Clinical reasoning of occupational therapists in selecting activities together with older adults with dementia to postpone further development of cognitive decline.

BACKGROUND: Research suggests that participation in activities has the potential to prevent or delay the development of later-life cognitive decline and dementia. This area is unexplored within occupational therapy. AIM: To explore and describe the clinical reasoning of occupational therapists in selecting activities together with older adults with dementia to participate in, with the goal to postpone further development of cognitive decline in a sample from the German part of Switzerland. METHODS: A constructivist grounded theory approach was used. Six in-depth, semi-structured interviews with occupational therapists working in geriatric units in the German part of Switzerland were conducted. RESULTS: Three main categories were identified: (i) from the discovery of 'who the older adult is' to the discovery of 'meaningful activities', (ii) reflecting on occupational therapists' individuality, and (iii) matching the activity to older adults' skills. A core category was developed: Pursuing active participation through meaningful and chosen activities. CONCLUSIONS: The study suggests that to pursue enabling active participation in activities among older adults with dementia, and promoting the quality of participation, occupational therapists must consider the identified elements that are important in selecting the activities which might be used to postpone cognitive decline in each individual.

Dementia-friendliness - Inclusion or exclusion: A critical discourse analysis.

This article explores how individuals with dementia and their relatives discursively construct dementia-friendliness in a situation where different definitions of this term exists. Thirteen semi-structured interviews were conducted, including seven individual interviews with people living with dementia. The remaining six interviews consisted of three interviews with the relatives of a person with dementia and three with married couples of which one were diagnosed with dementia. Notes taken by the first author during 6 months of fieldwork at a day centre and a drop-in centre for people with dementia and their families were used to supplement the interviews. Critical discourse analysis provides an analytical tool for revealing the discourses constructing dementia-friendliness. The analysis revealed that people with dementia and their relatives draw on the three discourses of sameness, security and care and autonomy during their attempts to construct dementia-friendliness. The ensuing discursive battles over dementia-friendliness appear to constitute a tightrope walk between the inclusion and exclusion of people with dementia, which underscores the importance of including the voices of people living with dementia when dementia-friendly initiatives and communities are developed.

Dementia-Friendliness in Danish and International Contexts: A Critical Discourse Analysis.

BACKGROUND AND OBJECTIVES: Initiatives to create dementia-friendly environments are subject to political attention all over the world. As the interpretation of dementia-friendliness is influenced by current cultural trends, the concept is highly ambiguous. The present study aims to explore how discourses concerning dementia-friendliness are manifested in Danish and international policy documents and how they interact internationally. RESEARCH DESIGN AND METHODS: Inspired by Fairclough's critical discourse approach, 21 policy documents were analyzed to reveal how power is exerted through language and the discursive construction. RESULTS: We identified 5 types of discourses, namely, those concerning the domains of socioeconomy, rehabilitation, knowledge, responsibility, and a good life. Dementia-friendliness was found to be embedded in an overall ideology aimed toward supporting the individual's autonomy in life and health choices and their participation in society. DISCUSSION AND IMPLICATIONS: Our analysis furthermore suggests that dementia-friendly initiatives are used collectively as a lever to achieve these policy aims to ultimately compensate for and protect people with dementia against the consequences of the loss of competencies, identity, and control. Thus, to develop and establish sustainable dementia-friendly environments and communities that meet the needs of people living with dementia, we need to be aware of and discuss the implications of the discourses constructing dementia-friendliness and their influence on the appearance of dementia-friendliness in society.

Dementia-friendliness - A matter of knowledge, responsibility, dignity, and illusion.

Worldwide, dementia-friendly initiatives are being developed primarily based on and driven by political strategies. Health professionals, local government officials, and initiators alike are working to create dementia-friendly communities, but little is known about how professionals discursively construct dementia-friendliness and how their various interpretations affect current practices in the field. This study aimed to explore how those involved in establishing dementia-friendly initiatives, nursing homes, and dementia villages ascribe meaning to and construct dementia-friendliness. Three focus groups were conducted, including two with five health professionals each from two nursing homes for people with dementia and one with seven initiators involved in the development and establishment of nursing homes and dementia villages. We further conducted a small-group interview with a consultant and a project worker representing a local authority. Seeing dementia-friendliness as a discursive construction, we conducted a critical discourse analysis, taking inspiration from the work of Norman Fairclough. The surveyed professionals reported relying on knowledge, responsibility, dignity, and illusion discourses to construct dementia-friendliness. Our results also indicated that the construct of dementia-friendliness fosters discursive battles indicated by dilemmas concerning the adequate and dignified treatment of people with dementia and health professionals' critical stances toward the construct of dementia-friendliness.

Long-Term Effects of Individually Tailored Physical Training and Activity on Physical Function, Well-Being and Cognition in Scandinavian Nursing Home Residents: A Randomized Controlled Trial.

BACKGROUND: The preservation of physical functions such as muscle strength, balance and mobility is fundamental to maintaining independence in activities of daily living (ADL). The physical activity level of most nursing home residents is very low, which implies that they are often subject to a decline in health, mobility, autonomy and social contacts and are also at risk of suffering a decline in mental well-being. In a previous study, we demonstrated that transfers, balance and physical activity level improved after 3 months of individually tailored intervention in nursing home residents. OBJECTIVE: To evaluate the long-term effects on ADL, balance function, physical activity level, physical performance, falls-related self-efficacy, well-being and cognitive function 3 months after the completion of our intervention in nursing home residents. METHODS: The study was a multicenter randomized, controlled clinical trial with a parallel-group design. It was conducted in nursing homes in Sweden, Norway and Denmark, with an intervention period lasting 3 months and a follow-up at 6 months. Initially, 322 nursing home residents with a mean age of 85 years were included; 85 from Sweden, 171 from Norway and 66 from Denmark. Of these, 241 [129 intervention group (IG), 112 control group (CG)] were eligible for the 6-month follow-up tests. The level of dependence in ADL, physical activity level, several dimensions of physical function, well-being, falls-related self-efficacy and cognitive function were assessed with reliable and valid instruments at baseline, immediately after 3 months of intervention and 3 months later at the 6-month follow-up. RESULTS: After 3 months of intervention and an additional period of 3 months without intervention, only the following 2 variables demonstrated significant group differences: social and cognitive function, measured by the Functional Independence Measure n-r, where the IG deteriorated while the CG was almost stable. However, regarding transfers, the IG deteriorated significantly less than the CG. CONCLUSION: Without supervised physical exercise that challenged the individuals' capability, gains in ADL function, balance and transfer ability deteriorated during the 3 months following the intervention period. Thus, continuous, individually adjusted and supported physical activity seems crucial for the maintenance of physical functions in these vulnerable elderly persons.

European-French Cross-Cultural Adaptation of the Developmental Coordination Disorder Questionnaire and Pretest in French-Speaking Switzerland.

UNLABELLED: The Developmental Coordination Disorder Questionnaire (DCDQ'07) is a Canadian-English instrument recommended for screening children aged 5 to 15 years who are at risk for developmental coordination disorder. While a Canadian-French version of the DCDQ'07 presently exists, a European-French version does not. AIMS: To produce a cross-cultural adaptation of the DCDQ'07 for use in areas of Europe where French is spoken and to test its cultural relevance in French-speaking Switzerland. METHODS: Cross-cultural adaptation was done using established guidelines. Cultural relevance was analyzed with cognitive interviews of thirteen parents of children aged 5.0 to 14.6 years (mean age: 8.5 years, SD = 3.4), using think-aloud and probing techniques. RESULTS: Cultural and linguistic differences were noted between the European-French, the Canadian-French, and the original versions of the DCDQ'07. Despite correct translation and expert committee review, cognitive interviews revealed that certain items of the European-French version were unclear or misinterpreted and further modifications were needed. CONCLUSIONS: After rewording items as a result of the outcomes of the cognitive interview, the European-French version of the DCDQ'07 is culturally appropriate for use in French-speaking Switzerland. Further studies are necessary to determine its psychometric properties.

Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: a randomized controlled trial.

BACKGROUND: Nursing home residents are extremely inactive and deterioration in health and an increasing dependence in activities of daily living (ADL) are common. Physical activity and exercise play a major role in the preservation of physical function and quality of life late in life. However, evidence for the benefit of rehabilitation in nursing home residents is conflicting and inconclusive. OBJECTIVE: To evaluate the effect of an individually tailored intervention program of 3 months, for nursing home residents, on ADL, balance, physical activity level, mobility and muscle strength. METHODS: In this single-blind randomized clinical trial with parallel groups, nursing home residents >64 years of age from three Nordic countries were included. The intervention group (IG) was assigned to individually tailored physical and daily activities, while the control group (CG) received ordinary care. Primary outcomes were ADL and balance, and secondary outcomes physical activity level, mobility and muscle strength. RESULTS: At baseline, 322 nursing home residents were included, of whom 266 were assessed after 3 months of intervention. Following the intervention, a significant difference was found between participants in the IG and CG on measures of balance, physical activity and transfers. The IG significantly improved walking/wheelchair speed and functional leg muscle strength. The CG had significantly deteriorated in ADL, balance and transfers. Persons who had taken part in the intervention for more than 150 min/week significantly improved their balance and physical activity level. Participation in more than 10 weeks of intervention significantly improved physical activity and walking/wheelchair speed, while a deterioration was seen in those who had participated less. CONCLUSION: Individually tailored intervention in nursing home residents focusing on physical and daily activities is effective in improving transfers, balance and physical activity level compared to usual care. The effect of the intervention is dependent on the total activity time.

Quality assessment of butter cookies applying multispectral imaging.

A method for characterization of butter cookie quality by assessing the surface browning and water content using multispectral images is presented. Based on evaluations of the browning of butter cookies, cookies were manually divided into groups. From this categorization, reference values were calculated for a statistical prediction model correlating multispectral images with a browning score. The browning score is calculated as a function of oven temperature and baking time. It is presented as a quadratic response surface. The investigated process window was the intervals 4-16 min and 160-200°C in a forced convection electrically heated oven. In addition to the browning score, a model for predicting the average water content based on the same images is presented. This shows how multispectral images of butter cookies may be used for the assessment of different quality parameters. Statistical analysis showed that the most significant wavelengths for browning predictions were in the interval 400-700 nm and the wavelengths significant for water prediction were primarily located in the near-infrared spectrum. The water prediction model was found to correctly estimate the average water content with an absolute error of 0.22%. From the images it was also possible to follow the browning and drying propagation from the cookie edge toward the center.

Functional level, physical activity and wellbeing in nursing home residents in three Nordic countries.

BACKGROUND AND AIMS: The main aim of this study was to describe physical and cognitive function and wellbeing among nursing home residents in three Nordic countries. A second aim was to compare groups of differing ages, levels of dependency in daily life activities (ADL), degree of fall-related self-efficacy, wellbeing and cognitive function. METHODS: 322 residents from nursing homes in Sweden, Norway and Denmark were included. Physical and cognitive function, level of physical activity and wellbeing were assessed by means of reliable and valid instruments. RESULTS: The mean age of participants was 85 years. Sixty percent could rise from a chair and 64% could walk independently. Men were younger and more physically active than women. Participants with a high level of dependency in ADL had lower physical and cognitive functions, were less physically active, and had lower fall-related self-efficacy than participants less dependent in ADL. Participants with low cognitive function had high fall-related self-efficacy. CONCLUSIONS: These data demonstrate that elderly residents in nursing homes in Sweden, Norway and Denmark are frail but heterogeneous. Significant differences in physical activity, physical function and dependency in ADL were seen in relation to age, fall-related self-efficacy, wellbeing and cognitive function.

A Nordic multi-center study on physical and daily activities for residents in nursing home settings: design of a randomized, controlled trial.

BACKGROUND AND AIMS: Nursing home residents constitute a frail, multi-diseased and heterogeneous group. As physical activity is essential for the preservation of function, personalized training and activities are of great importance. The main objective of this study was to describe the influence of an individually tailored intervention program, in a nursing home setting, on physical capacity, degree of dependence in Activities of Daily Living (ADL), long-term participation in physical and/or daily activities, and self-rated wellbeing. The aim of the present work is to describe the overall design of the study. METHODS: Nursing homes in Sweden, Norway and Denmark were involved, and 322 residents were randomized to either Intervention or Control groups. The intervention lasted for three months and consisted of physical and daily activities, led by physiotherapists and occupational therapists, and was built on their evaluations and on the goals expressed by each resident. Tests of muscle strength, mobility, balance function and confidence, ADL, level of physical activity, wellbeing and cognitive function were performed at baseline, directly after the intervention period and three months later. RESULTS: They will be presented in articles to follow. CONCLUSIONS: Although it is a great challenge to carry out an intervention study directed toward such a frail population, it is of great interest to find out whether individually tailored and enhanced activities can lead to decreased dependence in ADL and increased wellbeing.

Perceived autonomy and activity choices among physically disabled older people in nursing home settings: a randomized trial.

OBJECTIVE. To evaluate the effect of individually tailored programs on perceived autonomy in institutionalized physically disabled older people and to describe participants' activity wishes and content of the programs. METHOD. This blinded randomized trial with follow up included a total of nine nursing homes and 50 nursing home residents who were randomized into either a control group or an intervention group. Perceived autonomy was measured at baseline (T1), after 12 weeks (T2) of intervention and after 24 weeks (T3) Wishes for daily activities was identified at T1. Weekly reports of individual programs were drawn up. RESULTS. Both groups perceived autonomy as average at baseline and increased their mean score at T2 to high or close to high. At T3, both groups scored average but exceeded the level of T1. Activity wishes and the content of the programs indicate incoherence. DISCUSSION. Although the correspondence between the individual wishes for activities and the concrete content of the programs was not obvious, results indicate potential for enabling the perception of autonomy among physically disabled older nursing home residents. The clinical consequences may suggest a focus on existing traditions, methods, and tools in the nursing home practice.

Autonomy among physically frail older people in nursing home settings: a study protocol for an intervention study.

BACKGROUND: Experiencing autonomy is recognised to promote health and well-being for all age groups. Perceived lack of control has been found to be detrimental to physical and mental health. There is a lack of evidence-based knowledge elucidating how frail older people in nursing home settings themselves perceive autonomy in daily life. Further, there are no studies on the extent to which this perception can be influenced positively by participating in an individually tailored programme based on residents' own wishes for daily activities. METHODS AND DESIGN: A total of 9 nursing homes and 55 participants aged 65 years or older were included in the study. All the participants were restricted in performing at least one P-ADL activity unassisted and had a Mini Mental State Examination-score above 16. Perceived autonomy was measured at baseline, after 12 weeks and after 24 weeks by The Autonomy Sub-dimension in the Measure of Actualisation of Potential test. Programmes were based on participants' individual assessment of their most important daily activities. Staff at all nursing homes who usually organize physical training, social or creative activities carried out individually tailored programmes using their usual methods and equipment. Participants in each nursing home were divided by lot into either a control group or an intervention group. The control groups received their usual care and treatment. DISCUSSION: This study is designed to assess the status of perceived autonomy at baseline and to provide information about the effectiveness of individually tailored programmes according to perceptions of autonomy registered in institutionalised physically frail older people. This will add knowledge to assist response to present and future challenges in relation to health promotion initiatives for this group.