index. A multivariate regression model explaining health-related quality of life at 3 months included age, lower limb strength, and walking ability during rehabilitation (r2 = 0.5511). Participation at 3 months was explained by age, body mass index, lower limb strength, and duration of tracheal intubation (r2 = 0.6229). CONCLUSION: Patients who have experienced serious sepsis with severe sequelae can achieve a moderate level of quality of life and participation within a multidisciplinary pathway.