Changes in Community Mobility in Older Men and Women. A 13-Year Prospective Study

Community mobility, defined as “moving [ones] self in the community and using public or private transportation”, has a unique ability to promote older peoples’ wellbeing by enabling independence and access to activity arenas for interaction with others. Early predictors of decreased community mobility among older men and women are useful in developing health promoting strategies. However, long-term prediction is rare, especially when it comes to including both public and private transportation. The present study describes factors associated with community mobility and decreased community mobility over time among older men and women. In total, 119 men and 147 women responded to a questionnaire in 1994 and 2007. Respondents were between 82 and 96 years old at follow-up. After 13 years, 40% of men and 43% of women had decreased community mobility, but 47% of men and 45% of women still experienced some independent community mobility. Cross-sectional independent community mobility among men was associated with higher ratings of subjective health, reporting no depression and more involvement in sport activities. Among women, cross-sectional independent community mobility was associated with better subjective health and doing more instrumental activities of daily living outside the home. Lower subjective health predicted decreased community mobility for both men and women, whereas self-reported health conditions did not. Consequently, general policies and individual interventions aiming to improve community mobility should consider older persons’ subjective health

On the structure and contents of occupational therapist paradigms : empirical studies of occupational therapy students' and occupational therapists' views on occupational therapy

The ambition of this thesis is to contribute, from a paradigm theoretical frame of reference, to the development of occupational therapy knowledge in Sweden. The specified thesis aim was to identify and characterize occupational therapy students' and occupational therapists' perceptions of occupational therapy, especially regarding world view and field of action view in Törnebohm's sense. The thesis includes five sub-studies. The first and second studies are based on newly enrolled and qualified occupational therapy students' written answers to essay-questions. The third study comprises occupational therapists' audio- and video-taped thematic discussions and involves a focus group approach. Study four concerns occupational therapists' exam papers and study five occupational therapists' personal accounts of the meaning of health. In study one the newly enrolled occupational therapy students were shown to possess varied information about occupational therapy, but to have difficulty in joining the information together into a coherent unity. Three themes were identified in the material: Notions of some concepts fundamental to occupational therapy; Notions of the setting of occupational therapy, and Notions of the operational reality of occupational therapy. In study two a major finding was that the qualified occupational therapy students' notions gave expression to a constant application of a holistic health perspective which, in contrast to that of newly enrolled occupational therapy students, resulted in numerous examples of interrelations within, but also between, themes belonging to different paradigm components. According to Törnebohm this is characteristic of paradigms. In study three the results showed several unifying factors within the two paradigm components world view and field of action view, and the dissimilarities were limited to specifications within the unifying factors, with regard to the respondents' notions. The unifying factors could be described as a potential local ideology for the group. A major finding is that the lasting core of occupational therapy work consists of three components: concern for uniqueness of patients; concern for details of everyday life; and concern to set free willpower/facilitate autonomous actions. In study four the occupational therapists' interest in research subjects related to the field of action view components of paradigms and in applied research on strategical matters, dominated throughout the material. The interest in research subjects related to the world view components of paradigms, and in basic research on ontological matters, however, was shown to have increased in the last five-year period. In study five the results showed a strong tendency towards holistic health conceptions and also towards a phenomenological view of the body. If this tendency should be taken to reflect current basic views within the profession, it would indicate a movement away from biomedical frames of reference on the theoretical level. This would seem to imply consequent movements on the practice level away from organ-focused interventions to the benefit of interventions in the person/context dimension of occupational performance

Professional views on patient education in osteoporosis

Summary The aim of this study was to investigate patient education in osteoporosis, with a consensus-building Delphi survey. The results showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain. Introduction According to the World Health Organization, osteoporosis is a major health problem. The morbidity is caused by fractures associated with pain and decreased physical function, social function and well-being. The aim of this study was to investigate and reach consensus about how so-called osteoporosis schools are run by professionals in Sweden with a focus on intervention and evaluation. Method The study design was a consensus-building, threeround Delphi survey. Questionnaires were sent by web and post to an expert panel comprising 15 nurses, occupational therapists and physiotherapists. In round 1, they were asked to write descriptions within the frame of eight domains related to intervention and evaluation. In the second and third rounds, the Delphi panel was asked to mark on a Likert scale the importance of 40 statements within these domains. Results The answers showed that the purposes of osteoporosis schools are to reduce the risk of falling, facilitate empowerment, increase levels of function and activity and teach participants to master or reduce pain. The schools comprise theoretical elements as well as practical exercises. Patients with fractures related to osteoporosis are offered participation. There is a lack of a theoretical basis, as well as of evidence, for present treatment models. Evaluation ought to be done systematically, and for this purpose, different questionnaires are used. Experts assert that evaluations show that patients gain increased activity levels, function, knowledge about osteoporosis, empowerment and pain reduction. Conclusions Consensus was reached in 29 of 40 items

The impact of lifestyle interventions on older persons' health, wellbeing and occupational adaptation

Background: The demographic development, with the older population growing fast, is becoming a huge challenge for society, with great demands on health and social care and concerning the individual’s well-being. The aim of this study was to investigate whether a four-month occupational based health-promoting programme for older persons living in community dwellings could maintain/improve their general health and well- being. Further the aim was to explore whether the programme facilitated the older persons’ occupational adaptation. Method: The study had a quasi- experimental design combined with semi-structured interviews. The intervention group comprised 22 participants, and the control group 18. Outcomes were measured using the Short Form 36, Life Satisfaction Index-Z and Meaningful Activity Participation Assessment. Content analysis, based on concepts from the Model of Occupational Adaptation, was used to analyse the interviews. Results: The intervention group showed statistically significant improvements in general health variables such as vitality and mental health, and positive trends for psychological well-being. There were no statistically significant differences between the intervention group and the control group. The qualitative analysis based on Occupational Adaptation pointed out social aspects as a compliment to the overall results. Conclusion: Participating in meaningful, challenging activities in different environments stimulates the occupational adaptation process. Application to Practice: Occupational therapists can use this result to empower older persons to find their optimal occupational lives

Focus on Health, Motivation, and Pride : A discussion of three theoretical perspectives on the rehabilitation of sick-listed people

During the last decades sickness absence from work has become a great societal problem. Questions of how rehabilitation processes should become successful and how peoples’ ability to work can be improved have become of great public interest. In this paper we discuss three well-known theoretical perspectives regarding their usefulness when it comes to research on rehabilitation for return to work. The three perspectives are: Antonovsky’s salutogenic model of health, Kielhofner’s model of human occupation and Scheff’s sociological theory of “shame and pride”. Each of these can be applied to increase understanding and knowledge concerning sickness absence and return to work. We discuss points of affinity among the three perspectives, as well as significant differences, and we propose that a very essential common denominator is the importance of self-experience

Teknikstöd för anhörigvårdare : Problem, behov och försörjning av produkter/teknologi och webbaserade tjänster

Syftet med projektet var att ta reda på om erhållet stöd i form av produkter, teknologi och webbaserade tjänster motsvarar de behov som anhörigvårdare har när de vårdar en person över 65 år i hemmet. Enkäter med nationell spridning angående aktivitetsbegränsningar, behov av stöd och erhållet stöd besvarades av 368 anhörigvårdare och 332 arbetsterapeuter, som mött anhörigvårdare inom tjänsten. Dessutom intervjuades 58 anhörigvårdare från två län individuellt. Resultatet av enkätstudierna visar att anhörigvårdare uppfattade aktivitetsbegränsningar hos den person de vårdar i högre grad än vad de ansåg sig ha behov av stöd i form av produkter/teknologi och webbaserade tjänster. De angav dock behov av stöd i större omfattning än vad de uppgav att de erhållit. Anhörigvårdarna uppfattade aktivitetsbegränsningar hos den de vårdar i högre grad än arbetsterapeuterna inom samtliga nio aktivitetsområden i WHO:s klassifikation över funktionstillstånd, funktionshinder och hälsa (ICF). Anhörigvårdarna uppfattade behov av produkter/teknologi i något större utsträckning eller i lika stor utsträckning som arbetsterapeuterna. Undantagen var förflyttning och personlig vård, där arbetsterapeuterna uppfattade behoven av produkter/teknologi som större än anhörigvårdarna. När det gäller webbaserade tjänster var underlaget alltför bristfälligt för att möjliggöra jämförelse mellan anhörigvårdarnas och arbetsterapeuternas uppfattningar. Resultatet av intervjustudierna visar att informationen om utbudet behöver förbättras och att man efterfrågade bättre uppföljning av de förskrivningar som skett. Kunskapen om webbaserade tjänster var begränsad men man tyckte att de verkade bra, framförallt för andra än sig själv. Man ansåg vidare att de produkter och den teknologi som man fått ta del av behöver utvecklas så att de blir mer användarvänliga, men att det man erhållit gav säkerhet, trygghet och självständighet. Sammanfattningsvis kan inte nog betonas vikten av att utgå från anhörigvårdarnas egna uppfattningar om aktuella aktivitetsbegränsningar hos den de vårdar för att kunna ge relevant information och rätt stöd för vårdandet i form av produkter, teknologi och webbaserade tjänster.Teknik för äldre

The impact of occupational therapy and lifestyle interventions on older persons’ health, well-being, and occupational adaptation : A mixed-design study

Aim: The aim of this study was to investigate whether a four-month occupational based health-promoting programme for older persons living in community dwellings could maintain/improve their general health and well-being. Further, the aim was to explore whether the programme facilitated the older persons’ occupational adaptation. Methods: The study had a quasi-experimental design, with a non-equivalent control group combined with semi-structured interviews. The intervention group comprised 22 participants, and the control group 18. Outcomes were measured using the Short Form 36, Life Satisfaction Index-Z and Meaningful Activity Participation Assessment. Content analysis, based on concepts from the Model of Occupational Adaptation, was used to analyse the interviews. Results: The intervention group showed statistically significant improvements in general health variables such as vitality and mental health, and positive trends for psychological well-being. There were no statistically significant differences between the intervention group and the control group, but the groups were not fully matched. The qualitative analysis based on Occupational Adaptation pointed out social aspects as a compliment to the overall results. Conclusions: Participating in meaningful, challenging activities in different environments stimulates the occupational adaptation process; this is something occupational therapists could use to empower older persons to find their optimal occupational live

Family caregivers' conceptions of usage and information of products, technology and Web-based services. : -

The aim of this study was to identify and characterize family caregivers' conceptions of usage of and information on products, technology, and Web-based services when caring at home for next of kin aged over 65 years. A phenomenographic method with semi-structured interviews with ten family caregivers was used. The results show that the family caregivers considerd products and technology to be essential for an active life, and they stressed both facilitators for and hindrances to their optimal usage. The family caregivers apprehended a lack of information regarding products, technology and Web-based services, and additionally showed limited interest in using Web-based services. There is a need for better information about existing availability and for improvement in follow-up regarding prescriptions given. Therefore, it is necessary to involve family caregivers in the prescription and decision process in line with their wishes, since this to a highly degree influences their possibility to take care of their next of kin at home.Teknikstöd för anhörigvårdar