ABSTRACT
INTRODUCTION: While Singapore is rapidly ageing and the need for palliative care services is projected to rise, there has been limited exploration of the occupations of Chinese older adults with life-limiting conditions. This study is the third in a series of three studies aimed to address this issue. This study also sought to discuss future directions for occupational therapy practice with Chinese older adults living with life-limiting illnesses in Singapore. METHOD: The study adopted a qualitative exploratory design using focus groups. Participants were recruited using convenience and snowball sampling. Inclusion criteria were occupational therapists who had attained full registration status with the Allied Health Professionals Council in Singapore, had two or more years of practice as an occupational therapist, and had a current or recent palliative care caseload. FINDINGS: Three focus groups with 16 participants were conducted, and three themes were constructed from the data through reflexive thematic analysis. Reflections on culture and occupations is about the impact of a collectivist culture on occupations, such as tensions new caregivers experience between keeping clients safe and respecting clients' choices. It also highlights that there will always be individual differences within any cultural group. Challenges of occupational therapy practice in palliative care describe the need for therapists to be comfortable with rest and ethical tensions participants faced with billing for sessions that mainly involved time spent conversing with clients and when clients and caregivers' goals differed. Finally, Moving forward is about the importance of having mentors and the learning needs of occupational therapists in palliative care. CONCLUSION: Occupational therapists experienced in providing services to palliative care clients in Singapore emphasised the collectivist nature of Singaporean Chinese families and contributed more information to its possible impact on occupations and occupational therapy practice and made suggestions for future practice.
ABSTRACT
INTRODUCTION: As the majority of occupational therapy philosophy has Western origins, occupational therapists working with palliative care clients in Singapore can provide invaluable insight into the practice of occupational therapy within a non-Western, family-centric population. This study aimed to describe occupational therapists' perceptions of the occupations of terminally ill Chinese older adults and their caregivers and explore occupational therapy practice with terminally ill Chinese older adults in Singapore. METHODS: Eleven occupational therapists were recruited via convenience and snowball sampling. Inclusion criteria were being fully registered with the Allied Health Professionals Council (Singapore) with at least 2 years of working experience and currently working with/had experience working with terminally ill patients within the past 2 years. Interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis. FINDINGS: Five themes were constructed from the data: (1) Independence may not be for everyone, (2) it is a family unit, (3) contributing to others' lives is important, (4) what respecting clients means, and (5) a different way of engaging. These themes describe how occupational therapists adapted their practice to better meet the needs of clients and families in Singapore. DISCUSSION: In family-centric societies, it may be more relevant for occupational therapists to facilitate interdependence instead of independence in activities of daily living. In addition, activities that contribute to others' lives tangibly/intangibly may be more meaningful and relevant. Finally, occupational therapists could engage clients through the 'being' instead of 'doing' dimension of occupation. CONCLUSION: While occupational therapists in Singapore faced some challenges working with terminally ill clients and families due to differences between occupational therapy philosophy and practice context, by reframing their thinking, they were able to adapt their practices to meet the needs of a family-centric population.
Subject(s)
Occupational Therapy , Humans , Aged , Activities of Daily Living , Terminally Ill , Singapore , East Asian People , Occupational TherapistsABSTRACT
Occupations are everyday activities people do that bring meaning and purpose to life and is culturally shaped. This research aimed to explore the occupations of Chinese older adults living with a terminal illness and their caregivers in Singapore. Using a qualitative exploratory approach, 16 care recipient-family caregiver dyads were recruited from a local hospice provider. Semi-structured interviews were carried out and reflexive thematic analysis was employed. Three themes and seven subthemes described the challenges and changes to daily life faced by care recipients and caregivers as they adjusted to living with the terminal condition. Findings suggest that in a family-centric society, the occupations of care recipients are greatly impacted by their families. It is imperative to engage with family members in goal setting and intervention plans to facilitate therapy gains and carry-over into real life. These results may be applicable to other family-centric societies, but further research is required.
ABSTRACT
The aim of this study was to characterize multiscale interactions between high intensity focused ultrasound (HIFU) and dentin collagen and associated matrix-metalloproteinases, in addition to the analysis of the effect of HIFU on bacterial biofilms and biological properties. Dentin specimens were subjected to 5, 10 or 20 s HIFU. XPS spectra were acquired and TEM was performed on dentin slabs. Collagen orientation was performed using Raman spectroscopy. Calcium measurements in human dental pulpal cells (hDPCs) were carried out after 7 and 14 days. For macrophages, CD36+ and CD163+ were analysed. Biofilms were analyzed using CLSM. Tandem mass spectroscopy was performed for the detection of hydroxyproline sequences along with human MMP-2 quantification. Phosphorus, calcium, and nitrogen were detected in HIFU specimens. TEM images demonstrated the collagen network appearing to be fused together in the HIFU 10 and 20 s specimens. The band associated with 960 cm-1 corresponds to the stretching ν1 PO43-. The control specimens showed intensive calcium staining followed by HIFU 20 s > HIFU 10 s > HIFU 5 s specimens. Macrophages in the HIFU specimens co-expressed CD80+ and CD163+ cells. CLSM images showed the HIFU treatment inhibiting bacterial growth. SiteScore propensity determined the effect of HIFU on the binding site with a higher DScore representing better site exposure on MMPs. Multiscale mapping of dentin collagen after HIFU treatment showed no deleterious alterations on the organic structure of dentin.