Occupational gaps reported by proxies for persons with dementia residing in a nursing home.

BACKGROUND: In accordance with Swedish national dementia guidelines, persons with dementia residing in nursing homes should have the possibility to participate in everyday occupations. Securing choices and desires for participating in occupations is challenging due to the nature of dementia and is not evident in empirical studies regarding nursing home residents. AIM: to describe gaps in participation in everyday occupations among persons with dementia living in a nursing home, as reported by a proxy respondent. METHOD: To record the congruence or discrepancy between doing and wanting to do, the Occupational Gaps Questionnaire was used. Results were analysed with descriptive statistics. RESULTS: The respondents scored that over half of the persons with dementia had two or more occupational gaps and one-fourth wanted to participate in minor shopping. However, less than two percent were deemed to do this activity. CONCLUSIONS: Persons with dementia living in nursing homes risk restrictions in participation. Securing valuable information regarding individuals' choices and desires, adhering to the persons' inherent rights to expression, can be the first step in promoting participation in everyday occupations. SIGNIFICANCE: Occupational therapists with their unique theoretical knowledge can facilitate participation in occupations, supporting the citizenship of nursing home residents.

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.

Experiences of Active Everyday Life Among Persons with Prodromal Alzheimer's Disease: A Qualitative Study.

Introduction: Identifying strategies to prevent or delay cognitive decline among the rising numbers of elderly is acknowledged as a global public health priority. Research suggests that an active lifestyle in terms of participation in activities has the potential to reduce the risk of later-life cognitive decline. The concept of "active everyday life", however, needs to be further explored. Aim: The study aimed to explore and describe the active everyday lives of persons with prodromal Alzheimer's disease (AD) in terms of quality of participation in activities and perceived restrictions. Methods: This qualitative study was part of a larger project, the MIND-ADMINI trial. Nine in-depth interviews were conducted with seven participants (2 males, 5 females; mean age of 72.3) at baseline before the intervention. The data were collected from January to October 2018 and analyzed using the grounded theory approach. Results: Four categories emerged from the analysis: (i) active body and mind; (ii) doing desired meaningful activities to feel engaged, contented, and satisfied; (iii) doing in the context of being connected to others; (iv) ability in making decisions and taking actions. From these categories, which presented the key elements of an active everyday life, a core category was identified: Living a complete life in flow. Conclusion: The findings suggest key elements of participation quality that contribute to an active life. The identified elements are important to be considered in rehabilitation to provide opportunities and possibilities for participation to enable and improve the quality of participation among persons with cognitive impairments.

Changes in Perceived Impact of Stroke on Everyday Life over Five Years in a Rehabilitation Sample that Received an Activity of Daily Living Intervention: A Follow-Up Study.

OBJECTIVE: To compare changes in the perceived impact of stroke on everyday life over time in a rehabilitation sample that received a client-centred activities of daily living (CADL) intervention or usual ADL (UADL) intervention. DESIGN: Longitudinal follow-up of a randomized controlled trial. METHODS: A total of 145 persons with stroke were assigned into CADL or UADL. Groups were assessed using the Stroke Impact Scale (SIS) at 3 months, 12 months and 5 years post-intervention. Changes in SIS domain scores over time were compared within and between groups. RESULTS: Changes in the impact of stroke over time were not related to which intervention the groups received. There were no significant differences in the SIS domains or stroke recovery between groups at the 3-month, 12-month and 5-year follow-ups. Despite an increased impact of stroke over time in some domains in both groups, both groups perceived a decreased impact of stroke in the Participation domain at 12 months. Perceived participation was sustained at the same level at 12 months as at 5 years in both groups. CONCLUSION: These findings stress the importance of access to follow-up rehabilitation interventions 1-year post-stroke to enable participation in daily activities. Such follow-up and enablement would support the use of self-management strategies in the performance of persons' valued activities, which might be difficult to perform, due to, for example, impact on hand function or mobility. The results of this study emphasize the importance of prioritizing participation in activities that are meaningful from a personal perspective.

Experiences of Participation in a Multimodal Preventive Trial MIND-ADMINI Among Persons with Prodromal Alzheimer's Disease: A Qualitative Study.

INTRODUCTION: Alzheimer's disease (AD) is one of the world's leading public health challenges. One-third of AD cases are attributable to modifiable vascular and lifestyle-related risk factors. The Multimodal Preventive Trial for Alzheimer's Disease, MIND-ADMINI a 6-month multinational parallel-group randomized controlled trial (RCT), targeted persons with prodromal AD and built on the positive outcomes from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial. The intervention consisted of four main components of (i) physical exercise training program, (ii) nutrition guidance, (iii) cognitive training, and (iv) social stimulation, as well as (iv) monitoring of metabolic/vascular risk factors. AIM: The study aimed to explore and describe the experiences of participation in MIND-ADMINI among persons with prodromal AD. METHODS: This qualitative study was part of the larger MIND-ADMINI project. Eight participants were interviewed twice, before and after the intervention. The data was analyzed using qualitative content analysis. RESULTS: The results are presented as categories of (i) knowledge of AD and prevention, (ii) motives for study participation, (iii) experiences of the received information about the study, (iv) taking the decision to participate, (v) expectations on study participation, (vi) experiences of study participation and (vii) internal and external factors influencing study participation. CONCLUSION: The MIND-ADMINI was well-tolerated by the participants. At the beginning of the study, the number of tasks and visits was perceived as burdensome but was later well-tolerated. The participant' knowledge about AD and prevention increased during the trial. Their motives for participating in MIND-ADMINI were described as both altruistic and self-beneficial. Health benefits from the study components, access to specialized medical care were identified as benefits. Managing the intensive flow of information was described a major challenge. The participants' needs for personalized support during the trial stress the importance of applying a person-centered approach providing the preventive trials.

Communication and engagement as potentiality in everyday life between persons with young onset dementia living in a nursing home and caregivers.

OBJECTIVES: To explore communication and engagement in everyday situations between persons with young-onset dementia (YOD) living in a nursing home (NH) and the caregivers. METHODS: The study draws on ethnographic methods aligned with participatory design. Three residents with YOD living in a NH and eight staff members were recruited. A narrative approach was used for data collection and analysis. FINDINGS: Three narrative vignettes were developed representing everyday situations in which communication and engagement was enacted among residents and caregiver staff: (a) waiting for something to happen, (b) tensions about everyday communication, and (c) negotiating a combined living + working environment. The findings stress a paradoxical tension rooted in the NH as residence and workplace as well as place of calm and place of boredom. The everyday situations are interpreted differently from the perspective of the residents and staff. CONCLUSION: The identified paradox of planned and spontaneous situations influences communication and engagement in everyday life, and the potentiality for active engagement embedded in contexts of units for residents with YOD. The degree to which everyday activities and encounters are redefined and renegotiated is an important part of caregiving practices in NH settings for residents with YOD.

Depression, everyday technology use and life satisfaction in older adults with cognitive impairments: a cross-sectional exploratory study.

RATIONAL: Life satisfaction is strongly associated with participation in everyday life activities. Yet, older adults with cognitive impairments have been found to experience difficulties in accessing and engaging in more complex everyday activities, especially, if these involve everyday technology. Considering the rapidly advancing technological landscape, this may substantially affect individuals' life satisfaction and their participation in meaningful community-based and home-based activities. OBJECTIVES: This study aimed to explore the associations between life satisfaction, ability to use everyday technology and number of relevant everyday technologies used in older adults (n = 117) with and without mild cognitive impairment (MCI) and Alzheimer's disease (AD). It also aimed to understand the role of depression, activity involvement and diagnosis regarding life satisfaction in this sample. METHOD: Descriptive statistics, Mann-Whitney U tests and t-tests were applied to compare those satisfied and those dissatisfied with life regarding ability to use everyday technology and number of relevant everyday technologies used. FINDINGS: The number of relevant community-based everyday technologies currently not used was significantly associated with being dissatisfied with life (p < 0.05). Further, depression and withdrawal from activities and interests significantly differed across life satisfaction groups, while no group differences were found regarding overall number of everyday technologies in use and ability to use everyday technology. CONCLUSION: Attention from healthcare professionals and researchers to early withdrawal from activities that rely on community-based everyday technologies is called for, especially in older adults with depression. Preventing everyday technology-related barriers in community life may increase life satisfaction.

Dementia Care Education Targeting Job Strain and Organizational Climate Among Dementia Care Specialists in Swedish Home Care Services.

INTRODUCTION: An increasing number of older persons live at home with various limitations, such as dementia, requiring well-educated and trained home care staff to meet their complex care needs. Dementia care specialists working in home care service have reported high levels of job strain in comparison with home care staff in general. AIM: This pilot study aims to evaluate the effects of a dementia care education model targeting self-reported job strain and organizational climate, among dementia care specialists in home care service. METHODS: A quasi-experimental, one-group pretest-posttest design was applied, with 12 months' follow-up. Participants were dementia care specialists who worked in home care service (n=34 baseline; n=30 follow-up). The data were collected using the Strain in Dementia Care Scale and Creative Climate Questionnaires, administered pre- and post-intervention. The intervention applied an educational model based on previous research in dementia care and a person-centered approach. RESULTS: The educational model was implemented in the context of home care services. Of 34 participants at baseline, only 21 responded to the questionnaires, due to a drop off of 13 participants and recruitment of 9 new participants (follow-up=30). A significantly reduced perceived job strain among the participants was detected, indicating perceiving less difficulty in "Balancing competing needs" when caring for the older persons. No significant difference was found in the self-reported creative organizational climate between the two occasions. CONCLUSION: The educational model could be integrated into dementia home care and it seemed to reduce job strain among dementia care specialists. Future studies are needed to evaluate the effects of the intervention using a stronger study design and a larger sample.

Skill clusters of ability to manage everyday technology among people with and without cognitive impairment, dementia and acquired brain injury.

BACKGROUND: In order to develop supporting interventions for people demonstrating problems ET use, a detailed level of description of strengths and deficits is needed. AIMS: To explore clusters of specific performance skill required when using ET, and to evaluate if and in what way such clusters are associated with age, gender, diagnosis, and types of ETs managed. MATERIALS AND METHODS: A secondary analysis of 661 data records from 203 heterogeneous samples of participants using the Management of Everyday Technology Assessment (META) was used. Ward's method and a hierarchical tree cluster analysis were used to determine and define the skill clusters. RESULTS: Four distinct clusters of performance skill item profiles were found, across the 661 data records. These were then, based on each individuals' cluster profiles in managing ET, categorized into two groups. The two groups were associated with, diagnosis and type of ETs managed. CONCLUSIONS AND SIGNIFICANCE: The findings support a more dyadic person-ET approach in evaluation of ET management. The information from the skill clusters can be used to develop targeted intervention guides for occupational therapy and healthcare.

Leisure-activity participation to prevent later-life cognitive decline: a systematic review.

OBJECTIVE: A systematic literature review was conducted to characterise the current state of knowledge concerning the definition, categorisation, and operationalisation of leisure activity in studies examining its possible role in preventing later-life cognitive decline. Following PRISMA guidelines for a systematic review, the study examined peer-reviewed empirical research publications focused on leisure activity, cognitive decline, and prevention. METHODS: Searches in the PubMed/Medline reSEARCH, CINHAL, Ovid MEDLINE, Embase, Web of Science, PsychoINFO, ERIC Proquest, the Cochrane library, and PsycARTICLES databases for the years 2000 to 2011 identified 52 publications for inclusion. RESULTS: The results are discussed and based on these findings are further interpreted using the Model of Human Occupation, which focuses on key factors identified in the review that are salient to associations between participation in leisure activities and prevention of dementia. CONCLUSIONS: While the findings support a growing consensus that participation in leisure activities might significantly contribute to prevention of dementia, it also identifies major hindrances to progress. Important limitations detected include a lack of theoretical underpinnings, and little consensus and standardisation in the measured key variables. The study reinforces the critical need to overcome these limitations to enable health care professionals (e.g. occupational therapists) to make evidence-based recommendations for increased participation in activities as a means of promoting health and preventing cognitive decline.

Participation after acquired brain injury: Associations with everyday technology and activities in daily life.

BACKGROUND: The development of the information society has led to increased use of everyday technology and changed the conditions for participation. Enabling participation in everyday life situations is an important rehabilitation goal after acquired brain injury (ABI). Identifying factors associated with individuals' experienced participation and problems therein is therefore essential. OBJECTIVE: This study aimed at exploring the relationship between perceived difficulty in everyday technology use, perceived ability in the activities of daily living (ADL), and perceived participation, and participation problems in persons with ABI. METHODS: Eighty-one persons with ABI participated in the study and were assessed by the Impact on Participation and Autonomy questionnaire, the Everyday Technology Use Questionnaire, and the ADL taxonomy. RESULTS: Findings showed that the combined model of difficulty in everyday technology (ET) use, ADL ability, and the interaction between them explained both participation in various domains of everyday life, and also overall level of perceived participation and the perceived problems. CONCLUSIONS: The findings underscore the importance of evaluating individuals' ability in both ET use and ADL after ABI to increase the probability of explaining these persons' participation in desired everyday life situations and, also, for rehabilitation design.

Perceived difficulty in use of everyday technology in persons with acquired brain injury of different severity: a comparison with controls.

OBJECTIVE: To compare the perceived difficulty in use of everyday technology in persons with acquired brain injury with different levels of severity of disability with that of controls. METHODS: This comparison study recruited 2 samples of persons with acquired brain injury and controls, comprising a total of 161 participants, age range 18-64 years. The long and short versions of the Everyday Technology Use Questionnaire and the Extended Glasgow Outcome Scale were used to evaluate participants. RESULTS: Persons with acquired brain injury demonstrated lower mean levels of perceived ability in use of everyday technology than controls (F = 21.84, degrees of freedom = 1, p < 0.001). Further analysis showed a statistically significant mean difference in perceived difficulty in use of everyday technology between persons with severe disability and good recovery, between persons with severe disability and controls, and between persons with moderate disability and controls. No significant mean difference was found between persons with severe disability and moderate disability, between persons with moderate disability and good recovery, and between persons with good recovery and controls. CONCLUSION: Perceived difficulty in using everyday technology is significantly increased among persons with acquired brain injury with severe to moderate disability compared with controls. Rehabilitation services should consider the use of everyday technology in order to increase participation in everyday activities after acquired brain injury.

"I am not living my life": lived experience of participation in everyday occupations after stroke in Tehran.

OBJECTIVE: To describe and understand the lived experience and to identify what characterizes the phenomenon of participation in everyday occupations after stroke, in Tehran, Iran. METHODS: Eight individuals with stroke, who had previously been admitted to a neurological hospital ward in Tehran, were interviewed in-depth on one occasion. Data were collected and analysed using the Empirical, Phenomenological, Psychological method. RESULTS: The findings identified 3 main characteristics of the phenomenon of participation in everyday occupations as being: (i) I cannot do activities as before; (ii) I am not the same person - discovery of a different self; (iii) I am not living my life. CONCLUSION: Enabling participation after stroke within a client-centred paradigm in this socio-cultural context requires consideration of the essential meaning of this concept as characterized by the dynamic process between the characteristics of "doing", "identity", and "living life". The study highlights how the provision of efficient rehabilitation services in this Eastern context requires attention to both "doing" and to "identity" in rehabilitation interventions, in order to enable individuals to adapt to their new lives after stroke and to "live their lives".

The impact of mental practice on stroke patients' postural balance.

INTRODUCTION: The most common problem in stroke patients is reduced balance and derangements of postural control that lead to increase the chance of falling and instability during walking. Since physical practice improves balance and postural control, it is assumed also that the application of mental practice would be useful in enhancing such balance. Mental practice is defined as the cognitive rehearsal of a physical skill in the absence of overt physical movements. Factors such as similar time between actual execution and mental performance of a task, the increase of regional cerebral blood flow and also the vegetative activation, all suggest that mental practice imitates physical performance of a task. Thus, the main purpose of this study was to investigate the effect of such mental practice on postural balance among stroke survivors. METHOD AND MATERIALS: This study was implemented as an experimental (interventional), case-control, double blind and randomized trial design. A total of 30 subjects (16 males and 14 females) with necessary arousal, attention and memory functions as their major components of mental practice, participated. Subjects' mean ages were 48.1 ± 10.5 years. They were divided randomly in two control and experimental groups. Timed Get up and Go (TUG) test was used to evaluate the balance of all participants. They were assessed before-after treatment and two weeks post-treatment as research's follow up. The two groups received the same method of occupational therapy services, but the experimental group in addition to aforementioned occupational therapy, was requested to participate in mental practice sessions. RESULTS: Mental practice had a significant effect on postural balance in stroke survivors (P=<0.001). CONCLUSION: Mental practice may improve postural balance in stroke patients and can be considered for them as a beneficial rehabilitative technique.

Perceived participation and autonomy: aspects of functioning and contextual factors predicting participation after stroke.

OBJECTIVE: To describe perceived participation and autonomy among a sample of persons with stroke in Iran and to identify different aspects of functioning and contextual factors predicting participation after stroke. DESIGN: A cross-sectional study. SUBJECTS: A total of 102 persons, between 27 and 75 years of age, diagnosed with first-ever stroke. METHODS: Participants were assessed for different aspects of functioning, contextual factors and health conditions. Participation was assessed using the Persian version of the Impact on Participation and Autonomy questionnaire. RESULTS: This study demonstrated that the majority of the study population perceived their participation and autonomy to be good to fair in the different domains of their participation, but not with respect to the autonomy outdoors domain. In addition, physical function was found to be the most important variable predicting performance-based participation, whereas mood state was the most important variable predicting social-based participation. CONCLUSION: The results emphasize the importance of physical function, mood state and access to caregiving services as predictors of participation in everyday life after stroke. Whilst there are two dimensions of participation in this Persian sample of persons with stroke, the factors explaining participation seem to be the same across the cultures.

Impact on Participation and Autonomy (IPA): PSYChometric evaluation of the Persian version to use for persons with stroke.

The aim of this study was to evaluate the psychometric properties of the Persian version of the Impact on Participation and Autonomy questionnaire (IPA-P) to use for persons with stroke. A total of 102 persons diagnosed with first-ever stroke participated in this cross-sectional study. The psychometric properties were evaluated using a Rasch rating scale model. The results showed that IPA-P could not measure perceived participation as one unidimensional construct according to the criteria, but supported two different but related constructs. Performance-based participation consisted of 19 items including three IPA domains: autonomy indoors, family role, and autonomy outdoors. Social-based participation consisted of seven items from the social relations domain. The results provided evidence of internal scale validity, person response validity, and sensitivity for each of the two constructs of IPA-P. In conclusion, the results supported the psychometric properties of two constructs of perceived participation in the Persian sample tested. However further evaluation of psychometric properties of the IPA is needed in a variety of diagnoses and in other cultural backgrounds.