Critiquing representations of intellectual disability in occupation-based literature.

BACKGROUND: Within and beyond occupation-based scholarship, concerns abound regarding the pervasiveness of discourses that promote a negative, deficit-based view of intellectual disability and associated consequences for disabled people's lives. Such representations risk reducing the complexities of human doing and being and can limit the occupational possibilities of this group. Yet, there is a lack of critically reflexive research exploring how disability is discursively constructed in occupation-based literature. AIMS/OBJECTIVES: This paper critically analyses representations of intellectual disability within occupation-based literature. It considers the influence of such representations on the occupational possibilities of people labelled intellectually disabled. METHODS: This review employed a critical interpretive synthesis of 21 peer-reviewed articles from occupational therapy and occupational science that focused on intellectual disability. RESULTS: Three analytic threads were identified as contributing to how intellectual disability was represented across the reviewed literature: habilitating expected doings, becoming productive citizens, and activated, but insufficient. CONCLUSION & SIGNIFICANCE: Occupation-based discourses have powerful influence within society, particularly within occupational therapy, regarding understandings of intellectual disability and how these shape occupational possibilities for persons labelled intellectually disabled. Drawing attention to taken-for-granted representations of intellectual disability is essential to promote transformative occupational therapy practice and enhance occupational possibilities for this population.

"No one went into pharmacy to sell a lot of Coca-Cola. It's just sort of a necessary evil" - Community pharmacists' perceptions of front-of-store sales and ethical tensions in the retail environment.

Background: Community pharmacists are expected to uphold ethical duties to patients and society while maintaining independent businesses or fulfilling expectations of corporate owners. Canadian pharmacy colleges provide only indirect guidance on the retail setting of the profession. Little is known about whether pharmacists identify ethical issues in retail pharmacy or around the sales of non-drug products. Objective: This study sought to examine pharmacists' perceptions of their roles in health promotion, the factors that influence the selection of front-of-store products, and ethical issues relating to their dual roles as health care providers and retailers. Methods: In 2020, 25 Canadian pharmacists participated in semi-structured phone interviews. Interviews were audio-recorded, anonymized, transcribed verbatim, and thematically analyzed using qualitative methods. Results: Almost all participants described their role primarily as a health care provider, though some described themselves as 50-50 health care providers and retailers. Most staff pharmacists reported little control over front-of-store product selection. Where participants reported some control, external factors such as business viability and profitability impacted their choices, though some reported selecting products based on the needs of their patient community or their personal beliefs. The dominant tensions described stemmed from participants' dual roles as health care providers and retailers, though specific issues and situations were varied, ranging corporate targets, to service provision, to the sales of unproven or unhealthy products. Participants suggested solutions to the issues they described, ranging from a complete overhaul of the licensing structure of community pharmacies, down to one-on-one conversations with patients. Conclusion: Our findings suggest that the retail setting of community pharmacy produces unique ethical tensions: the imposition of retail sales standards and targets are commonplace, and business viability is a primary driving force in front-of-store product selection. Clear guidance from Canadian pharmacy colleges and legislators to address these tensions and issues may be necessary.

Representations of parenting autistic children: A critical interpretive synthesis.

BACKGROUND: Many taken-for-granted expectations for parents in Western societies are situated in normative assumptions. Social constructions of 'good' parenting may be a poor fit for parents whose children's development varies from a so-called typical trajectory. Normative assumptions about parenting can have harmful effects for parents of autistic children. AIMS/OBJECTIVES: This paper examines representations of parenting autistic children in contemporary research and considers the potential effects of these representations on these parents' occupational possibilities. METHODS: Informed by a critical occupational perspective, a critical interpretive synthesis (CIS) of 27 research articles focussed on parenting autistic children was conducted. FINDINGS: Three major discursive threads were identified regarding how parents of autistic children are represented in research: gendered assumptions, caregiving as all-consuming, and disruption of normative expectations of parenting. CONCLUSIONS AND SIGNIFICANCE: Normative discourses about parenting were (re)produced within this body of research which may perpetuate limitations in the occupational possibilities of parents of autistic children. Critical investigation into contemporary research is necessary to challenge taken for granted expectations for parents of children with autism, to mitigate harmful effects for parents, to inform transformative OT practices and policies, and to promote equitable service provision.

"I can't remember the last time I was comfortable about being home": lived experience perspectives on thriving following homelessness.

PURPOSE: Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to "thrive" following homelessness from the perspectives of persons with lived experience in Ontario, Canada. METHODS: Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice. RESULTS: Participants described experiences of "living in a state of lack" following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping "my people"; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances. CONCLUSIONS: Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment.

"I can't be the nurse I want to be": Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving.

As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses' experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.

Humor in rehabilitation professions: a scoping review.

PURPOSE: Studying humor in the rehabilitation professions is important given its positive effects on health and well-being. We conducted a scoping review to understand how the use of humor has been explored in the existing literature in four rehabilitation professions. The rehabilitation professions included audiology, speech-language pathology, physical therapy, and occupational therapy. MATERIALS AND METHODS: The five-stage method identified by Arksey and O'Malley was used to conduct this review. Six databases were searched. We included 57 articles in our final review, summarized in a narrative synthesis. RESULTS: We generated seven themes in our analysis: (1) humour as a management strategy in therapy; (2) humour as a power establisher vs. equalizer; (3) humour as a coping mechanism in rehabilitation; (4) conceptualizations of non-verbal humor cues in therapy; (5) Is humour trainable? (6) Humor used to foster group cohesion; and (7) Attitudes and beliefs surrounding humor practice. CONCLUSIONS: Our findings emphasize the importance of using humor in the rehabilitation professions, and the ways in which humor is conceptualized in a multitude of ways for both clinician and client. Future work is needed to further understand the presence and use of humor in rehabilitation professions.IMPLICATIONS FOR REHABILITATIONIn a scoping review of the literature, this study showed that humor was used mainly positively in rehabilitation by the included professions of audiology, speech-language pathology, physical therapy, and occupational therapy and contributed to a sense of belonging.Humor may be an effective way to improve management of client/clinician relations as well as improving group cohesion in rehabilitation settings.In the rehabilitation professions of audiology, speech-language pathology, physical therapy, and occupational therapy, non-verbal humor cues were used in instances where communication was difficult or impaired for clients.

Social Networks May Shape Visually Impaired Older Adults' Occupational Engagement: A Narrative Inquiry.

Age-related vision loss (ARVL) has been shown to interfere with older adults' occupational engagement. The primary purpose was to examine the role social networks play in facilitating/constraining engagement in desired occupations for older adults with ARVL. This study adopted a constructivist narrative methodology. Five older adults, ≥ 60 years of age with ARVL, participated in three virtual interviews, which were coded using thematic analysis. Three overarching themes were identified: (a) Diverse Social Networks Fulfill Different Occupational and Psychosocial Needs, (b) Retaining a Sense of Independence through Seeking Reciprocity in Social Relationships, and (c) Community Mobility and Technology Support as Essential for Preserving Social Relationships. Findings broaden understandings of how informal/formal social networks are involved in shaping visually-impaired older adults' adaptation to ARVL and related occupational changes. Findings may help improve the quality and delivery of low-vision rehabilitation services to optimize their contribution to occupational engagement.

"Making change by shared doing": An examination of occupation in processes of social transformation in five case studies.

BACKGROUND: As social and health inequalities deepen around the world, scholarship in occupational therapy and occupational science has increasingly emphasised the role of occupation as a powerful tool in transformative processes. OBJECTIVE: To explore how opportunities for everyday doing together may contribute to processes of social transformation by identifying ways occupation is being taken up in socially-transformative practice. MATERIAL AND METHODS: A generic descriptive qualitative case study design was utilised in order to describe current practice examples and identify ways occupation was being taken up in five initiatives working towards social transformation located in Canada, Germany, South Africa and the United Kingdom. RESULTS: Focussing on the positioning of occupation within the initiatives, three themes were developed: The intentionality of the process, the nature of occupation within the initiatives, and the role of occupation within the processes of social transformation. CONCLUSIONS AND SIGNIFICANCE: Providing examples of agency on the micro level and of engagement with socioeconomic, political and cultural power structures at the societal level, this analysis raises important considerations in addressing how occupational therapy practice can move in socially responsive and transformative directions.

Exemplary post-discharge stroke rehabilitation programs: A multiple case study.

OBJECTIVE: The objective of this study was to identify essential aspects of exemplary post-discharge stroke rehabilitation as perceived by patients, care partners, rehabilitation providers, and administrators. DESIGN: We carried out an exploratory qualitative, multiple case study. Stroke network representatives from four regions of the province of Ontario, Canada each nominated one post-discharge rehabilitation program they felt was exemplary. SETTING: The programs included: a mixed home- and clinic-based service; a home-based service; a clinic-based service with a stroke community navigator and; an out-patient clinic-based service. PARTICIPANTS: Participants included 32 patients, 16 of their care partners, 23 providers, and 5 administrators. METHODS: We carried out semi-structured qualitative interviews with patients and care partners, focus groups with providers, and semi-structured interviews with administrators. Health records of patient participants were reviewed. Using an interpretivist-informed inductive content analysis, we developed overarching categories and subcategories first for each program and then across programs. RESULTS: Across four regions with differing types of programs, exemplary care was characterized by three essential components: stroke and stroke rehabilitation knowledge, relationship built through personalized respectful care, and a commitment to high quality, person-centered care. CONCLUSION: Exemplary post-discharge care included knowledge regarding identification and treatment of stroke-related impairment, that is, information found in best practice guidelines. However, expertise related to building relationship through providing personalized respectful care, within a mutually supportive, improvement-oriented team was also essential. Additionally, administrators played a crucial role in ensuring continued ability to deliver exemplary care.

Primary care physicians' perceptions of the utility of novel education materials for patients with knee osteoarthritis.

PURPOSE: To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. MATERIALS AND METHOD: We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. RESULTS: Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. CONCLUSION: Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care.IMPLICATIONS FOR REHABILITATIONThe provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice.Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system.Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions.

The Impact of a Naturally Occurring Retirement Community Supportive Services Program on Older Adult Participants' Social Networks: Semistructured Interview Study.

BACKGROUND: Most older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently owing to lack of supports that allow for aging in place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer an approach to help older adults age in place. Although qualitative studies have examined the experiences of NORC-SSP participants, little is known about how participation in NORC-SSP programming affects participants' social networks. OBJECTIVE: This study aimed to explore the experiences of 13 NORC-SSP residents who participated in Oasis Senior Supportive Living (Oasis) and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. METHODS: Participants were recruited, using convenience sampling, from 4 naturally occurring retirement communities (NORCs) in Ontario, Canada. All participants (13/13, 100%) had participated in Oasis programming. Semistructured qualitative interviews were conducted with participants. Social network theory informed the interview guide and thematic analysis. RESULTS: In total, 13 participants (n=12, 92% women and n=1, 8% men) were interviewed. These participants were from 4 different NORCs where Oasis had been implemented, comprising 2 midrise apartment buildings, 1 low-rise apartment building, and 1 mobile home community. Overall, 3 main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). Participants noted that Oasis provided them with opportunities to meet new people and broaden their social networks, both within and outside their NORCs. They also indicated that Oasis provided them with meaningful ways to spend their time, including opportunities to socialize and try new activities. Participants stated that participating in Oasis helped to alleviate loneliness and improved their quality of life. They noted that Oasis provided them with a reason to get up in the morning. However, the experiences described by participants may not be reflective of all Oasis members. Those who had positive experiences may have been more likely to agree to be interviewed. CONCLUSIONS: On the basis of the participants' interviews, Oasis is an effective aging-in-place model that has been successfully implemented in low-rise apartment buildings, midrise apartment buildings, and mobile home communities. Participating in Oasis allowed participants to expand their social networks and improve their mental health and well-being. Therefore, NORCs may offer an ideal opportunity to build strong communities that provide deep, meaningful social connections that expand social networks. NORC-SSPs, such as Oasis, can support healthy aging and allow older adults to age in place.

'We stick people in a house and say okay, you're housed. The problem is solved': A qualitative study of service provider and organisational leader perspectives on thriving following homelessness.

Research aimed at identifying and evaluating approaches to homelessness has predominately focused on strategies for supporting tenancy sustainment. Fewer studies focus on strategies for enabling thriving following homelessness, and the perspectives of service providers and organisational leaders (SPOL) on this topic are rare. We conducted this study in the context of a community-based participatory research project in two cities in Ontario, Canada. This research was aimed at identifying the strengths and challenges of existing supports in enabling thriving following homelessness, followed by co-designing a novel intervention alongside persons with lived experience of homelessness (PWLEH) and SPOL. The current study presents the findings of interviews conducted in 2020-2021 with SPOL in organisations serving PWLEH. We interviewed 60 individuals including service providers (n = 38; 63.3%) and organisational leaders (n = 22; 36.7%) using semi-structured qualitative interviews. Interviews were conducted and recorded on Zoom to align with physical distancing protocols associated with the COVID-19 pandemic. Recordings were transcribed verbatim and analysed abductively informed by the lenses of social justice and health equity. The essence of our findings is represented by a quote from a research participant: 'We stick people in a house and say okay, you're housed. The problem is solved'. This essence was expressed through five themes: (1) stuck in a system that prevents thriving, (2) substance use as an important coping strategy that prevents tenancy sustainment and thriving, (3) the critical importance of targeting community integration following homelessness, (4) incorporating peer expertise as imperative and (5) people need to be afforded options in selecting housing and services following homelessness. Our findings indicate that SPOL envision possibilities of thriving following homelessness yet are embedded within a system that often prevents them from supporting individuals who are leaving homelessness to do so. Research, practice and policy implications are discussed.

Rethinking Driving Against Medical Advice: The Situated Nature of Driving After Stroke.

Background: As stroke can result in functional impairments that impact driving ability, many jurisdictions mandate a 30-day period of driving restriction post-stroke. However, between 26% and 38% of clients drive against medical advice during this period. Purpose: Informed by critical reflexivity of the literature and the first author's practice, this critical analysis paper (1) explicates and critiques how adherence to guidelines regarding driving after stroke in the first 30 days is conceptualized in individualistic, biomedically centred research and (2) argues for expanded understandings of driving based on a transactional occupational perspective. Key Issues: Individualistic, biomedical perspectives view driving against medical advice as an individually located phenomenon, generating partial understandings and individually focused solutions. Re-conceptualizing driving after stroke as a transactional occupational choice provides a productive basis for understanding and addressing driving within practice and research. Implications: Concepts from occupational science can generate new insights for research and client-centred practice regarding driving following stroke.

Assistive Technology Use among Older Adults with Vision Loss: A Critical Discourse Analysis of Canadian Newspapers.

Low vision assistive devices are often positioned as enabling continued social participation and engagement by older adults in everyday activities; however, previous research suggests that the use of such technologies is restricted by various environmental factors. With little attention previously paid to the discursive environment, this critical discourse analysis critically examined how aging persons with vision loss and assistive technology (AT) were constructed and the occupational possibilities promoted and marginalized through technology use in six Canadian newspapers. In total, 7,289 articles were screened, 1,867 articles underwent a full-text review, and 51 articles were selected for data analysis. Results highlight four key discursive threads related to the framing of disability and AT, positioning of seniors with vision loss, and the ideals and occupations to be attained through AT, and point to the importance of re-configuring discourses addressing AT for seniors with vision loss to expand occupational possibilities and embrace collaborative design approaches.

Taking Refuge in Religion: Buddhist-Oriented Coping following Late-Life Immigration.

Despite a recognition of religion as a resource for coping in later life, few studies have examined how religion is summoned to cope with the stressors of late-life immigration. Drawing upon data generated in a phenomenological study of the aging-out-place experience, this article presents a hermeneutic analysis of textual extracts addressing 10 Sri Lankan-born late-life immigrants' Buddhist beliefs and practices, and how these beliefs and practices contributed to coping with immigration stressors. Four shared experiences facilitated through religious engagement were revealed: religious engagement as a source of purpose, making meaning of suffering and experiencing hope, non-attachment, and connecting to the past and the ethnoreligious community. Late-life immigrants drew on religious engagement to remain resolute amidst adversities, thus reinforcing the importance of culturally responsive milieus and services to support religion-focused coping. Findings are interpreted in relation to Pargament's (1997) theory of religious coping.

Identification and engagement of naturally occurring retirement communities to support healthy aging in Canada: A set of methods for replication.

BACKGROUND: Naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada. METHODS: Three steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming. RESULTS: Four cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%). CONCLUSIONS: The increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities.

Examining Community-Based Housing Models to Support Aging in Place: A Scoping Review.

BACKGROUND AND OBJECTIVES: With the global population aging, there is a demand for older adults to age in place, that is, to live and age well in their home and community with some level of independence. Community-based housing models exist and may support this process. This scoping review aimed to describe and synthesize the ways in which community-based housing models relate to older adults' aging in place and identify strengths and gaps in the literature. RESEARCH DESIGN AND METHODS: The housing models explored were villages, naturally occurring retirement communities, congregate housing and cohousing, sheltered housing, and continuing care retirement communities. This exploratory scoping review examined international peer-reviewed literature published from 2004 to 2019. Six databases were searched using terms related to housing models and older adults. Forty-six articles met the inclusion criteria. Descriptive numerical summary and thematic analysis were used to synthesize study characteristics and findings. RESULTS: Our analysis revealed 4 themes relating to aging in place in the housing models: Social Relations, Health and Well-being, Sense of Self and Autonomy, and Activity Participation. Further analysis identified housing-specific characteristics that appeared to pose barriers to, or enable, aging in place. DISCUSSION AND IMPLICATIONS: To best support aging in place, the findings of the review suggest multiple characteristics worth considering when developing or relocating to a community-based housing model. Further research is required to understand how facilitating characteristics can promote aging in place for community-dwelling older adults.

A qualitative dominant mixed methods exploration of novel educational material for patients considering total knee arthroplasty.

PURPOSE: To optimize non-operative management and decision making surrounding TKR we created educational whiteboard videos for patients with knee OA. The purpose of this study was to pilot our educational videos with end-users (patients) to determine patients' experiences and perspectives regarding the content and clarity of videos and to better understand their potential impact on patient's health behaviour. MATERIALS AND METHODS: This was a mixed methods evaluation, using a qualitative descriptive approach, of patients attending their first consultation with an arthroplasty surgeon for TKR. We conducted in-depth semi-structured interviews with patients. Three members of the research team coded data independently, implementing a thematic analysis. RESULTS: Thirteen participants were included. Participants indicated that the videos enhanced their confidence and clarity surrounding their decision to undergo TKR. The videos also addressed several knowledge gaps in their understanding of OA management. Barriers to uptake of the education were identified including limited access to PTs and the challenge of weight loss. Conclusions: The current educational intervention was valued by patients with knee OA. Implementation of these videos may have important implications for patients, providers, and our health care system.IMPLICATIONS FOR REHABILITATIONPatients with knee OA referred by primary care physicians to arthroplasty surgeons have knowledge gaps that may influence their self-management and decision making surrounding their condition.Educational materials can address these gaps and support patients in their understanding and management of their condition, which may have important downstream implications.Barriers to accessing non-operative care including physiotherapy must be pre-emptively addressed to ensure that enhanced knowledge is met with improved access for patients.

Mobilizing Occupation for Social Transformation: Radical Resistance, Disruption, and Re-Configuration: Mobiliser l'occupation pour une transformation sociale : résistance radicale, perturbation et reconfiguration.

BACKGROUND.: Given the sociopolitical roots of widening occupational, social, and health inequities, it is imperative that occupational therapy move forward in mobilizing occupation for social transformation. PURPOSE.: Three key aims are addressed: articulating the imperative to mobilize occupation for social transformation; highlighting the political nature of occupation and occupational therapy; and providing guideposts for embracing a radical sensibility to inform moving forward in mobilizing occupation for social transformation. KEY ISSUES.: Conditions of possibility within occupational therapy leave the profession ill equipped to enact social transformation. Enacting calls to mobilize occupation for social transformation requires radically reconfiguring these conditions of possibility to inform practices that resist, disrupt, and re-configure sociopolitical conditions perpetuating occupational inequities. IMPLICATIONS.: Mobilizing occupation for social transformation holds much potential to contribute toward creating more equitable, humane societies. Realizing this potential involves committing to transforming our profession, as well as societal discourses, structures, systems, relations, and practices.

Producing precarity: The individualization of later life unemployment within employment support provision.

There have been marked policy shifts within many nations towards 'extended work lives', with such shifts often underpinned by an assumption that individual aging citizens can make the responsible choice to prolong work and thereby avoid dependency on the state. However, possibilities for extended work lives are inequitably distributed, and older workers who become unemployed often face prolonged unemployment and barriers to obtaining sustainable employment. Drawing on findings from an ethnographic study addressing the negotiation of long-term unemployment in two North American cities, this article attends to how jobseekers aged 50 and older, employment support service providers, and organizational stakeholders understood and attempted to manage later life unemployment. Employing a critical discourse analysis approach informed by a governmentality perspective, the findings illustrate how possibilities for framing the problems faced by older jobseekers and for managing later life unemployment were constrained by broader individualizing neoliberal mandates. Despite recognition of systemic barriers tied to ageism and its intersection with other axes of disadvantage, stakeholders and service providers enacted a narrow individualized approach to manage ageism. This individualized approach, in turn, produced tensions within service provision and shaped precarity for older jobseekers through encouraging them to be 'realistic' regarding the types of work and wages available to them as older workers. If the extended work life agenda continues to be politically promoted as a key solution in the management of population aging, it is imperative to re-configure policy and service approaches to avoid the downloading of insurmountable barriers onto older jobseekers in ways that increasingly produce precarious lives marked by uncertainty, instability, and vulnerability.