Qualité de vie, participation sociale et environnement des personnes âgées vivant dans la communauté

En raison du vieillissement de la population et des restrictions budgétaires du système de santé et des services sociaux, un nombre de plus en plus important de personnes âgées demeurent dans leur milieu de vie naturel, pour une période plus longue, même lors d'une diminution de leur autonomie fonctionnelle. L'environnement physique et social doit inévitablement contribuer à leur participation sociale et favoriser l'atteinte d'une qualité de vie (QV) optimale. La participation sociale réfère à la réalisation des activités courantes et des rôles sociaux. Il s'agit d'un résultat situationnel influencé par l'interaction de facteurs personnels et environnementaux. Cette étude, réalisée auprès de 156 personnes âgées de 60 ans et plus, vivant dans la communauté et ayant divers niveaux d'autonomie fonctionnelle, a utilisé un devis mixte, quantitatif longitudinal et quantitatif transversal d'orientation phénoménologique. Le volet quantitatif a d'abord permis de vérifier si la QV, la participation sociale (niveau et satisfaction) et l'environnement diffèrent en fonction du niveau d'autonomie fonctionnelle. Les participants ont été recrutés pour obtenir trois groupes égaux (n = 52 chacun) : un groupe ayant une bonne autonomie fonctionnelle (G1), un groupe ayant une atteinte légère à modérée (G2) et un groupe ayant une atteinte importante de l'autonomie fonctionnelle (G3). Le volet quantitatif a ensuite permis, seulement auprès des personnes âgées ayant une atteinte de leur autonomie fonctionnelle (G2 et G3), de vérifier si la QV varie dans le temps et d'explorer les prédicteurs de la QV et du changement de la QV. Les participants ont été invités à deux reprises, à environ deux ans d'intervalle, à répondre à trois questionnaires quantitatifs (Indice de la qualité de vie, Mesure des habitudes de vie et Mesure de la qualité de l'environnement) possédant de bonnes qualités métrologiques. Le volet qualitatif a permis d'explorer le sens que les personnes âgées accordent à leur QV et l'importance qu'elles accordent à certains facteurs personnels, à leur participation sociale et à leur environnement physique et social en lien avec leur QV. Deux entrevues semi-dirigées individuelles ont été réalisées auprès d'un sous-échantillon de 18 personnes, utilisant un guide d'entrevue semi-structuré validé par 13 cliniciens expérimentés. Les résultats quantitatifs indiquent que plus le niveau d'autonomie fonctionnelle est élevé, meilleures sont la QV et la satisfaction envers la participation sociale (p < 0,001). Toutefois, cette différence est seulement cliniquement significative entre les groupes extrêmes (G1 et G3). Plus l'autonomie fonctionnelle est diminuée, plus la participation sociale est restreinte (p < 0,001) et plus le nombre d'obstacles perçus dans l'environnement physique est élevé (p < 0,001). La QV a augmenté ou diminué de façon cliniquement significative entre les deux mesures pour près de la moitié des participants. Enfin, les meilleurs prédicteurs d'une QV optimale sont une meilleure satisfaction envers la participation dans les rôles sociaux et un nombre inférieur d'obstacles perçus dans l'environnement physique (R2 = 0,27; p < 0,001). Une augmentation de la QV entre les deux mesures est expliquée par une QV socio-économique initialement inférieure et des capacités perçues instables

Exploring the Impact of a New Intervention to Increase Participation of Frail Older Adults in Meaningful Leisure Activities

Abstract : Many frail older adults have difficulty maintaining social participation. We developed an innovative, personalized intervention to help frail older adults pursue meaningful leisure activities through the use of compensatory strategies. This pre-experimental pilot study conducted with 10 community-dwelling frail older adults (≥80 years) showed that the intervention improved their knowledge regarding the compensatory strategies learned and their participation in meaningful leisure activities. However, results also showed a decrease in feelings of well-being. This study provides promising results to support the implementation of an innovative intervention tailored to the needs of frail seniors and designed to foster their participation. However, further research is needed to improve our understanding of the impact of the intervention on well-being and explain the results obtained

Did waiting times really decrease following a service reorganization? Results from a retrospective study in a pediatric rehabilitation program in Québec

Abstract : Purpose: To examine changes in waiting times and types of services received before, during and after a pediatric rehabilitation service reorganization including new admission procedures; To compare waiting time data available in the program’s administrative database and children’s medical files. Method: Waiting time was defined as the time elapsed between referral and accessing a service provided by any clinician in the program (program waiting time) or by any clinician within a discipline (discipline-specific waiting time). Services were categorized as individual, group treatment, or other. ANOVAs and χ2 tests were used to examine changes in waiting times and type of services, respectively. Paired T-tests compared the program waiting times from the two databases. Results: Data were collected on 188 children (mean age: 4 years and 1 month). The program and occupational therapy waiting times were shorter following the service reorganization. For two disciplines, the proportion of children receiving individual treatment diminished over time, while group and other types of interventions increased. Program waiting times calculated using the two data sources did not differ significantly but differences in the available data highlighted administrative issues. Conclusions: Service reorganization can decrease waiting times and change the type of services offered over time

Relations entre la qualité de vie et l'environnement des personnes âgées ayant des incapacités fonctionnelles

Dans le contexte du système de santé actuel, un nombre important de personnes âgées demeure dans leur milieu de vie naturel même en présence d'incapacités, et ce, pour une période de plus en plus longue. L'environnement physique et social doit ainsi répondre à leurs besoins afin de leur permettre de maintenir une qualité de vie optimale et de limiter le développement de situations de handicap. Cette recherche vise à étudier la relation entre, d'une part, la qualité de vie et, d'autre part, l'environnement et le niveau de handicap dans les habitudes de vie (activités de la vie quotidienne et domestique et les rôles sociaux) des personnes âgées présentant des incapacités fonctionnelles. Un dispositif transversal a été utilisé auprès de 46 personnes âgées de 60 à 90 ans (moyenne: 77,0; écart type: 6,9), vivant à domicile et recrutées sur une base de convenance parmi les personnes recevant des services d'un Hôpital de jour ou de maintien à domicile d'un CLSC."--Résumé abrégé par UM

Multiple case study of changes in participation of adults with myotonic dystrophy type 1: Importance of redesigning accomplishment and resilience

This study explored and explained changes in participation post-diagnosis with myotonic dystrophy type 1 from the perspective of six adults, their relatives and nurse case managers. A multiple case study was carried out with these triads (n=18) using semi-structured individual interviews, medical charts, and a participation patient-reported outcome measure. The six cases were built around three women and three men (age: 40-56 years; disease duration: 19-39 years). Their “relatives” were mainly family members. Nurse case managers had done annual follow-ups with all the adults for approximately ten years. Changes in participation were characterized generally by: 1) heterogeneity, 2) insidious increase in restrictions, and more specifically by: 3) redesigning accomplishment, 4) progressive social isolation, 5) restrictions in life-space mobility, and 6) increasingly sedentary activities. Important facilitators of participation were the adult’s resilience, highly meaningful activities, social support, living arrangement, and willingness to use technical aids. Barriers were mostly related to symptoms and a precarious social network, and were affected by misfit and potential syndemic interactions between personal (e.g., comorbidities) and environmental (e.g., stigma) factors. This study identified key facilitators and barriers and their underlying processes, which should be integrated in the evaluation and intervention framework to optimize participation over time

Importance of collaboration and contextual factors in the development and implementation of social participation initiatives for older adults living in rural areas

Abstract : To encourage isolated and vulnerable older adults to accomplish meaningful social activities, occupational therapists and other healthcare workers must collaborate with community organisations and municipalities to develop and implement initiatives fostering social participation. In a rural Regional County Municipality in Quebec (Canada), four social participation initiatives were selected and implemented: 1) Benevolent Community, 2) urban transportation system, 3) creation of a website on social participation activities, and 4) social participation workshop. Little is known about contextual factors such as the structures and organisations, stakeholders, and physical environment that influence the development and implementation of such initiatives

Do quality of life, participation and environment of older adults differ according to level of activity?

<p>Abstract</p> <p>Background</p> <p>Activity limitation is one of the most frequent geriatric clinical syndromes that have significant individual and societal impacts. People living with activity limitations might have fewer opportunities to be satisfied with life or experience happiness, which can have a negative effect on their quality of life. Participation and environment are also important modifiable variables that influence community living and are targeted by health interventions. However, little is known about how quality of life, participation and environment differ according to activity level. This study examines if quality of life, participation (level and satisfaction) and perceived quality of the environment (facilitators or obstacles in the physical or social environment) of community-dwelling older adults differ according to level of activity.</p> <p>Methods</p> <p>A cross-sectional design was used with a convenience sample of 156 older adults (mean age = 73.7; 76.9% women), living at home and having good cognitive functions, recruited according to three levels of activity limitations (none, slight to moderate and moderate to severe). Quality of life was estimated with the Quality of Life Index, participation with the Assessment of Life Habits and environment with the Measure of the Quality of the Environment. Analysis of variance (ANOVA) or Welch F-ratio indicated if the main variables differed according to activity level.</p> <p>Results</p> <p>Quality of life and satisfaction with participation were greater with a higher activity level (p < 0.001). However, these differences were clinically significant only between participants without activity limitations and those with moderate to severe activity limitations. When activity level was more limited, participation level was further restricted (p < 0.001) and the physical environment was perceived as having more obstacles (p < 0.001). No differences were observed for facilitators in the physical and social environment or for obstacles in the social environment.</p> <p>Conclusion</p> <p>This study suggests that older adults' participation level and obstacles in the physical environment differ according to level of activity. Quality of life and satisfaction with participation also differ but only when activity level is sufficiently disrupted. The study suggests the importance of looking beyond activity when helping older adults live in the community.</p

Progressive Decline in Daily and Social Activities: A 9-year Longitudinal Study of Participation in Myotonic Dystrophy Type 1

Abstract : Objective: To describe and compare changes in participation over a 9-year period in women and men with myotonic dystrophy type 1 (DM1). To compare participation restrictions with available reference values from a typical aging population living in the community. Design: Descriptive longitudinal design comparing data from baseline (2002) with data from follow-up (2011). Setting: Neuromuscular clinic and participant’s home. Participants: Adults with DM1 participated in the follow-up study (NZ115). Interventions: Not applicable. Main Outcome Measure: The Assessment of Life Habits measured participation in 10 domains of daily and social activities. The minimal clinically important difference is 0.5 on a 10-point scale for participation accomplishment level. Results: A total of 62% of participants were women, and the mean age was 52.3 10.3 years. A decline (P<.01) was observed with increasing difficulty and assistance required in global participation (mean SD, 0.5 0.9), social activities subscore ( 0.6 1.2), nutrition ( 0.7 1.4), fitness ( 1.0 1.6), personal care ( 0.7 1.2), mobility ( 0.5 1.9), community life ( 0.8 1.9), and recreation ( 1.5 3.0). More life areas are disrupted over time: 8 domains were below reference values from a population aged 55-64 years at follow-up compared with 2 domains at baseline. Satisfaction with participation remains high and stable over time. Conclusion: As disease duration increases, global participation and more daily and social domains were restricted with increasing difficulty and assistance required. Adults with DM1 showed not only age-associated but disease-specific changes in participation. Description over time of participation could improve clinical assessment and guide interdisciplinary management of DM1, leading to higher rehabilitation success. Further investigation of the factors influencing changes in participation is required to support disease management and services planning. [Symboles non conformes

Réadaptation à base communautaire versus interventions communautaires de réadaptation et réadaptation dans la communauté : comparaison des concepts, et enjeux québécois et internationaux

Les situations de crise humanitaire touchent fréquemment les pays en voie de développement, pays où l’organisation des services de réadaptation s’appuie couramment sur la réadaptation à base communautaire (RBC). Parallèlement, la RBC est de plus en plus utilisée dans les pays industrialisés. La RBC est officiellement une stratégie de développement communautaire inclusif qui vise à favoriser la participation sociale des personnes en situations de handicap. Il existe cependant un flou conceptuel dans les écrits scientifiques sur la RBC et deux autres formes de collaboration avec la communauté, soit les interventions communautaires de réadaptation et la réadaptation dans la communauté. Les objectifs de cet article conceptuel sont : 1) de comparer ces trois formes de collaboration et 2) d’identifier quelques enjeux associés au travail en collaboration avec la communauté, et ce, pour le Québec, les pays industrialisés, les pays en voie de développement et les situations de crise. Les comparaisons mettent en évidence le fait que la RBC est une forme de collaboration avec la communauté qui demande une approche plus systémique, pouvant inclure les interventions communautaires de réadaptation (qui renvoient surtout à un type de services) et la réadaptation dans la communauté (qui renvoie principalement à un lieu d’intervention). Quelques enjeux sont propres à la RBC (ex. : le renforcement des liens avec les services spécialisés en comparaison avec les services communautaires) alors que d’autres sont communs aux trois formes de collaboration (ex. : les déplacements). De plus, la majorité des enjeux présentent des défis différents selon le contexte. La RBC est une stratégie globale de réadaptation qui est intéressante dans l’optique de favoriser, notamment en situation de crise, la participation sociale des membres de la communauté. D’autres recherches sont toutefois nécessaires afin de préciser les formes de collaboration avec la communauté les plus efficientes dans divers contextes.Abstract: Humanitarian crisis situations frequently affect developing countries that have adopted Community Based Rehabilitation (CBR) to organize rehabilitation services at the community level. At the same time, CBR has increasingly been used in industrialized countries. CBR should be understood as an inclusive community development strategy aiming to promote the social participation of persons living in disabling situations. However, there is conceptual confusion in the scientific literature about CBR and two other forms of community collaboration, either the community-based rehabilitation interventions or community rehabilitation. The objectives of this conceptual article are: 1) to compare these three forms of collaboration, and 2) to identify some of the issues associated with the work in partnership with communities of the province of Québec (Canada), industrialized countries, developing countries, as well as in the context of humanitarian crisis situations. Comparisons put into evidence that CBR is a form of community collaboration that calls for a more systemic approach that may include community-based rehabilitation interventions (mainly referring to a certain type of services) and rehabilitation in the community (mainly referring to the location where services are delivered). Some issues are specific to RBC (e.g. strengthening of partnerships with specialized services compared to community services), while the others are common to the three forms of community collaboration (e.g. transportation). In addition, the majority of the issues present challenges that are different depending on the context. CBR is a global rehabilitation strategy that might be of interest to those wishing to promote, notably in crisis situations, the social participation of all community members. However, further research is needed to identify the forms of community collaboration that are the most efficient in various settings

A 9-year follow-up study of the natural progression of upper limb performance in myotonic dystrophy type 1: a similar decline for phenotypes but not for gender

Abstract: This study aimed to document and compare the decline of upper limb performance among adults with myotonic dystrophy type 1 according to phenotype and gender. A longitudinal descriptive design compared upper limb performance at baseline and follow-up of 70 women and 38 men with the late-onset or adult phenotypes. Grip strength and pinch strength as well as gross dexterity and fine dexterity were assessed. All four performance measures decreased significantly (p < 0.001). The decline over time was similar for individuals with the late-onset and adult-onset phenotypes, but differed according to gender. For late-onset and adult-onset phenotypes respectively, women lost less grip strength than men: 0.4 and minus 0.8 kg (2.0% and -9.4%) in women vs. minus 7.4 and minus 3.1 kg (-19.2% and -30.7%) in men. A similar situation was found for gross dexterity: minus 3.0 and minus 3.2 blocks (-4.6% and -5.9%) in women vs. minus 12.4 and minus 8.7 blocks (-19.4% and -16.6%) in men. Pinch gauge had the smallest standard deviations and was one of the only measurement tools with significant detectable changes in relation to the standard error of measurement. Given these results, health professionals and researchers should consider phenotype and gender differently when planning health services or future studies. Indeed, as their upper limb strength and dexterity differed, even if their decline was similar, the phenotypes should not be pooled. Finally, the use of the pinch gauge to assess long-term change in upper limb ability seems preferable to the three other measurements