Brenda Vrkljan

Meaning of Occupational Engagement in Life-Threatening Illness: A Qualitative Pilot Project

INTRODUCTION: The onset of a personal crisis combined with the resultant disruption in occupational routines may challenge a persons identity as a capable and healthy individual. However, it remains unclear how individuals regain a sense of health and well-being in the period following a personal crisis. RESEARCH OBJECTIVE: To explore occupational engagement and its meaning to individuals following a life-threatening diagnosis. METHOD: Semi-structured interviews were conducted with three women diagnosed with breast cancer. The data were analyzed using a constant-comparative approach to identify common themes. RESULTS: The primary theme that emerged was “Doing = Living.” This theme and the underlying themes illustrated the connection between meaningful occupational engagement and ones self-perception as capable and healthy. These findings suggest that occupational engagement may provide the medium through which ‘deconstructive’ or ‘reconstructive’ messages concerning the self are relayed between persons and their environment. IMPLICATIONS: In a period of personal crisis, such as a life-threatening diagnosis, individuals may turn to those occupations that are meaningful to regain a sense of control and normalcy in their lives.

Linking Occupational Participation and Occupational Identity: An Exploratory Study of the Transition from Driving to Driving Cessation in Older Adulthood

Abstract Changes in the ability to participate in meaningful occupations are common during and following significant life changes and/or events. Using qualitative methods, this study explored how changes in occupational participation can influence an individuals identity as exemplified during the transitional period from driving to driving cessation in older adulthood. The findings discussed in this paper illustrate the interdependent relationship that exists between occupational participation and occupational identity. In particular, this study highlights the potential consequences on identity when meaningful occupations are disrupted. The findings in this study lend support to previous findings, which identified a critical link between engagement in meaningful occupations and identity as an occupational being. Given that individuals may experience many transitional periods in their lifetime, this study provides preliminary evidence regarding the importance of occupational adaptation. Based on findings in this study, occupational participation may provide the context in which individuals begin the process of reconstructing their lives thereby linking their past and future occupational self.

Driving, navigation, and vehicular technology: experiences of older drivers and their co-pilots.

Objective. The objective of this article is to explore relationship between older drivers and their passengers (co-pilots) and potential implications of in-vehicle navigation technology on their driving safety. Methods. Semi-structured interviews were conducted with 44 healthy, community-dwelling older adults (aged 60–83) or 22 married couples. Males identified themselves as drivers and females identified themselves as passengers (i.e., co-pilot). Results. Findings indicate that operating a motor vehicle in older adulthood is a shared activity between drivers and passengers. Older drivers and co-pilots reported their level of interaction depended on their familiarity with their route. Navigating unfamiliar areas, particularly large urban centers, was identified as the most challenging driving situation. Participants identified their level of collaboration would increase with the advent of in-vehicle navigation technology. Safety concerns related to the use of this technology, included distraction of both drivers and passengers. Differences amongst couples in their perceptions of using this technology were linked to their level of experience with using other forms of technology. Conclusions. Older drivers and passengers identified working closely together when operating a motor vehicle. Further investigation into the effects of in-vehicle navigation technology on the driving safety of older drivers and their co-pilots is warranted.

Assessment tools for evaluating fitness to drive: a critical appraisal of evidence

Background. Many office-based assessment tools are used by occupational therapists to predict fitness to drive. Purpose. To appraise psychometric properties of such tools, specifically predictive validity for on-road performance. Methods. A literature search was conducted to identify assessment tools and studies involving on-road outcomes (behind-the-wheel evaluation, crashes, traffic violations). Using a standardized appraisal process, reviewers rated each tools psychometrric properties, including its predictive validity with on-road performance. Findings. Seventeen measures met the inclusion criteria. Evidence suggests many tools do not have cut-off scores linked with on-road outcomes, although some had stronger evidence than others. Implications. When making a determination regarding driver fitness, clinicians should consider the psychometric properties of the tool as well as existing evidence concerning its utility in predicting on-road performance. Caution is warranted in using any one office-based tool to predict driving fitness; rather, a multifactorial-based assessment approach that includes physical, cognitive, and visual-perceptual components, is recommended.

The relationship between cognitive performance, perceptions of driving comfort and abilities, and self-reported driving restrictions among healthy older drivers

The objective of the present study was to examine the relationship between cognitive performance, driver perceptions and self-reported driving restrictions. A cross-sectional analysis was conducted on baseline data from Candrive II, a five-year prospective cohort study of 928 older drivers aged 70-94 years from seven cities. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) as well as the Trail Making Test, parts A and B. Driver perceptions were assessed using the Day and Night Driving Comfort Scales and the Perceived Driving Abilities scale, while driving practices were captured by the Situational Driving Frequency and Avoidance scales, as well as the Driving Habits and Intentions Questionnaire. The baseline data indicates this cohort is largely a cognitively intact group. Univariate regression analysis showed that longer Trails A and B completion times were significantly, but only modestly associated with reduced driving frequency and perceived driving abilities and comfort, as well as a significant tendency to avoid more difficult driving situations (all p<.05). Most of these associations persisted after adjusting for age and sex, as well as indicators of health, vision, mood and physical functioning. Exceptions were Trails A and B completion times and situational driving frequency, as well as time to complete Trails B and current driving restrictions. After adjusting for the confounding factors, the total MoCA score was not associated with any of the driving measure scores while the number of errors on Trails A was significantly associated only with situational driving frequency and number of errors on Trails B was significantly associated only with situational driving avoidance. Prospective follow-up will permit examination of whether baseline cognition or changes in cognition are associated with changes in driver perceptions, actual driving restrictions and on-road driving outcomes (e.g., crashes, violations) over time.

A systematic review of the quality of psychometric evidence supporting the use of an obesity-specific quality of life measure for use with persons who have class III obesity.

With global obesity rates at 42%, there is a need for high‐quality outcome measures that capture important aspects of quality of life for persons with obesity. The aim of this paper was to systematically review and critique the psychometric properties and utility of the impact of weight on quality of life‐lite (IWQOL‐Lite) for use with persons who have class III obesity. Databases were searched for articles that addressed obesity‐specific quality of life. A critical appraisal of the psychometric properties of the IWQOL‐Lite and connection to a quality of life conceptual framework was completed. Raters used a standardized data extraction and quality appraisal form to guide evidence extraction. Two articles that reviewed obesity‐specific quality of life measures were found; none were based on a systematic review. Six articles on the IWQOL‐Lite met the criteria for critical appraisal using guidelines. The mean quality score for these articles was 59.2%. Concepts measured were consistent with the biopsychosocial concept of health defined by the World Health Organization. There is limited but consistent evidence that the IWQOL‐Lite is a reliable, valid and responsive outcome measure that can be used to assess disease‐specific quality of life in persons with class III obesity.

The Experience of Participation in Everyday Occupations for Adults with Obesity

Background. Participation in occupations of everyday life, such as self-care, work, and leisure, contribute to health and well-being. Obesity has been shown to influence health-related quality of life, but it is unclear how obesity influences participation in specific occupations. Purpose. To describe the lived experience of adults with class III obesity and the associated impact on participation in occupations of daily living. Methods. Ten adults enrolled in an obesity treatment program were interviewed. Data were interpreted using descriptive phenomenological methods. Findings. Participants underscored the tensions, barriers, and coping strategies across and within specific occupations. Although participation across occupations of daily living was described, the quality and diversity of occupations was influenced by real and perceived barriers within the environment. Implications. Participation in daily occupations is limited for persons with class III obesity. Intervention approaches should address health-related concerns and consider environmental adaptations that facilitate meaningful engagement in everyday life.

Older Driver Estimates of Driving Exposure Compared to In-Vehicle Data in the Candrive II Study

Objective: Most studies on older adults’ driving practices have relied on self-reported information. With technological advances it is now possible to objectively measure the everyday driving of older adults in their own vehicles over time. The purpose of this study was to examine the ability of older drivers to accurately estimate their kilometers driven over one year relative to objectively measured driving exposure. Methods: A subsample (n = 159 of 928; 50.9% male) of Candrive II participants (age ≥ 70 years of age) was used in these analyses based on strict criteria for data collected from questionnaires as well as an OttoView-CD Autonomous Data Logging Device installed in their vehicle, over the first year of the prospective cohort study. Results: Although there was no significant difference overall between the self-reported and objectively measured distance categories, only moderate agreement was found (weighted kappa = 0.57; 95% confidence interval, 0.47–0.67). Almost half (45.3%) chose the wrong distance category, and some people misestimated their distance driven by up to 20,000 km. Those who misjudged in the low mileage group (≤5000 km) consistently underestimated, whereas the reverse was found for those in the high distance categories (≥ 20,000); that is, they always overestimated their driving distance. Conclusions: Although self-reported driving distance categories may be adequate for studies entailing broad group comparisons, caution should be used in interpreting results. Use of self-reported estimates for individual assessments should be discouraged.

What vehicle features are considered important when buying an automobile? An examination of driver preferences by age and gender.

INTRODUCTION Certain vehicle features can help drivers avoid collisions and/or protect occupants in the event of a crash, and therefore, might play an important role when deciding which vehicle to purchase. The objective of this study was to examine the importance attributed to key vehicle features (including safety) that drivers consider when buying a car and its association with age and gender. METHODS A sample of 2,002 Canadian drivers aged 18 years and older completed a survey that asked them to rank the importance of eight vehicle features if they were to purchase a vehicle (storage, mileage, safety, price, comfort, performance, design, and reliability). ANOVA tests were performed to: (a) determine if there were differences in the level of importance between features and; (b) examine the effect of age and gender on the importance attributed to these features. RESULTS Of the features examined, safety and reliability were the most highly rated in terms of importance, whereas design and performance had the lowest rating. Differences in safety and performance across age groups were dependent on gender. This effect was most evident in the youngest and oldest age groups. CONCLUSIONS Safety and reliability were considered the most important features. Age and gender play a significant role in explaining the importance of certain features. IMPACT ON INDUSTRY Targeted efforts for translating safety-related information to the youngest and oldest consumers should be emphasized due to their high collision, injury, and fatality rates.

Associations between age, gender, psychosocial and health characteristics in the Candrive II study cohort

The relations among driving-related psychosocial measures (e.g., driving comfort, attitudes toward driving) and measures of self-reported health were examined in the context of driver characteristics (i.e., age and gender) within the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive II) baseline data, available for the cohort of 928 drivers, 70 years of age and older. Older members of the cohort had lower comfort scores and poorer perceptions of their driving abilities. Men reported significantly higher levels of driving comfort than women. When analyses including health were controlled for age and gender, significant relations with health status were evident for most of the psychosocial measures. These findings extend previous research and suggest that attitudes, beliefs, and perceptions about driving may be influenced by health status and act as mediators in the self-regulation process.