Effectiveness of Comprehensive Environmental Support for Community-Dwelling Older Adults: A Single-Blind Randomized Controlled Trial.

IMPORTANCE: The importance of developing age-friendly environments is globally recognized. However, few clinical trials have comprehensively evaluated physical and social components of environments and examined the effects of offering support. OBJECTIVE: To clarify the effectiveness of occupational therapy-based comprehensive environmental support for community-dwelling older adults. DESIGN: A single-blind parallel-groups randomized controlled trial with blinded participants. SETTING: Eight community-based settings under the long-term-care insurance system in regional towns and cities throughout Japan. PARTICIPANTS: Sixty older adults age ≥65 yr who were new users of adult day care or adult day health care and allocated by stratified block randomization on the basis of age. INTERVENTION: Comprehensive environmental support was provided to participants for 3 mo according to results on the Comprehensive Environmental Questionnaire for older adults (CEQ) to make improvements in environmental factors participants wanted to change to create a more satisfying life. OUTCOMES AND MEASURES: The primary outcome measure was the Japanese Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) score at 3 mo postrandomization. Additionally, scores on the Short-Form Six-Dimension utility index were calculated. RESULTS: The experimental group showed significant improvements in the SF-36's Role/Social Component Summary (p = .005) and Role-Physical (p = .02), Role-Emotional (p = .01), and Mental Health (p = .05) domains, with moderate effect sizes. The number needed to treat was 3.46, showing statistical significance. CONCLUSIONS AND RELEVANCE: Occupational therapy-based comprehensive environmental support based on CEQ scores was effective, resulting in moderate improvements in health-related quality of life among community-dwelling older adults. Plain-Language Summary: Older adults experience a decline in physical and mental functions along with changes in social relationships. These problems make it challenging for older adults to perform valuable occupations, thus reducing their quality of life. This study demonstrated that occupational therapy based on the Comprehensive Environmental Questionnaire for older adults can improve health-related quality of life among community-dwelling older adults. Our findings pave the way for the development of an effective compensatory intervention model in occupational therapy practice.

An examination of the psychometric properties of the occupational identity questionnaire for community-living elderly who require care.

INTRODUCTION: Authors created an Occupational Identity Questionnaire Provisional version (OIQ-P) to assess occupational identity for elderly individuals. The purpose of this study was to examine the psychometric properties of the OIQ-P. METHODS: Participants included 135 (42 males) elderly who lived locally and required care or support. OIQ-P was evaluated in terms of structural validity, criterion validity and internal consistency. RESULTS: Based on the results of an exploratory factor analysis and confirmatory factor analysis, an OIQ with a factor structure of 3 factors and 14 items was created. Rasch rating scale model revealed that 14 participants and 1 item did not fit the goodness of fit, nevertheless, the overall result was good. Spearman's rank correlation coefficient indicates that there was a law correlation between OIQ and the occupational identity scale of the Occupational Performance History Interview Version 2. In terms of internal consistency, the person separation index and person separation reliability coefficient were 2.30 and 0.84, respectively. CONCLUSION: This study confirmed the structural validity, criterion validity and internal consistency for the OIQ. To enhance the clinical utility of the OIQ, it is necessary to examine the interpretability and conduct an intervention study using the OIQ.

Factor structure of "personhood" for elderly healthcare services: a questionnaire survey of long-term care facilities in Japan.

OBJECTIVE: The purpose of this study was to develop the Personhood Questionnaire (PQ) to determine the factor structure of "personhood" for elderly healthcare services and identify personhood components other than PQ items. METHOD: We enrolled 314 healthcare professionals at long-term care facilities in Japan. Participants completed a questionnaire consisting of 17 PQ items. The PQ was designed to assess the degree of need in elderly healthcare services on a 5-point Likert scale (Question 1), and identify personhood components other than PQ items (Question 2). We performed factor analysis for answers to Question 1, and text mining and cluster analysis for answers to Question 2. RESULTS: Factor analysis revealed a four-factor structure. Cronbach's α was 0.87 for the 17 original items and 0.86 for the 15 items after removing two items. Text mining identified 27 personhood components, which were classified into three clusters. The second cluster consisted of non-PQ items. CONCLUSIONS: Factor 1 was "forming daily life," factor 2 was "forming career and context," factor 3 was "affecting psychological behavior," and factor 4 was "forming basic attributes." Components of the second cluster require further examination before incorporation into the concept of personhood. IMPLICATIONS FOR REHABILITATION: • Improving the quality of individualized care, in which "personhood" and dignity of elderly people are respected, is an urgent goal. • The Model of Human Occupation (MOHO), a conceptual practice model for occupational therapy, should be used jointly with the International Classification of Functioning, Disability and Health (ICF) to establish the concept of personhood. • The construction of personhood in elderly health care services consists of a four-factor structure, including "forming daily life," "forming career and context," "affecting psychological behavior," and "forming basic attributes." • This study suggests that provision of high-quality individualized care can be achieved by promoting services that focus on "forming daily life," which has the highest factor contribution.

Association of cognitive judgment and shyness with frequency and quality of flow experience.

OBJECTIVE: To determine the association of cognitive judgment and shyness with frequency and quality of flow experience. DESIGN AND METHODS: This was a cross-sectional survey of the relationship between psychological tendency and frequency and quality of flow experience in 68 college students, undertaken in Hiroshima, Japan. The predictors were Shyness Scale scores, measure of ambiguity tolerance scores, and Life Orientation Test scores, and the outcome was the frequency and quality of flow experience. RESULTS: The results of the binary logistic regression analysis indicated that only the measure of ambiguity tolerance (P = 0.02, odds ratio = 1.06, and 95% confidence interval = 1.01-1.11) was a predictor of the quality of flow experience, and only the Shyness Scale (P = 0.007, odds ratio = 0.95, and 95% confidence interval = 0.91-0.98) was a predictor of the frequency of flow experience. CONCLUSION: The findings suggest that ambiguity tolerance and shyness are associated with the frequency and quality of the flow experience.