Multispecies Occupations Involving Equines: An Action-Oriented Inquiry to Inform Occupational Therapy Practitioners.

Research related to human-animal engagement often fails to address the complexity and nuance present in occupations and occupational therapy services that incorporate animals. The goal of this research was to develop a basic understanding of multispecies occupations (MSO) involving humans and equines, focusing on the action-oriented processes and transactions during socialization in outdoor, non-therapeutic contexts. We employed a multi-modal qualitative design with interviews and videography with n = 6 horse-human dyads, creating opportunities to understand and represent engagement beyond anthropocentric norms. Findings included a variety of dyad-specific features of occupation, including processes of embodied communication, the presence of behavioral synchrony, and perceptions of attunement arising from these processes. Examining MSO via a multi-modal inquiry offers new perspectives about the nature and experience of such occupations and supports a deeper understanding of potential mechanisms of change when animals are incorporated in occupational therapy interventions and practice.

"You Know, I Swipe My Card and Hope for the Best": Technology and Cognition as Dual Landscapes of Change.

Mild cognitive impairment (MCI), or objective and subjective cognitive decline, affects an estimated 15%-20% of individuals over the age of 65 . People with MCI generally live in community settings but may be at risk for functional changes in out-of-home participation, particularly when their instrumental activities are cognitively demanding or complex. Technology is part of the interface in complex person-place relationships. The purpose of this study is to examine the nature of everyday technology use in the context of out-of-home participation for community-dwelling older adults with MCI. Community-dwelling older adults with MCI (MoCA <26, >17; (n = 10)) were recruited for data collection using a Go-along method (naturalistic observation, semi-structured interviews, and photography) for multiple out-of-home activities. Findings from this project suggested that participants felt that technology, like their cognition, was out of their control and difficult to predict or change. Four ways the participants experienced the "technology landscape" in their daily lives included: enabling being present, facilitating participation, impeding goals, and constricting options. We present a model of the intersection of cognition, participation, and technology in daily life, and discuss ways that technology can most effectively be used to extend well-being for a population aging in place.

Fidelity and utility of GPS loggers as a tool for understanding community participation of older adults.

OBJECTIVE: The purpose of this research was to examine the fidelity and utility of global positioning system (GPS) technology for studying community mobility indicators, and to explore implications for community participation for older adults. METHOD: A longitudinal cohort design with community-dwelling older adults (n = 33) was employed. GPS spatial data and activity logs were collected at baseline and one year later. Data were analysed to evaluate the fidelity of the GPS protocol, the nature and frequency of destinations, and the stability of community mobility over time. RESULTS: Findings include evidence for high reliability of the GPS loggers to record out-of-home trips when compared to activity logs; utility of the technology for identifying frequency and type of occupational destinations; and the relative stability of two community mobility variables over time. GPS loggers generate key insights into how older adults move in and through their community as they engage in a range of occupations. CONCLUSION: GPS technology is a robust and useful tool for gathering novel information, especially when combined with qualitative data. GPS loggers may be incorporated in evaluation or to tailor interventions. Community mobility enables social participation, and warrants further research using these methods to support processes of aging in place.

Disparities in postacute rehabilitation care for stroke: an analysis of the state inpatient databases.

OBJECTIVE: To determine the extent to which sociodemographic and geographic disparities exist in the use of postacute rehabilitation care (PARC) after stroke. DESIGN: Cross-sectional analysis of data for 2 years (2005-2006) from the State Inpatient Databases. SETTING: All short-term acute-care hospitals in 4 demographically and geographically diverse states. PARTICIPANTS: Individuals (age, ≥45y; mean age, 72.6y) with a primary diagnosis of stroke who survived their inpatient stay (N=187,188). The sample was 52.4% women, 79.5% white, 11.4% black, and 9.1% Hispanic. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Discharge to an institution versus home. (2) For those discharged to home, receipt of home health (HH) versus no HH care. (3) For those discharged to an institution, receipt of inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) care. Multilevel logistic regression analyses were conducted to identify sociodemographic and geographic disparities in PARC use, controlling for illness severity/comorbid conditions, hospital characteristics, and PARC supply. RESULTS: Blacks, women, older individuals, and those with lower incomes were more likely to receive institutional care; Hispanics and the uninsured were less likely. Racial minorities, women, older individuals, and those with lower incomes were more likely to receive HH care; uninsured individuals were less likely. Blacks, women, older individuals, the uninsured, and those with lower incomes were more likely to receive SNF versus IRF care. PARC use varied significantly by hospital and geographic location. CONCLUSIONS: Several sociodemographic and geographic disparities in PARC use were identified.

"We need more things for us": Being low income and underoccupied in older age.

BACKGROUND.: Low-income older adult populations have increased vulnerability to occupational engagement barriers and poor health outcomes while aging in community settings. PURPOSE.: The purpose of this study was to examine the relationship between community navigation and well-being for low-income older adults. METHOD.: Community-dwelling older adults (N = 10) were recruited for this multimethod observational cohort study, which employed GPS data, measures of well-being, and semistructured interviews across 12 months. Grounded theory processes were followed to analyze and integrate the qualitative, quantitative, and spatial data. FINDINGS.: Findings were three patterns of community navigation. In particular, patterns of being chronically underoccupied were noted for this low-income population. Specific place-based challenges are explained along with strategies used to mitigate these challenges. IMPLICATIONS.: Supporting community navigation, especially social interaction opportunities, can maximize well-being; and older residents' occupational participation may be unnecessarily curtailed by geographic, economic, and social factors beyond their control. Community navigation strategies should be considered holistically by occupational therapists as part of interventions supporting aging in place.

Geospatial Mapping of Late-Life Couplehood: Dimensions of Joint Participation.

For older adults aging in place, community mobility affects a constellation of interconnected occupations and can become a problematic aspect of the person-place relationship. The purpose of this research was to examine an older couple's mutually negotiated change in their community mobility and navigation patterns. Spatial data (using global positioning system [GPS] trackers), maps, activity logs, interviews, and well-being measures were collected longitudinally for both members of a long-married community-dwelling couple. Analyses showed changing patterns of occupational engagement and declining navigation and function over time, as well as three dimensions of joint navigation (intersection of health and abilities, perpetuation of long-term roles through participation, and an orientation toward future potentialities). Findings suggest that joint community navigation is multidimensional and may buffer individual functional losses as well as maximize perception of and performance in meaningful activities. This study also demonstrates the utility of mapping methods to better understand occupation for community-dwelling populations.

Processes of developing 'community livability' in older age.

OBJECTIVE: 'Community livability' is a widely used term that is still under-conceptualized. The purpose of the project was to theorize key dynamics of livability for older adults who are aging in place in their homes and communities. METHODS: Twelve community-dwelling adults (70+) were recruited in a multiple-case study design. Interviews and naturalistic observations were used over the course of 6months. Global positioning system (GPS) devices were used to generate maps (routines, routes, type and duration of activities) to elicit additional insights through interviews. We used grounded theory analysis. RESULTS: For older adults, livability is not experienced as the presence of amenities, but rather involves active and ongoing negotiation of physical and social dimensions of their communities. We identify three core processes of livability including enacting an ideology of aging, building social infrastructure, and negotiating daily participation. These three processes unfolded in varied ways, yet closely shaped-and were shaped by-the older adults' participation in their necessary and chosen daily activities. DISCUSSION: Community livability is a process that varies considerably from the current conceptualizations. Understanding and expanding livability considerations will have positive implications for older adults' well-being while aging in community settings.

Delivery of physical therapy in the acute care setting: a population-based study.

BACKGROUND: Population-based studies on physical therapy use in acute care are lacking. OBJECTIVES: The purpose of this study was to examine population-based, hospital discharge data from North Carolina to describe the demographic and diagnostic characteristics of individuals who receive physical therapy and, for common diagnostic subgroups, to identify factors associated with the receipt of and intensity of physical therapy use. DESIGN: This was a cross-sectional, descriptive study. METHODS: Hospital discharge data for 2006-2007 from the 128 acute care hospitals in the state were examined to identify the most common diagnoses that receive physical therapy and to describe the characteristics of physical therapy users. For 2 of the most common diagnoses, logistic and linear regression analyses were conducted to identify factors associated with the receipt and intensity of physical therapy. RESULTS: Of the more than 2 million people treated in acute care hospitals, 22.5% received physical therapy (mean age=66 years; 58% female). Individuals with osteoarthritis (admitted for joint replacement) and stroke were 2 of the most common patient types to receive physical therapy. Almost all individuals admitted for a joint replacement received physical therapy, with little between-hospital variation. Between-hospital variation in physical therapy use for stroke was greater. Demographic and hospital-related factors were associated with physical therapy use and physical therapy intensity for both diagnoses, after controlling for illness severity and comorbidities. LIMITATIONS: Data from only one state were examined, and the studied variables were limited. CONCLUSIONS: The use and intensity of physical therapy for stroke and joint replacement in acute care hospitals in North Carolina vary by clinical and nonclinical factors. Reasons behind the association of hospital characteristics and physical therapy use need further investigation.

Disparities in post-acute rehabilitation care for joint replacement.

OBJECTIVE: To determine the extent to which demographic and geographic disparities exist in the use of post-acute rehabilitation care (PARC) for joint replacement. METHODS: We conducted a cross-sectional analysis of 2 years (2005 and 2006) of population-based hospital discharge data from 392 hospitals in 4 states (Arizona, Florida, New Jersey, and Wisconsin). A total of 164,875 individuals who were age ≥ 45 years, admitted to the hospital for a hip or knee joint replacement, and who survived their inpatient stay were identified. Three dichotomous dependent variables were examined: 1) discharge to home versus institution (i.e., skilled nursing facility [SNF] or inpatient rehabilitation facility [IRF]), 2) discharge to home with versus without home health (HH), and 3) discharge to an SNF versus an IRF. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. Interactions among race, socioeconomic, and geographic variables were explored. RESULTS: Considering PARC as a continuum from more to less intensive care in regard to hours of rehabilitation per day (e.g., IRF→SNF→HH→no HH), the uninsured received less intensive care in all 3 models. Individuals receiving Medicaid and those of lower socioeconomic status received less intensive care in the HH versus no HH and SNF versus IRF models. Individuals living in rural areas received less intensive care in the institution versus home and HH versus no HH models. The effect of race was modified by insurance and by state. In most instances, minorities received less intensive care. PARC use varied by hospital. CONCLUSION: Efforts to further understand the reasons behind these disparities and their effect on outcomes are needed.