What older people do: Time use and exploring the link between role participation and life satisfaction in people aged 65 years and over

Objectives:  Data on time use and role participation can provide rich information that can help occupational therapists better understand older people's lives. This study aimed to (i) describe the time use and role participation of community-dwelling people aged 65 years and older, (ii) analyse whether time use and role participation changed with increasing age, and (iii) determine if there is a link between maintenance of role participation and life satisfaction in older age.
Methods:  Using a cross-sectional design, interviews including the Activity Configuration, Role Checklist and Life Satisfaction Index-Z were used to collect data on 195 participants (mean age 75 years, 58.5% female).
Results:  Participants spent most of their time on sleep (8.4 h/day), solitary leisure (4.5 h/day), instrumental activities of daily living (3.1 h/day), social leisure (2.7 h/day) and basic activities of daily living (2.6 h/day). The most common roles were friend (96.4%), family member (95.4%) and home maintainer (87.2%). Participants aged 75 years and older spent significantly more time on solitary leisure and less time on paid work and transport compared to those aged 65–74 years. Role maintenance was significantly related to greater life satisfaction in participants aged 75–84 years.
Conclusion:  Older people's occupations and roles are diverse, and increasing age does not appear to reduce occupational or role engagement. The value of roles is not always reflected in the amount of time devoted to them and facilitating continued participation in valued roles may be important for older people's life satisfaction.     

Discharge decision-making with older people: The influence of the institutional environment

Background/Aim:  Occupational therapists often participate in decision-making about postdischarge accommodations. This paper presents the findings of a study that identified and explored institutional factors influencing discharge accommodation decision-making with older people, from the perspective of occupational therapists.
Methods:  Qualitative, semistructured, face-to-face interviews were conducted with 10 occupational therapists. Interviews were recorded, transcribed, coded and analysed for the presence and emergence of themes.
Results:  Decision-making processes were influenced by the institutional environment. The medical model and pressure for fast decisions seemed to impede client-centred processes in acute settings.
Conclusions:  When possible, decision-making about long-term care needs to occur in community or longer-stay rehabilitation settings that allow time for negotiated client-centred processes.     

Occupational therapy in acute hospitals: The effectiveness of a pilot program to maintain occupational performance in older clients

Background:  Research evidence suggests that during acute hospitalisation, older people may experience reduced occupational performance, reduced quality of life, and an increased length of hospital stay. The aim of this study was to pilot a randomised controlled trial to determine whether an additional occupational therapy program could assist older adults to maintain their occupational performance.
Methods and Results:  A pilot study evaluated 15 clients on admission to and discharge from an acute hospital, using measures of level of independence in performing daily activities, quality of life, and confidence. Participants were randomly allocated to either the control group (those receiving current allied health management) or the experimental group (those receiving an additional program, which included daily self-care, domestic and community activities). Although the differences between the groups on admission and discharge measures only approached statistical significance, several benefits of the program were noted by clinicians and clients, and are highlighted through the presentation of client case studies.
Conclusion:  This pilot has highlighted the need for future research on deconditioning, the timing and nature of occupational therapy interventions, and environmental and cultural influences in acute care for older people.     

Improving handwriting without teaching handwriting: The consultative clinical reasoning process

Background and Aim:  Children who have difficulty with handwriting are often referred for occupational therapy. This case report describes a dynamic intervention process and consultative relationship between an occupational therapist and physiotherapist, meeting the needs of an adolescent with handwriting problems.
Methods and Results:  Examples are given of the collaborative clinical reasoning process, problem-solving strategies, and ongoing adaptation of activities, materials, and equipment, leading to moderate improvement in handwriting and significant improvements in school reports and athletic competence, maintained for 6 years.
Conclusion:  Clinical decisions for selecting and modifying intervention techniques can be derived from assessment of occupational performance areas and performance components (underlying motor, sensory, and perceptual deficits interfering with the production of legible handwriting), within relevant performance contexts.     

Retirement: What will you do? A narrative inquiry of occupation‐based planning for retirement: Implications for practice

Aim:  To examine, using a retrospective narrative study, the factors influencing four older people's decision to plan for the activities they would undertake once retired, the planning process undertaken and their subsequent experience of retirement.
Method:  Semi-structured interviews were conducted to examine the factors influencing older people's decision to commence pre-retirement planning, the planning process undertaken and their experience of retirement. In keeping with narrative inquiry, paradigmatic-type narrative analysis led to the development of categories and subsequent themes to reveal the participants' experiences of these issues.
Results:  Three themes: environmental influences, the planning process and retirement experiences: the outcome of planning, were derived from the participants' narratives. Overall, retirement activities that were continued or initiated led to a positive experience even when these planned activities were temporarily interrupted or altered. Planning for future years in retirement and older age also continued.
Conclusion:  Occupational therapists have a unique understanding of the centrality of occupation to health and wellbeing. Thus occupational therapists are well-positioned to assist people identify, plan and engage in meaningful occupations outside work in retirement.     

Employer-sponsored occupational therapy professional development in a multicampus facility: A quality project

Aim:  To critically assess and develop recommendations for professional development (PD) for occupational therapists in a multisite specialist cerebral palsy occupational therapy service.
Method:  Quality improvement project based on principles of participatory action research: audit of PD resources/activity; stakeholder consultations and literature review.
Results:  The PD program goal, resources, strategies, activities and evaluations conducted at the centre were identified and described. Areas for improvement were identified by critically considering the PD program in the context of reviewed literature. There was an assumption that personal change through PD would help attain the organisational goal of clinically competent practitioners who use evidence-based practice in a family-centred context.
Recommendations:  Future PD plans and evaluations need to explicitly address this assumption. The use of structured reflection and the 'clinical reasoning' conceptual framework was recommended as one way to help personal change from PD to have workplace impact. This project provides a precedent and guide to occupational therapy PD planners regarding a whole-of-organisation approach to developing and maintaining competence through PD.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

Exploration of Australian and New Zealand indigenous people's spirituality and mental health

Background:  Spirituality has been defined as an overarching construct that involves personal beliefs or values that provide a sense of meaning and unity with self, people, nature and universe. Spirituality may be experienced within or outside formal religion. At least in English-speaking countries, therapists reported discussing spiritual issues with service users more frequently than before. In the literature, there continues to be debate regarding definitions of spirituality and how spirituality fits with occupational therapy practice models.
Methods and Results:  To advance the discussion, we explore the concept of spirituality among indigenous people of Australia and New Zealand, and use mental health as a practice setting to suggest how occupational therapists can address the spiritual needs of individuals recovering from mental health problems.
Conclusion:  The implications for assessment and interventions to improve coping skills, social support, self-esteem and instil hope of recovery from mental illness are considered.     

Comparison of time use, role participation and life satisfaction of older people after stroke with a sample without stroke

Background/aims:  This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1–3 years post-stroke and living in the community. The results of this study were compared with a published study on the time use, role participation and life satisfaction of older Australians who had not experienced stroke.
Methods:  Twenty-three participants with stroke (mean age 74.2 years, 69.6% men) were interviewed using measures of time use, role participation and life satisfaction.
Results:  Participants with stroke spent most of their time in sleep (7.2 h/day), solitary leisure (7.0 h/day), social leisure (3.0 h/day), and basic activities of daily living (2.9 h/day). Compared to the sample without stroke, participants with stroke spent significantly less time in sleep, instrumental activities of daily living, and volunteer work, and significantly more time at home, with others, and engaged in solitary leisure. Similar to the sample without stroke, the most common roles for participants with stroke were family member, friend, and home maintainer. Participants with stroke engaged in fewer roles than participants without stroke. Unlike the sample without stroke, role loss was not correlated with life satisfaction for participants with stroke; however, having more roles was correlated with greater life satisfaction.
Conclusion:  Experiencing a stroke can affect the configuration of older people's time use and reduce their role participation. Facilitation of older people's role participation after stroke may enhance their life satisfaction.     

Leisure and ageing: The leisure experiences of older Italians in an Australian community

Background:   A search of the occupational therapy literature revealed a paucity of research on how older adults make use of their leisure time, what meaning these pursuits have to them, and whether their chosen leisure occupations are health enhancing. Occupational therapy literature on how people of culturally and linguistically diverse backgrounds understood leisure was also lacking.
Aim:   This thesis documented a qualitative research study that aimed to discover how Italians aged 65 years and older living in the City of Greater Geelong, Victoria, Australia engaged in leisure occupations, the meanings that were derived from leisure engagement, and whether such subjective experiences of leisure produced health benefits.
Methods and results:   A phenomenological study design was utilised, and data were collected through semistructured interviews and a reflective journal. Participants engaged in numerous meaningful leisure occupations that directly impacted on positive subjective experiences and health outcomes. The subjective experiences found concurred with current research, and were categorised under the three main constructs of leisure theory: 'intrinsic motivation', 'internal control' and 'suspension from reality'.
Conclusion:   Leisure was found to promote positive subjective experiences, health benefits and successful ageing for the participants. It is suggested that the subjective experiences categorised under the 'intrinsic motivation' construct of leisure theory is the main determinant of positive leisure experiences. Furthermore, culturally meaningful leisure occupations were highlighted, and the 'Leisure Engagement Model' is proposed to demonstrate the power of leisure on people's lives and on their sense of health towards continued leisure engagement and health promotion.     

Occupational performance modification and personal change among clients receiving rehabilitation services for rheumatoid arthritis

Background:  A client's personal process of change is recognised as an important element in the rehabilitation process that may affect the acceptance and outcome of recommended occupational therapy self-management interventions. Recent research has examined the transformative process of changing underlying values, beliefs, feelings and knowledge, collectively known as meaning perspectives, in clients receiving rehabilitation for various chronic conditions.
Aim/methods:  This article presents the findings of a Grounded Theory Qualitative retrospective study of 10 adults diagnosed with rheumatoid arthritis receiving occupational therapy to modify their daily living environment and activities to maximise the quality of life and occupational performance. They were interviewed twice in a semidirected manner.
Results:  Two personal change processes were identified for two different courses of the illness: progressive adaptation during a course of gradual steady development of symptoms without remission, and complex adaptation that led to transformation during a course of acute development of symptoms with periods of remission.
Conclusion:  Implications for more effective and efficient occupational therapy interventions are suggested.     

Inpatients' perspectives of occupational therapy in acute mental health

Background:  Research into service users' views of occupational therapy in acute mental health is extremely limited. This collaborative study by the South West London and St George's Mental Health NHS Trust and the Brunel University (UK) obtained inpatients' perspectives of occupational therapy.
Methods:  Service users and occupational therapists were involved in designing a self-report questionnaire and, following training, in recruiting participants and collecting data.
Results:  Sixty-four (28.6%) inpatients responded and most had met an occupational therapist who had explained the purpose of the intervention. The most frequent group interventions were arts and crafts, relaxation, community meetings, cookery, sports and gym, with the latter two rated as the most beneficial. There was much less choice about individual goals and interventions. A highly significant and positive correlation was found between occupational therapy meeting the needs of individuals and it improving the inpatients' daily functioning and quality of their admission.
Conclusions:  Occupational therapists need to provide more individual interventions and more fully involve inpatients in deciding on individual goals. Group interventions, which are meaningful, relevant and with an occupational focus, are most beneficial. Further research examining the effectiveness of cookery and sport and gym and establishing the benefits of engaging in group and individual interventions in acute wards is warranted.     

Interests that occupy 86-year-old persons living at home: Associations with functional ability, self-rated health and sociodemographic characteristics

Background and Aims:  Interest is generated from the experience of pleasure in occupational behaviour. However, there is little known about the type and amount of interests that occupy very old people. The aims of the present study were to explore the interests of people aged 86 years who are living at home (n = 205) and to study the association between these interests and functional ability, self-rated health and sociodemographic characteristics.
Methods:  Participants were interviewed during home visits and data were analysed by using content analysis and statistics.
Results:  Participants had a broad range of interests. Personal and environmental factors played a part in people giving up their interests. Participants who regarded their health as good or who had no problems in carrying out daily activities had more interests than those with poor health or limited ability to participate in daily activities. Few differences based on gender and sociodemographics were found.
Conclusions:  Being active (i.e. practising many interests) also means experiencing good health. In the name of occupational justice, it is important to enable elderly persons to pursue interests.     

The association between leisure motivation and recovery: A pilot study

Background and aims:  Recovery from mental illness may be facilitated by participation in activities that provide meaning and purpose in the lives of consumers. Leisure participation can be a major source of enjoyment as well as mental and physical well-being.
Methods and results:  This study examined the association between consumers' motivation to engage in leisure and their self-reported perception of recovery in a sample of 44 Clubhouse members. The Leisure Motivation Scale and the Recovery Assessment Scale were used to measure the association between leisure motivation and recovery. The results indicated a statistically significant association between leisure motivation and recovery.
Conclusion:  These findings have implications for service delivery within mental health settings, as occupational therapists may be able to design leisure-based programs more effectively if they can understand the needs and motives for participation. More emphasis should be placed on supporting consumers to re-integrate and be socially included within the community through leisure-based initiatives.     

The environment and falls prevention: Do environmental modifications make a difference?

Background and Aims:  Environmental modification is a strategy widely recommended in many falls prevention programs. However the effectiveness of such a strategy has not been well established. This study aimed to evaluate published research related to falls prevention and environmental modification for older people.
Method:  A review of research conducted between 1993 and 2004 was undertaken. Ageline, Cinahl and OvidMedline databases were searched using falls prevention, home modifications, environmental modifications and occupational therapy as key words.
Results:  Eighteen articles were found relating to community and institutional dwellings and the relevance of environmental modifications.
Conclusion:  There is some evidence to support the use of environmental modification as a strategy in falls prevention for older people particularly in association with multidisciplinary/multifactorial programs targeted to those people with a history of falls.     

Attitudes of entry level occupational therapy doctoral students towards inclusion for students with disabilities

Background/Aims:  The increasing popularity of inclusive education for students with disabilities and the attitudes towards it inevitably affect school-based occupational therapy practice. This survey study investigated the attitudes of entry-level occupational therapy doctoral (EOTD) students towards inclusive education and the effect of professional education on their perception.
Methods:  A total of 62 EOTD students responded to a self-developed questionnaire, Attitudes and Inclusive Education Survey , yielding a response rate of 91.2%.
Results:  Results of the study revealed that entry level occupational therapy doctoral students have positive attitudes towards inclusive education and believe that the inclusion movement has an inevitable impact on school-based occupational therapy practice. Professional education in occupational therapy might positively affect students' attitudes.
Conclusion:  Given the close association between one's attitude and behaviour, the findings of the study are particularly encouraging. Future research needs to further examine school-based occupational therapy practice in inclusive environments.     

Developing a worker role: Stories of four people with mental illness

Background and Aims:  Work plays an important role in adults' well-being, irrespective of health status. Vocational rehabilitation can enable people with mental illness to return to open employment. A narrative approach was used to explore how individuals with a mental illness made sense of their work-related experiences.
Methods and Results:  Four Clubhouse members in open employment for at least 6 months completed in-depth, semistructured interviews, from which narratives were created to reveal events, significant persons and actions that assisted these individuals to resume work. Woven into the participants' stories were four 'impelling forces' contributing to a sense-of-self as a worker. These impelling forces were: support from significant others, the personal meaning of work, experiences within the Clubhouse programme, and the ongoing struggle with illness. Implications for occupational therapy practice are discussed.
Conclusion:  The findings of this study urge occupational therapists and others to provide opportunities to provide on-going support to people with a mental illness who seek paid employment.     

Older people: The enigma of satisfaction surveys

Background and Aims:  Health and social care reforms have emphasised the need for health and social care professionals to monitor user satisfaction. Obtaining the opinions of clients is an important mechanism for improving quality in health and social care. This paper discusses methodological issues in measuring satisfaction among older service clients.
Methods and Results:  Examples will be used from the authors' own experiences of conducting research with older people to ascertain opinions and levels of satisfaction. The strengths and weakness of methods used to collect the opinions of older clients using interview and non-standardised questionnaires are critically considered. The authors suggest that occupational therapists need to understand the methodological issues that can impact upon older clients' responses to satisfaction questions.
Conclusion:  If occupational therapists are committed to the ethos of client-centred practice, then clients must not only be consulted and involved in service delivery, but also in the design and implementation of satisfaction surveys.