Agency and Engagement: Older Adults' Experiences of Participation in Occupation during Home-Based Rehabilitation

2008 ◽  
Vol 75 (5) ◽  
pp. 262-271 ◽  
Author(s):  
Kjersti Vik ◽  
Louise Nygård ◽  
Lena Borell ◽  
Staffan Josephsson
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Daily Life ◽  
Comparative Method ◽  
Daily Lives ◽  
Rehabilitation Professionals ◽  
Individual Agency ◽  
Home Based ◽  
Life Itself ◽  
Occupational Therapy Intervention

Background. Participation is considered the main goal of rehabilitation and occupational therapy intervention. This study focuses on older adults' participation in occupations in daily life when receiving home-based rehabilitation.Purpose. To explore how older adults with disabilities participate in daily life subsequent to hospitalization.Methods. A prospective case-orientated design was used, with repeated interviews with three older adults and a constant comparative method of analysis.Findings. Two main categories emerged as the participants' experience of participation: “Continuing to be an agent in daily life” captured the participants' decision making, choosing, and acting in daily life. “Life itself is the agent” identified how the participants, despite their strong wishes to be agents, also could let their participation be directed by their engagement in ongoing daily life.Implications. The findings identified participation as a dynamic engagement ranging from individual agency, including decision-making, choosing, and acting in daily life, to letting life itself be the agent. The emphasis on agency in the participants' experiences challenges rehabilitation professionals to find further means of facilitating the clients' possibilities of being agents in their daily lives.

scholarly journals A Qualitative Analysis of the Relationship Between Older Adults’ Daily Lives and Life Outlook

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 608-608
Author(s):  
Isabella Bouklas ◽  
Giancarlo Pasquini ◽  
Renee Gilbert ◽  
Cindy Bergeman ◽  
Stacey Scott
Keyword(s):  
Older Adults ◽  
Adult Development ◽  
Daily Life ◽  
Comparative Method ◽  
Well Being ◽  
Structured Interviews ◽  
Daily Lives ◽  
Use Of Time ◽  
Age Related ◽  
Dialectical Relationship

Abstract Leading theories of adult development suggest age-related changes in one’s life perspective and changes in one’s priorities are reflected in daily behavior. The present study explored how older adults understand their current lives through a qualitative study of midwestern Americans. Twenty-four participants (Mage= 69.53 years; age range=63-78 years) from the Notre Dame Study of Health & Well-Being (Whitehead & Bergeman, 2014) completed semi-structured interviews in which they were asked about turning points across their lives. Inductive analysis using the constant comparative method (Maykut & Morehouse, 1994) resulted in 10 life-domains based on common descriptions across participants. These domains represented the ways in which participants understood their identities over the course of their lives, as well as their organization and use of time and space in daily life. Participants’ descriptions of both general life outlook and daily life informed one another, revealing the dialectical relationship between micro-level behaviors and macro-level attitudes.

“The Right to Make Choices”: The National Resource Center for Supported Decision-Making

Inclusion ◽  
2015 ◽  
Vol 3 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Peter Blanck ◽  
Jonathan G. Martinis
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Daily Life ◽  
Self Determination ◽  
Life Choices ◽  
Resource Center ◽  
Independent Life ◽  
The Right ◽  
National Resource

Abstract Research shows that self-determination and the right to make life choices are key elements for a meaningful and independent life. Yet, older adults and people with disabilities are often placed in overly broad and restrictive guardianships, denying them their right to make daily life choices about where they live and who they interact with, their finances, and their health care. Supported decision-making (SDM)—where people use trusted friends, family members, and professionals to help them understand the situations and choices they face, so they may make their own decisions—is a means for increasing self-determination by encouraging and empowering people to make decisions about their lives to the maximum extent possible. This article examines the implications of overly broad guardianship and the potential for supported decision-making to address such circumstances. It introduces the National Resource Center for Supported Decision-Making as one means to advance the use of supported decision-making and increase self-determination.

scholarly journals The Decision-Making and Communication Capacities of Older Adults with Dementia: A Population-Based Study

2014 ◽  
Vol 8 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Kazuko Mitoku ◽  
Setsu Shimanouchi
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Long Term Care ◽  
Population Based ◽  
Term Care ◽  
Daily Lives ◽  
People With Dementia ◽  
Decision Making Capacity ◽  
One Year

The present study assessed the decision-making and communication capacities of older adults with dementia who required assistance and care and measured the subsequent changes in these capacities. Of 845 older adults who received long-term care between April 2003 and December 2004, about half of them without dementia were excluded and the remaining 448 were finally included in the analyses. These individuals were completed follow-up for assessment for two years. The data were obtained from the Long-Term Care Insurance Certification Committee for Eligibility in Gujo City. A total of 73.7% of people with dementia were somewhat capable of making decisions (32.4% were reported as being “always capable”; 41.3% were reported as being “sometimes capable”). A total of 93.7% were somewhat capable of communicating with others (78.3% were reported as being “always capable”; 15.4% were reported as being “sometimes capable”). The results indicate that older adults with dementia can participate in their own care decisions, even if they require assistance and support in their daily lives. The present study shows, however, that baseline decision-making capacity declined to about half what they were after one year and to about one-third of what they were after two years, suggesting that earlier efforts are needed to ensure that the preferences of individuals with dementia are reflected in their care.

scholarly journals Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

2020 ◽  
Vol 40 (3) ◽  
pp. 279-288
Author(s):  
Eleonore V. Grant ◽  
Jenny Summapund ◽  
Daniel D. Matlock ◽  
Victoria Vaughan Dickson ◽  
Sohah Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Comparative Method ◽  
Patient Specific ◽  
Shared Decision ◽  
Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

scholarly journals Meaningful Activities Among Vulnerable Older Adults Living With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 838-838
Author(s):  
Theresa Allison ◽  
Jennie Gubner ◽  
Alexander Smith
Keyword(s):  
Older Adults ◽  
Cigarette Smoking ◽  
Tai Chi ◽  
Meaning Making ◽  
Daily Life ◽  
Daily Lives ◽  
The People ◽  
Starting Point ◽  
Ethnographic Observation ◽  
Hymn Singing

Abstract This paper examines self-identified meaningful activities in the daily lives of 21 vulnerable older adults living with dementia and the people who care for them at home (dyads). Using ethnographic observation and interviews, we asked the dyads to identify which aspects of daily life were most meaningful and how these activities changed as dementia progressed. Results ranged from pleasure-seeking activities like cigarette smoking and eating, to spiritual or mindfulness activities like hymn-singing, prayer and tai chi. Dyads identified specific examples of the ways in which meaningful activities and meaning-making both persisted and adapted throughout the progression of dementia. Using these identifiable moments of meaning-making as a starting point for inquiry, we explore underlying questions of how to adapt to dementia progression while retaining meaning in relationships.

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions

2017 ◽  
Vol 30 (5) ◽  
pp. 778-799 ◽  
Author(s):  
Rosie Ferris ◽  
Caroline Blaum ◽  
Eliza Kiwak ◽  
Janet Austin ◽  
Jessica Esterson ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Chronic Conditions ◽  
Comparative Method ◽  
Quality Metrics ◽  
Health Priorities ◽  
Multiple Chronic Conditions ◽  
Structural Factors ◽  
Trade Offs

Objective: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Method: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Results: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that “physicians know best.” Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients’ priorities. Clinician–patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Discussion: Stakeholders’ recommendations suggest health care redesigns that incorporate patients’ health priorities into care decisions and realign relationships across patients and clinicians.

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