The Development of a Design and Construction Process Protocol to Support the Home Modification Process Delivered by Occupational Therapists.

Modifying the home environments of older people as they age in place is a well-established health and social care intervention. Using design and construction methods to redress any imbalance caused by the ageing process or disability within the home environment, occupational therapists are seen as the experts in this field of practice. However, the process used by occupational therapists when modifying home environments has been criticised for being disorganised and not founded on theoretical principles and concepts underpinning the profession. To address this issue, research was conducted to develop a design and construction process protocol specifically for home modifications. A three-stage approach was taken for the analysis of qualitative data generated from an online survey, completed by 135 occupational therapists in the UK. Using both the existing occupational therapy intervention process model and the design and construction process protocol as the theoretical frameworks, a 4-phase, 9-subphase design and construction process protocol for home modifications was developed. Overall, the study is innovative in developing the first process protocol for home modifications, potentially providing occupational therapists with a systematic and effective approach to the design and delivery of home modification services for older and disabled people.

Developing an audit checklist to assess outdoor falls risk.

Falls by older people (aged 65+) are linked to disability and a decrease in mobility, presenting a challenge to active ageing. As such, older fallers represent a vulnerable road user group. Despite this there is little research into the causes and prevention of outdoor falls. This paper develops an understanding of environmental factors causing falls or fear of falling using a walk-along interview approach with recent fallers to explore how older people navigate the outdoor environment and which aspects of it they perceived facilitate or hinder their ability to go outdoors and fear of falling. While there are a number of audit checklists focused on assessing the indoor environment for risk or fear of falls, nothing exists for the outdoor environment. Many existing street audit tools are focused on general environmental qualities and have not been designed with an older population in mind. We present a checklist that assesses aspects of the environment most likely to encourage or hinder those who are at risk of falling outdoors, developed through accounting for the experiences and navigational strategies of elderly individuals. The audit checklist can assist occupational therapists and urban planners, designers and managers in working to reduce the occurrence of outdoor falls among this vulnerable user group.

Slip resistance of winter footwear on snow and ice measured using maximum achievable incline.

Protective footwear is necessary for preventing injurious slips and falls in winter conditions. Valid methods for assessing footwear slip resistance on winter surfaces are needed in order to evaluate footwear and outsole designs. The purpose of this study was to utilise a method of testing winter footwear that was ecologically valid in terms of involving actual human testers walking on realistic winter surfaces to produce objective measures of slip resistance. During the experiment, eight participants tested six styles of footwear on wet ice, on dry ice, and on dry ice after walking over soft snow. Slip resistance was measured by determining the maximum incline angles participants were able to walk up and down in each footwear-surface combination. The results indicated that testing on a variety of surfaces is necessary for establishing winter footwear performance and that standard mechanical bench tests for footwear slip resistance do not adequately reflect actual performance. Practitioner Summary: Existing standardised methods for measuring footwear slip resistance lack validation on winter surfaces. By determining the maximum inclines participants could walk up and down slopes of wet ice, dry ice, and ice with snow, in a range of footwear, an ecologically valid test for measuring winter footwear performance was established.

Engaging life in two Irish nursing home units for people with dementia: quantitative comparisons before and after implementing household environments.

OBJECTIVES: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice. METHOD: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work. RESULTS: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p < 0.001). CONCLUSION: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications.