Annika Öhman

Managing Changes in Everyday Occupations: The Experience of Persons with Alzheimer's Disease

The aim of this study was to uncover how people with dementia respond to the problems and changes they experience in everyday occupations. Seven participants with dementia were included. Data were collected by means of repeated interviews and observations that focused on the persons experiences of competence and management in everyday occupations. The analysis was carried out from within a phenomenological perspective and resulted in a structure describing management strategies. It was concluded that the participants used a wide variety of strategies. Some strategies were directed toward managing the altered conditions caused by the disease while others served the purpose of responding to the occupational problems of everyday life. The latter strategies were of three types based mainly on environment, habituation, and cognition. Overall, the implicit and explicit cognitive awareness underpinning many strategies seems to call for great caution when assuming that people with dementia soon lose their awareness of disability.

Accessibility in public space as perceived by people with Alzheimer’s disease:

Most people with dementia remain living at home as long as possible after being diagnosed, and hence their lives also include activities in the public space. The aim of this study was to illuminate experiences of accessibility in public space in people with Alzheimer’s disease. A qualitative grounded theory approach with repeated in-depth interviews was used. The core category, accessibility as a constantly changing experience, was characterized by changes in the relationship between informants and public space. Changes in the relationship took place in activities and use of place and related to familiarity and comfort, individual motives and interests, and planning and protecting. Other changes occurred in places and problematic situations related to everyday technologies, crowded places with high tempo and noise, and change of landmarks. These changes reduced feelings of accessibility and increased difficulties in carrying out activities in public space. These findings may be helpful when providing support, and supporting community living.

Awareness through interaction in everyday occupations: Experiences of people with Alzheimer's disease

The aim of this study was to explore and describe the characteristics of awareness of the consequences of having Alzheimers disease on everyday life occupations. Six community-dwelling participants with Alzheimers disease were interviewed on repeated occasions about their lived experiences of everyday occupations. A phenomenological method was adopted for the analysis. The findings show that the participants discovered and explored the changes in how they performed everyday occupations in the context of their social relations and through immediate reflections on their forgetfulness. They attempted to handle the changes by adapting their behaviour. Awareness of the changes in their lives was evident in their reflections, as they tried to make sense of what was happening to them. This seemed to be related to an elusive perception of change in situations that they found impossible to influence. The participants reflected on the impact their condition had on other people near them. Their reflections also involved emotional reactions to the shortcomings they experienced. In conclusion, the findings show how these people with Alzheimers disease were able to express awareness of the consequences of their illness through their reflections on their experiences of interaction with the occupations and the social environment.

Occupational performance and awareness of disability in mild cognitive impairment or dementia.

Abstract Limited awareness of disabilities is common in mild cognitive impairment and dementia. In order to get a broader base in planning interventions, it is important to consider a persons awareness of his/her disability encountered in performance. The aim of this study was to examine the relationship between occupational performance and awareness of disability in older adults with mild cognitive impairment or dementia. Thirty-five older adults were evaluated with the AMPS (Assessment of Motor and Process Skills) and with the AAD (Assessment of Awareness of Disability). Many-faceted Rasch models generated individual measures of ADL performance and awareness of disability. Non-parametric correlation statistics were used to analyse the relationships. The findings showed that there was an overall positive relationship between occupational performance and awareness of disability. However, individual variations in the sample implied that limitations in performance were not equivalent to a limited awareness of disability. In conclusion, awareness of disability should be individually evaluated when planning interventions together with clients and their families.

Managing critical incidents in grocery shopping by community-living people with Alzheimer's disease

Abstract Aim: People with Alzheimers disease (AD) remain in their ordinary housing and continue to use public space despite increasing disabilities. The aim of this study was to discover and describe problematic situations and critical incidents that took place when people with AD performed the ordinary outside-home activity of grocery shopping and how these were met by them. Methods: Individual interviews (n = 12) and participant observations (n = 8) with six informants were performed and analysed using a grounded theory approach. Results: The findings are presented in six categories and each category describes different critical incidents and actions used to meet these. The categories were: (a) Remembering to bring things when leaving home, (b) Finding the way to and from the grocery shop without getting lost, (c) Finding a way through traffic when not feeling safe, (d) Finding objects when organization is disrupted, (e) Choosing when a lot of objects and products are available, and (f) Finding a method to pay when payment opportunities are restricted. The core category, “A challenging and unstable process of meeting critical incidents in grocery shopping”, was characterised by reflections and creativity to achieve relative harmony in each critical incident. Conclusions: In conclusion, it is important that relatives and professionals take into account relevant actions to help people with AD coordinate with their environment.

Effects of perphenazine enanthate injections on prolactin levels in plasma from schizophrenic women and men

Levels of prolactin (PRL) in plasma were determined in schizophrenic women and men after i.m. injections of 50–150 mg perphenazine enanthate (PE). In both sexes PRL levels increased dose-dependently. In men the effect was significant for 2 and in women for 9 days. Biperiden treatment did not influence the effect of PE on the PRL levels. The data support the view that clinically used doses of PE induce a small but significant blockade of central dopamine receptors.

Access to and use of everyday technology among older people : an occupational justice issue – but for whom?

ABSTRACT Research into older peoples use of remote controls, mobile phones, digital home appliances, and computerized communication systems reveals that many have difficulty accessing and using these everyday technologies. By using occupational justice theory as a lens onto this technological development, we argue in this commentary that critical analysis of the findings from an occupational perspective reveals systematic injustices that disadvantage certain sectors of the older population. In particular we propose that, contrary to what might be expected, diagnosis or disability is not the sole marker for a vulnerable population at high risk of occupational injustices. Rather, the empirical findings support that other aspects (e.g., economic, educational) may also be influencing both everyday technology access and use among the older population. In light of these concerns, we argue that (a) occupation-centred outcome measures are needed to target everyday technology populations at risk of occupational injustices, and (b) future studies evaluating the access and use of everyday technology among older people must also monitor and target socio-demographic diversities.

Associations between performance of activities of daily living and everyday technology use among older adults with mild stage Alzheimer's disease or mild cognitive impairment.

Abstract Background: The use of everyday technology (ET) is important for many activities in daily life (ADL) and can be especially challenging for older adults with cognitive impairments. Objective: The aim was to explore associations between ADL performance and perceived ability to use ET among older adults with mild stage Alzheimer’s disease (AD) and mild cognitive impairment (MCI). ADL motor and process ability, and ability to use ET were also compared between the groups. Methods: Participants with AD (n = 39) and MCI (n = 28) were included. Associations and group differences were explored with non-parametric statistics. Results: Significant correlations were found between ADL process ability and ET use in both groups (Rs = 0.44 and 0.32, p < 0.05), but for ADL motor ability and ET use, correlations were only found in the MCI group (Rs = 0.51, p < 0.01). The MCI group had significantly higher measures of ADL process ability (p < 0.001) and ET use (p < 0.05). Conclusion: ADL performance ability and perceived ability to use ET are important to consider in evaluations of older adults with cognitive impairments. Group differences indicate that measures of ADL performance ability and ET use are sensitive enough to discriminate the MCI group from the AD group with individually overlapping measures.

Can the everyday technology use questionnaire predict overall functional level among older adults with mild cognitive impairment or mild-stage alzheimer's disease? - a pilot study.

INTRODUCTION The number of older adults living with mild cognitive impairment (MCI) or mild-stage Alzheimers disease (AD) is increasing and they are often expected to live in their own homes without support, despite limited ability to perform daily life activities. The Everyday Technology Use Questionnaire (ETUQ) has proven to be able to separate these groups and might also have potential to predict overall functional level (need of assistance in daily life activities) among them. AIM To investigate whether the ETUQ can predict overall functional level among older adults with MCI or mild-stage AD. METHOD Participants were older adults with a mean age of 76 years with MCI (n = 28) or mild-stage AD (n = 39). A three-step scale indicating (i) independence, (ii) need for minimal assistance or (iii) need for moderate to maximal assistance in daily life was dichotomised in two ways and used as outcome variables in two logistic regression models. Predictors in both models were perceived ability to use everyday technology (ET) and amount of relevant everyday technologies measured by the ETUQ. Ethical approval was obtained from the regional Ethical Committee. RESULT Perceived ability to use ET discriminated individuals who were independent or in need of minimal support from those in need of moderate to maximal assistance (OR = 1.82, p < 0.01, confidence interval = 95%; 1.76-2.82). The amount of relevant everyday technologies discriminated individuals who were independent from those in need of assistance at any level (OR = 1.39; p < 0.01; confidence interval = 95%; 1.11-1.75). CONCLUSION Both perceived ability to use ET and amount of relevant everyday technologies had potential to predict overall function but at different levels. The findings support the predictive validity of the ETUQ and suggest further research for the development of clinical cut-off criteria.

Being a pedestrian with dementia: a qualitative study using photo documentation and focus group interviews

The aim of the study was to identify problematic situations in using zebra crossings. They were identified from photo documentations comprising film sequences and the perspectives of people with dementia. The aim was also to identify how they would understand, interpret and act in these problematic situations based on their previous experiences and linked to the film sequences. A qualitative grounded theory approach was used. Film sequences from five zebra crossings were analysed. The same film sequences were used as triggers in two focus group interviews with persons with dementia. Individual interviews with three informants were also performed. The core category, the hazard of meeting unfolding problematic traffic situations when only one layer at a time can be kept in focus, showed how a problematic situation as a whole consisted of different layers of problematic situations. The first category, adding layers of problematic traffic situations to each other, was characterized by the informants’ creation of a problematic situation as a whole. The different layers were described in the subcategories of layout of streets and zebra crossings, weather conditions, vehicles and crowding of pedestrians. The second category, actions used to meet different layers of problematic traffic situations, was characterized by avoiding problematic situations, using traffic lights as reminders and security precautions, following the flow at the zebra crossing and being cautious pedestrians. In conclusion, as community-dwelling people with dementia commonly are pedestrians, it is important that health care professionals and caregivers take their experiences and management of problematic traffic situations into account when providing support.