The saliency of geographical landmarks for community navigation: A photovoice study with persons living with dementia

This study uses the photovoice method to explore how persons living with mild-to-moderate dementia perceive neighborhood landmarks and identify characteristics that render these landmarks salient for outdoor navigation. Previous research has highlighted the role of well-designed, stable geographical landmarks in improving the navigability of neighborhoods for persons living with dementia. However, the specific attributes that render landmarks salient have not yet been sufficiently explored, resulting in inadequate evidence-based environmental design guidelines for dementia-friendly communities. To address this gap, a photovoice study was conducted with five community-dwelling persons living with dementia and their care partners, as part of a dementia-friendly neighborhood walking program in the city of Seattle, USA. Photovoice facilitated the exploration of saliency of neighborhood landmarks from an emic perspective by (i) empowering persons living with dementia to identify and take photos of salient landmarks during the group walk and (ii) interpret and reflect on attributes that contributed to saliency using the photos as visual aids in a focus group discussion and survey questionnaire. Participants associated the saliency of landmarks with two groups of attributes: (i) visual distinctiveness, which encompassed physical aspects, such as size, shape, color, texture; and (ii) meaningfulness, which included subjective factors of personal and emotional significance that linked the landmarks to participants’ pasts, passions, hobbies, and emotions related to having dementia. Findings suggest that outdoor landmarks should be designed for maximum legibility and noticeability, as well as familiarity, recognizability, and memorability. The evidence from this research also points to the likely positive effect of salient neighborhood landmarks on the community navigation of persons living with dementia.

“We need more things for us”: Being low income and underoccupied in older age

Background. Low-income older adult populations have increased vulnerability to occupational engagement barriers and poor health outcomes while aging in community settings. Purpose. The purpose of this study was to examine the relationship between community navigation and well-being for low-income older adults. Method. Community-dwelling older adults ( N = 10) were recruited for this multimethod observational cohort study, which employed GPS data, measures of well-being, and semistructured interviews across 12 months. Grounded theory processes were followed to analyze and integrate the qualitative, quantitative, and spatial data. Findings. Findings were three patterns of community navigation. In particular, patterns of being chronically underoccupied were noted for this low-income population. Specific place-based challenges are explained along with strategies used to mitigate these challenges. Implications. Supporting community navigation, especially social interaction opportunities, can maximize well-being; and older residents’ occupational participation may be unnecessarily curtailed by geographic, economic, and social factors beyond their control. Community navigation strategies should be considered holistically by occupational therapists as part of interventions supporting aging in place.

Physical Performance and Fall Risk in Persons With Traumatic Brain Injury

Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.

Abstract NS16: What’s Important for Post-Stroke Community Re-integration? Viewpoints of Stroke Survivors and Service Providers in Ontario, Canada

Background: Stroke is a leading cause of disability worldwide. Stroke survivors living in the community require regular, ongoing, and coordinated services to prevent deterioration and maximize health outcomes. Published evidence, often conducted in large urban centres, suggests that community reintegration services are an important component of care for stroke survivors. This evidence, however, often does not address the particular challenges inherent in servicing stroke survivors who reside in smaller urban and rural contexts. Purpose: The purpose of this study was to gain an understanding of the priorities that are needed to support stroke recovery and community reintegration from the perspectives of survivors and service providers living in four geographic districts in Northeastern Ontario, Canada. Methods: Using Q methodology, 45 service providers, and 43 stroke survivors and their family caregivers ranked 30 theoretical statement cards. Each card identified a feature specific to stroke recovery, community navigation and community reintegration. These statements were generated through a review of health care literature and qualitative data collected from interviews with stroke survivors. Q analysis of the priority ranked statements involved centroid factor analysis and varimax rotation. Results: The three discrete viewpoints of survivors were Role of Skilled Navigators, Survivors as Co-navigators, and Striving for Well-being. The survivors’ consensus perspective, labelled Quality Service, identified the importance of timeliness and appropriateness of service. The three discrete viewpoints for service providers were Role of Skilled Navigators, Survivor-centered Practices, and Optimizing Survivors’ Resources. The consensus perspective of service providers was labelled Involvement of Family Carers. Findings were consistent across all 4 geographic districts. Conclusion: This research suggests that survivors’ and providers’ conceptualized role of community navigators is focused on building upon the strengths and capacity of survivors through cooperative inquiry with multiple stakeholders. A time-sensitive, appropriate, and family involved service structure supports survivor-centric community reintegration.