Personal factors,communication and vision predict social participation in older adults

Social isolation is a predictor of morbidity and mortality in older people. Speech pathologists often consider that communication disabilities associated with normal ageing (sensory loss, language and discourse changes) contribute to social isolation. The aims of this study were to describe the functioning of older people using the International Classification of Functioning, Disability and Health (WHO, ) as a conceptual framework for language and sensory functioning, communicative activity, and social participation, and to explore the relationship between communication (both at an impairment level and an activity level), social participation and personal factors (demographics and emotional health). In a prospective study, 47 women and 28 men aged 62 to 98 years (mean = 74 yrs) completed objective and subjective assessments of functioning and participation, and provided personal information. Assessments were individually conducted in a face-to-face interview situation with the primary researcher, who was a speech pathologist. Assessments revealed the sample had predominantly mild hearing and vision impairments, unimpaired naming ability, frequent involvement in a wide range of communication activities, and variable social network size and social activities participation. Social participation was shown to be associated with vision, communication activities, age, education and emotional health. Naming and hearing impairments were not reliable predictors of social participation. It was concluded that professionals interested in maintaining and improving social participation of older people could well consider these predictors in community-directed interventions. Speech pathologists should therefore promote older people's involvement in everyday communicative activities while also limiting the impact of communication-related impairments, so that social participation is maintained in our ageing population.     

Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Family and carer participation in mental health care: perspectives of consumers and carers in hospital and home care settings

It is widely accepted that family and carer participation in adult mental health care is desirable. However, rarely is service development informed by representative opinions of both carers and service users. This study took place in the context of a larger project to introduce and evaluate practice standards relating to family participation. The aim of this paper is to explore the perceptions of service users and carers to carer participation in adult mental health services. One hundred and twenty-nine service users and 86 family members recruited via hospital and community settings completed a survey which addressed obstacles to family participation, perceived benefits of participation and areas for improvement. Many service users and family were entirely satisfied with existing levels of family participation. Different needs for information, support and the nature of participation in mental health care are highlighted in acute hospital and community settings. Across settings, the provision of support and accessing services were identified as the most useful aspects of family participation. Meaningful carer and family participation in mental health care should proceed from respectful connection with carers and be informed by need which will vary depending on setting and circumstances.     

Important aspects of participation and participation restrictions in people with a mild intellectual disability

Abstract

Purpose: This study explored a possibility to assess the concepts of participation and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) by combining self-ratings of the perceived importance with the actual performance of different everyday activities in people with a mild intellectual disability. Method: Structured interviews regarding 68 items from the ICF activity/participation domain were conducted (n?=?69). The items were ranked by perceived importance, performance and by combined measures. Furthermore, the measures were related to a single question about subjective general well-being. Results: Rankings of performance highlighted about the same items as “important participation”, while rankings of low performance addressed quite different items compared with “important participation restriction”. Significant correlations were found between subjective general well-being and high performance (r?=?0.56), high performance/high importance (important participation) (r?=?0.56), low performance (r?=?–0.56) and low performance/high importance (important participation restriction; r?=?–0.55). Conclusions: The results support the clinical relevance of the ICF and the studied selection of 68 items. Although performance only may sometimes be a relevant aspect, knowledge about the relationship between the perceived importance and the actual performance is essential for clinical interventions and for research aiming to understand specific needs regarding participation.

• Implications for Rehabilitation

• The concepts of participation and participation restriction are highly relevant in people with a mild intellectual disability.

• Self-rated performance might be sufficient to assess participation at a group level.

• In clinical practices, the relationship between the perceived importance and the actual performance of an activity is essential to assess.

     

Evaluating communication for resident participation in an aged care facility

Speech pathologists who work in aged care facilities are often challenged to find appropriate measures of communication that consider the frailty of residents and the policy environment that speech pathologists are required to work within. This article describes a process for evaluating resident participation in an aged care facility (ACF) using the framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF). It also presents the findings of this process from one ACF, a 60-bed high care facility. Assessments of individual resident's communication impairments, activity limitations and participation restrictions were conducted initially, followed by evaluations of the physical and social communication environment of the facility. At the individual level, residents were found to have a high prevalence of communication impairments and reported activity limitations and participation restrictions associated with these. The environmental assessments identified that residents had few opportunities to communicate, and that the physical and social environment was not conducive to communication. This study supports many others that have found a high prevalence of communication disabilities in residents of ACFs. It also confirms that the communication environment is not conducive to participation and recommends assessments for identifying both resident and facility-wide communication problems.     

The ups and downs of social participation: experiences of wheelchair users in Norway

Purpose.?The primary aim of the study was to explore how people with a disability experience participation in society. A secondary aim was to contribute to the understanding of the concept of participation in terms of the International Classification of Functioning, Disability and Health (ICF).

Method.?Six people with disabilities participated in focus group discussions. The data were analysed following the guidelines for the constant comparative method.

Results.?Three main categories emerged with regard to the participants' experiences of participation in society. These included: (1) being engaged, (2) being a member of society and (3) interacting as a citizen. Furthermore, a sense of ‘climbing up and sliding down the participation ladder’ emerged as a core category of participation. This image reflected the dynamic interaction between individual and society; between, on one hand, an individual’ attitude, engagement, motivation, interest and capacity, as well as their sense of responsibility vis-a-vis an activity or a social group; and, on the other hand, the opportunities that society and their immediate social worlds offer them.

Conclusions.?The fact that participants experience social participation as ‘climbing up and sliding down the participation ladder’ is important as it enables service providers, managers and policy makers to identify which intrapersonal and environmental factors operate together to limit or enhance the social participation of people with disabilities. This also implies that there is a need for a committed relationship in issues concerning participation for all in society, between people with disabilities and urban planners, and service providers. Findings also imply that participation means being autonomous and making decisions about one's own life and that the subjective dimension of participation must be considered in the revision of the ICF model. Another consideration is to separate activity and participation into two dimensions; i.e. to render more visible the fact that participation is related to environmental, as well as to personal, factors.     

The effects of mutual goal-setting practice in older adults with chronic illness

Goal setting is a strategy that can enhance performance. The purpose of this study was to examine how engaging older adults with chronic illness in setting goals for their care would affect their performance in achieving those goals. This study employed a quasi-experimental design with repeated measures to evaluate the effect of an intervention, namely mutual goal-setting (MGS) practice, on elderly patients with chronic illness. Eighty such patients receiving nursing care at home were recruited for the study. Repeated measures showed that the intervention group achieved a higher percentage of their goals, though insignificant group and time interaction effects between groups were found in perceived functional disability, perceived functional health and self-efficacy in self-managing chronic illness. The findings of this study with a specific group, namely elderly patients with chronic illness, support the general premise that patients who participate in determining their care are more likely to improve in physical and mental well-being.     

Health-related and subjective quality of life of older adults with visual impairment

Purpose.?To document health-related quality of life (HRQOL) and subjective quality of life (SQOL) and explore their correlates in older adults seeking services for visual impairment (VI).

Method.?A convenience sample of 64 participants (79.3?±?5.9 years) with VI was interviewed at home. HRQOL was measured with the Visual Function Questionnaire-25 and SQOL with the Quality of Life Index. The potential correlates were as follows: personal factors (sociodemographic characteristics, co-morbidity, depressive symptoms, activity level), environmental factors (technical aids, social support) and participation in daily activities and social roles (level and satisfaction).

Results.?Compared to normative data from previous studies of older adults, the participants had lower HRQOL but similar SQOL. Greater level of participation in social roles, higher perceived activity level, use of a writing aid and greater satisfaction with participation in social roles together explained better HRQOL (R²?=?0.66). Fewer depressive symptoms, greater satisfaction with participation in social roles and with social support and fewer co-morbidities together explained better SQOL (R²?=?0.70).

Conclusions.?HRQOL of older adults with VI is mainly explained by level of participation correlates, while their SQOL is mainly explained by depressive symptoms and satisfaction variables. The results also underscore the importance of social roles for HRQOL and SQOL of this population.     

Challenges to aging in place for African American older adults living with dementia and their families

A culturally informed community health assessment was conducted to explore the community context of care for older adults in African American urban neighborhoods. The purpose of this study is to explore the challenges to aging in place for African American older adults living with dementia and their family members. Data collection and analysis were conducted as concurrent iterative procedures between photographs, media clippings, semi-structured interviews (N?=?24), observation notes, and journaling. Content analysis revealed shame, improper housing, financial constraints, resource inadequacy, transportation concerns, and knowledge deficit as common challenges faced by the older adults and their families to receiving health services to support aging in place within urban neighborhoods. Data from this report are to inform clinicians, community partners, families, and service organizations, to promote uptake of future research and programing to improve outcomes for African American older adults living with dementia and their family members.     

Patient participation on a ward for frail older people

AIMS: The paper reports a study whose aims were to explore the meaning of participation for older people in hospital and their health care workers and ways in which staff can enhance patient participation in their care. BACKGROUND: Participation in care is a concept that is central to nursing practice. However, little is known about patient and staff views of participation and how it takes place in practice. METHODS: Action research was used, and data were collected by means of focus groups and in-depth interviews. Three focus groups and 24 interviews were undertaken with staff, and 19 interviews were undertaken with patients. The main action undertaken with staff aimed at raising their awareness of participation. In addition small changes in practice were introduced, such as the use of a patient biographical booklet. FINDINGS: The findings suggest that participation is a dynamic process that is integral to the work of nurses and carers. The process is enacted through the themes of facilitation, partnership, understanding the person, and emotional work. CONCLUSION: The study demonstrates how nurses can become increasingly aware of the potential for facilitation and creation of opportunities for participation. It is crucial that practitioners working with older people develop a deeper understanding of participation and are also empowered to act in ways that fit with the needs of this specific client group.     

Informal carers' experience of caring for stroke survivors

BACKGROUND: Stroke is the third most common cause of death in industrialized countries and a major cause of adult disability. However, the burden of caring for stroke survivors usually rests with family members who have neither chosen nor volunteered for the role of 'carer'. AIMS: This paper reports on a study which aimed to describe the experience of caring for a stroke survivor at one year after stroke in Scotland. STUDY DESIGN: Semi-structured, taped interviews were conducted with 90 carers of stroke survivors one year after stroke and the data analysed using NUD*IST. The interviews were part of a larger study, which included the administration of a range of valid and reliable multidimensional instruments to both carers and stroke survivors. The interview prompt schedule had been developed and tested in a previous study. FINDINGS: Although a medical emergency, stroke was not always diagnosed or treated as such by either the public or general practitioners. Initially most carers found that they lacked the knowledge and skills to care for the stroke survivor at home and so they had to learn how to obtain the information and assistance required. Carers had to adapt to the changes that stroke effected in the stroke survivor and seek alternative ways of securing the resources they needed for managing their lives. They thought that they had not been prepared adequately for the caring role or assessed satisfactorily in terms of whether they could manage given their skill level, age and/or health status. CONCLUSIONS: A public health campaign to educate and inform that stroke is a medical emergency is required if stroke disability is to be minimized. The use of new technologies should be considered in facilitating carers' learning how to care. There is a need to test alternative models of stroke follow-up in multi-centre studies that are holistic and place the carer-stroke survivor at the centre of care.     

Barriers,activities and participation: Incorporating ICF into service planning datasets

Purpose.?Guided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF), a measure of activity and participation (MAP) was developed and incorporated into the National Physical and Sensory Disability Database in Ireland. The aims of this article are to investigate and explore the relationship between the barriers, participation restriction and functioning levels experienced by people with disabilities.

Method.?Seven thousand five hundred and sixty-two personal interviews with people meeting specific eligibility criteria for registering onto the database were conducted across four health service executive regions in Ireland.

Results.?Overall, differences in barriers, participation restriction and activity limitations experienced by people with different types of disabilities were found to be significant. Furthermore, low functioning and experience of barriers were indicators of participation restriction.

Conclusions.?This article has shown that elements of the ICF have been successfully operationalised in a service planning tool through the development of the MAP. This provides a more holistic view of disability and will enable the impact of service interventions to be measured over time.     

Barriers,activities and participation: Incorporating ICF into service planning datasets

Abstract

Purpose. Guided by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), a measure of activity and participation (MAP) was developed and incorporated into the National Physical and Sensory Disability Database in Ireland. The aims of this article are to investigate and explore the relationship between the barriers, participation restriction and functioning levels experienced by people with disabilities.

Method. Seven thousand five hundred and sixty-two personal interviews with people meeting specific eligibility criteria for registering onto the database were conducted across four health service executive regions in Ireland.

Results. Overall, differences in barriers, participation restriction and activity limitations experienced by people with different types of disabilities were found to be significant. Furthermore, low functioning and experience of barriers were indicators of participation restriction.

Conclusions. This article has shown that elements of the ICF have been successfully operationalised in a service planning tool through the development of the MAP. This provides a more holistic view of disability and will enable the impact of service interventions to be measured over time.     

Optimizing social participation in community-dwelling older adults through the use of behavioral coping strategies

Purpose: This study aimed to (1) determine the categories of behavioral coping strategies most strongly correlated with optimal seniors’ social participation in different activity and role domains and (2) identify the demographic, health and environmental factors associated with the use of these coping strategies optimizing social participation. Method: The sample consisted of 350 randomly recruited community-dwelling older adults (≥65 years). Coping strategies and social participation were measured, respectively, using the Inventory of Coping Strategies Used by the Elderly and Assessment of Life Habits questionnaires. Information about demographic, health and environmental factors was also collected during the interview. Results: Regression analyses showed a strong relationship between the use of cooking- and transportation-related coping strategies and optimal participation in the domains of nutrition and community life, respectively. Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors’ residence were correlated with greater use of transportation-related strategies. Conclusions: Our study helped to identify useful behavioral coping strategies that should be incorporated in disability prevention programs designed to promote community-dwelling seniors’ social participation. However, the appropriateness of these strategies depends on whether they are used in relevant contexts and tailored to specific needs.

• Implications for Rehabilitation

• Our results support the relevance of including behavioral coping strategies related to cooking and transportation in disability prevention programs designed to promote community-dwelling seniors’ social participation in the domains of nutrition and community life, respectively.

• Older age and living alone were associated with increased use of cooking-related strategies, while good self-rated health and not living in a seniors’ residence were correlated with greater use of transportation-related strategies. These factors should be considered in order to optimize implementation of these useful strategies in disability prevention programs.

• The appropriateness of these selected strategies depends on whether they are used in relevant contexts and tailored to specific needs.