Participation in everyday occupations and situations outside home for older adults living with and without dementia : places, familiarity and risks.

Participation in occupations and places outside the home has been related to health and social benefits as well as offering challenging and risks for older adults living with and without dementia, yet little is known about how this participation is experienced, also considering the places visited and the occupations performed. Places are central in a transactional and occupational perspective to understand how visiting, maintaining and abandoning them affects their participation outside the home. Acknowledging the complexity and interrelatedness properties of participation, with the embodiment of places by the occupation while it is embedded in the place, provides a new way of examining participation. Thus, the overarching aim of the fours studies was to explore and provide new knowledge on participation in places outside the home for older adults with mild-to-moderate dementia as compared with older adults without dementia, as well as developing an understanding of the transactions between the persons and the places, and how places outside home are associated with perceived participation. To attain this aim, the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire was developed in Study I, as no tool existed that combined occupations and places. ACT-OUT was revised and aligned using cognitive interviews with 26 older adults living without dementia and five older adults living with dementia. ACT-OUT was then used in Study II, together with the occupational gap questionnaire OGQ, to evaluate stability and change in places visited outside home, and associations between number of places currently visited and perceived occupational gaps, and in Study III to consider factors, e.g. perceived risks, that potentially affected perceived participation outside the home with 35 older adults living with dementia, in comparison with 35 older adults living without dementia. Study IV used qualitative, mobile interviews to explore familiarity outside home as experienced by nine older adults living with dementia. Findings (Study II) showed that participants living with dementia visited places to a lesser extent than the comparison group. Social and cultural places as well as places for recreation and physical activity tended to be abandoned, in contrast to places for medical care. Overall, they maintained less places and abandoned more places than the group of comparison, and participation in places was associated with occupational gaps for those living without dementia. In Study III, number of places visited, were associated with the perception of participation outside home, but only for the group of persons living without dementia, while risks of falling and for getting lost were associated for those living with dementia. Findings in Study IV showed that familiarity was experienced in a continuous way, as a whole and in repeated occurrences in personal territories that encompassed diverse places and occupations. This thesis contributed new knowledge about how visiting places contributed to our understanding of the conception of participation outside the home of older adults living with and without dementia, including how perceived risks would influence participation. Familiarity was seen as an overarching concept that links place with participation outside the home, as personal territories including places support participation outside the home for older adults living with dementia

La perspective transactionnelle de l'occupation racontée pas à pas

L’approche transactionnelle de l’occupation émerge au début des années 2000, par la publication de plusieurs articles aux États-Unis. Elle se fonde principalement sur la pensée de John Dewey, un philosophe américain du pragmatisme du début du 20e siècle. L’approche transactionnelle de l’occupation implique la déconstruction de la séparation entre les concepts de Personne (P), d’Environnement (E) et d’Occupation (O) ; et la reconstruction d’une vision holistique de ces concepts à travers la reconnaissance de l’existence d’une situation contextualisée. De plus en plus d’études qualitatives utilisent cette perspective pour théoriser les situations étudiées. Pour pouvoir comprendre les résultats de la recherche et appréhender l’intérêt de ceux-ci pour sa pratique, il est nécessaire de connaître la perspective transactionnelle. La continuité de l’expérience, la contingence du monde, les situations contextualisées et la résolution des conflits par l’action et l’intelligence sont les bases théoriques de la philosophie de Dewey. Celles-ci, décrites par Malcolm Cutchin (2004), sont interprétées dans le vocabulaire professionnel des ergothérapeutes pour concevoir des situations problématiques fondées sur l’occupation. Ainsi, l’expérience humaine est toujours contextualisée et située, d’où la possibilité de comprendre l’expérience humaine à travers la situation. Les situations problématiques sont une rupture de l’harmonie de l’expérience, nécessitant une action intelligente pour reconstruire les interrelations entre l’environnement et la personne, d’où l’idée de « place integration » proposée par Cutchin (2004). La personne ne s’adapte pas à son environnement, mais elle est en interrelation constante avec les éléments de son environnement qu’elle expérimente en même temps. Mots-clés. Perspective transactionnelle, science de l'occupation, théorie __________________________________________________   Occupation's transactional perspective explained step by step   Abstract The transactional perspective on occupation has emerged in the early 2000s with the publication of several articles in the United States. It is based on John Dewey’s work, an American pragmatist of the first half of the 20th century. The transactional perspective on occupation implies the deconstruction of the relationships between the concepts of Person (P), Environment (E) and Occupation (O); and the reconstruction of a holistic vision of these concepts through a recognition of contextualised situations. More and more qualitative studies are using this perspective to theorise studied situations. To understand research results and assess their interest for practice, it is necessary to know about the transactional perspective. A continuous experience, the world contingency, contextualised situations, and conflicts’ resolution by action and intelligence, are the theoretical basis of Dewey’s philosophy. Described by Cutchin (2004), these concepts are translated into the professional terminology in occupational therapy to conceive occupation-based problematic situations. Thus, human experience is contextualised and situated, allowing its understanding through the situation. Problematic situations are a rupture in the harmony of the experience, needing an intelligent action to reconstruct the relationships between the environment and the person, promoting the idea of place integration proposed by Cutchin (2004). The person doesn’t adapt to the environment, but rather he or she is in constant relationship with the environment that he or she experiences. Keywords. Transactional perspective, occupational science, theor

Associations between community participation and types of places visited among persons living with and without dementia: risks perception and socio-demographic aspects

INTRODUCTION: Increasingly, literature has focused on community participation in places visited by persons living with and without dementia. Earlier research indicates that multiple factors, including socio-demographic aspects and risk perception may influence community participation. AIM AND METHODS: This cross-sectional, explorative study aims to inquire into how places visited, socio-demographic aspects and risks perception are associated with self-rated community participation for persons living with and without dementia (n = 70) in Switzerland. Data was collected through face-to-face interviews with questionnaires (ACT-OUT, MoCA, sociodemographic). First, we investigated whether the number of places visited was correlated with self-rated participation; then we added socio-demographic and risks perception factors with a bivariate analysis; and searched for a model using multinomial logistic regressions. RESULTS: For the group of participants living with dementia, risks of falling (p = .014) and of getting lost (p = .037) were significantly associated with self-rated participation. For the group of participants living without dementia, visiting places outside the home was significantly associated with self-rated participation, especially visiting places in domain D/places for recreational and physical activities (p = .005). DISCUSSION AND CONCLUSIONS: The results of exploring multiple factors and searching for a model highlights the complexity of community participation as a construct. Risks and visiting places for recreational and physical activities seem to play a role in self-rated participation. Mobile interviews might be better suited to gain in-depth understanding on community participation for persons living with dementia

Linking people and activities through community mobility : an international comparison of the mobility patterns of older drivers and non-drivers

Community mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N= 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport – Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life

« Les contacts avec le monde extérieur renforcent notre sentiment d’appartenance »

Une étude romande analyse la manière dont les personnes âgées atteintes de démence se déplacent dans l’espace public et ce dont elles auraient besoin pour participer davantage à la vie sociale

« Aussenkontakte stärken das Zugehörigkeitsgefühl »

Eine Westschweizer Studie geht der Frage nach, wie sich Ältere Menschen mit Demenz im öffentlichen Raum bewegen und was es braucht, damit sie am gesellschaftlichen Leben teilhaben können

Participation in everyday occupations and situations outside home for older adults living with and without dementia ::places, familiarity and risks

Participation in occupations and places outside the home has been related to health and social benefits as well as offering challenging and risks for older adults living with and without dementia, yet little is known about how this participation is experienced, also considering the places visited and the occupations performed. Places are central in a transactional and occupational perspective to understand how visiting, maintaining and abandoning them affects their participation outside the home. Acknowledging the complexity and interrelatedness properties of participation, with the embodiment of places by the occupation while it is embedded in the place, provides a new way of examining participation. Thus, the overarching aim of the fours studies was to explore and provide new knowledge on participation in places outside the home for older adults with mild-to-moderate dementia as compared with older adults without dementia, as well as developing an understanding of the transactions between the persons and the places, and how places outside home are associated with perceived participation. To attain this aim, the Participation in Activities and Places Outside Home (ACT-OUT) questionnaire was developed in Study I, as no tool existed that combined occupations and places. ACT-OUT was revised and aligned using cognitive interviews with 26 older adults living without dementia and five older adults living with dementia. ACT-OUT was then used in Study II, together with the occupational gap questionnaire OGQ, to evaluate stability and change in places visited outside home, and associations between number of places currently visited and perceived occupational gaps, and in Study III to consider factors, e.g. perceived risks, that potentially affected perceived participation outside the home with 35 older adults living with dementia, in comparison with 35 older adults living without dementia. Study IV used qualitative, mobile interviews to explore familiarity outside home as experienced by nine older adults living with dementia. Findings (Study II) showed that participants living with dementia visited places to a lesser extent than the comparison group. Social and cultural places as well as places for recreation and physical activity tended to be abandoned, in contrast to places for medical care. Overall, they maintained less places and abandoned more places than the group of comparison, and participation in places was associated with occupational gaps for those living without dementia. In Study III, number of places visited, were associated with the perception of participation outside home, but only for the group of persons living without dementia, while risks of falling and for getting lost were associated for those living with dementia. Findings in Study IV showed that familiarity was experienced in a continuous way, as a whole and in repeated occurrences in personal territories that encompassed diverse places and occupations. This thesis contributed new knowledge about how visiting places contributed to our understanding of the conception of participation outside the home of older adults living with and without dementia, including how perceived risks would influence participation. Familiarity was seen as an overarching concept that links place with participation outside the home, as personal territories including places support participation outside the home for older adults living with dementia