Colleen McGrath

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.

Factors That Influence the Occupational Engagement of Older Adults with Low Vision: A Scoping Review:

Introduction: Prior research has provided occupational therapists with an understanding of the negative impact of low vision on self care, leisure and productivity. In order to guide future low-vision rehabilitation services, an understanding of the factors that influence the occupational engagement of older adults with age-related vision loss (ARVL) is also needed. Method: A scoping review of the literature was conducted in order to identify those factors that have been shown to influence the occupational engagement of older adults with ARVL, and to identify future research needs. Findings: As identified in this scoping review, five types of factors were shown to influence occupational engagement for older adults with ARVL including: demographic variables, emotional components, behavioural components, diagnostic components, and environmental aspects. Conclusion: Although findings pertaining to personal factors can inform practice, few studies explored the influence of environmental factors on occupational engagement. Given that occupation is a result of person-environment transactions, it is important that future research more fully explores environmental influences in order to enable occupational therapists to deliver services that optimize the occupational performance of seniors with ARVL.

The benefits and barriers to technology acquisition: Understanding the decision-making processes of older adults with age-related vision loss (ARVL)

Introduction While research has investigated the factors influencing acquisition and use of technologies/assistive devices by older adults, few studies have addressed the decision-making processes regarding technology adoption of older adults with age-related vision loss. Method This critical ethnography engaged 10 older adults with age-related vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews to understand their decision-making processes related to the acquisition and use of low vision assistive devices to support occupational engagement. Findings Study findings focused on the benefits and barriers to technology acquisition and use. Benefits of technology acquisition included: enhanced occupational engagement; independence; safety; insurance; and validation of the disability, while the barriers to technology acquisition included: cost; training; usability; lack of awareness of low vision rehabilitation services; fear of being taken advantage of; and desire to preserve a preferred self-image. Conclusion Considering the low uptake of vision rehabilitation services, the study findings are important to occupational therapy. A better understanding of the perceived benefits and barriers to technology adoption from the perspective of older adults will help occupational therapists maximize treatment planning designed to enhance the occupational engagement of older adults aging with vision loss.

Problematising risk in stroke rehabilitation.

Abstract Purpose: Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Method: Alvesson and Sandberg’s method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Results: Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conclusions: Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke. Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.

Why would I want to go out?: Age-related Vision Loss and Social Participation

RÉSUMÉ: La participation sociale, un élément déterminant du vieillissement en santé, est souvent liée négativement par une perte de vision à l’âge (PVA). Cette étude de théorie ancrée visait à comprendre la participation sociale comme un processus négocié dans la vie quotidienne par les adultes âgés souffrant de PVA. Les entrevues, les agendas audio et les cartes de la vie-espace ont servi à recueillir des données avec 21 aînés dans deux villes de l’Ontario. Les données, qui ont été analysées par induction, ont indiqué un modèle transactionnel du processus de négocier la participation sociale dans le contexte. Ce modèle illustre comment les caractéristiques et les ressources de l’environnement, les compétences et les habiletés, et les risques et les vulnérabilités interagissent avec les valeurs et les priorités d’affecter si et comment la participation sociale s’est produite dans le cadre de la vie quotidienne. Les conclusions soulignent plusieurs façons dont la recherche et les services s’adressant à la participation sociale des personnes âgées qui donnent signe de souffrir de la PVA ont besoin de développer, en particulier en ce qui concerne les caractéristiques de l’environnement et les ressources, le risque, et la priorisation de l’indépendance. ABSTRACT: Social participation, a key determinant of healthy aging, is often negatively impacted by age-related vision loss (ARVL). This grounded theory study aimed to understand social participation as a process negotiated in everyday life by older adults with ARVL. Interviews, audio diaries, and life space maps were used to collect data with 21 older adults in two Ontario cities. Inductive data analysis resulted in a transactional model of the process of negotiating social participation in context. This model depicts how environmental features and resources, skills and abilities, and risks and vulnerabilities transacted with values and priorities to affect if and how social participation occurred within the context of daily life. The findings point to several ways that research and services addressing the social participation of older adults with ARVL need to expand, particularly in relation to environmental features and resources, risk, and the prioritization of independence.

Seniors, risk and rehabilitation: broadening our thinking

Abstract Purpose: Conceptualizations of risk in seniors’ rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations. Method: Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life. Results: Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully living, and foster safe spaces for seniors and clinicians to speak candidly, comprehensively and respectfully about risk. To ensure that seniors’ rehabilitation targets a satisfying life as defined by seniors, increased focus on the environment and more explicit examination of how cost containment concerns are driving services is also necessary. Conclusion: This work reinforced current concerns about conceptualizations of risk in seniors’ rehabilitation and generated ways forward that re-focus rehabilitation more on promoting a satisfying life. Implications for rehabilitation In seniors’ rehabilitation, considerations of risk focus on physical injury, functional dependence and cost containment. Focus on provider-defined risk of physical injury limits examination of patient goals and patients’ histories of judging and dealing with risk. Focus on functional dependence and cost containment may lead to practice that is depersonalized and decontextualized. Abandonment of ableist and ageist thinking and an explicit focus on person-centered definitions of risk and a satisfying life are recommended.

The Environmental Production of Disability for Seniors with Age-Related Vision Loss

RÉSUMÉ:À ce jour, l’attention portée aux causes environnementales d’infirmité parmi les personnes âgées ayant une perte de vision liée à l’âge a été limitée. Cette étude ethnographique critique visait à révéler les façons dont les barrières environnementales ont produit ou perpétué l’invalidité chez 10 personnes âgées atteintes de PVLA. Une version modifiée de l’approche en cinq étapes de l’ethnographie critique de Carspecken a été adoptée en utilisant trois méthodes de collecte de données, notamment une entrevue narrative, une séance d’observation participante et une entrevue semistructurée en profondeur. Les résultats ont révélé comment l’invalidité est façonnée pour les personnes âgées avec PVLA quand ils rencontrent des caractéristiques environnementales intégrées d’une société ageiste et invalidante. Ces résultats sont illustrés par la présentation d’analyses de trois activités couramment discutées: faire de shopping, manger et déplacement dans la communauté. Notre discussion suggère que la prise en compte de la production environnementale de l’infirmité nécessite une politique sociale inclusive, le plaidoyer et un accent sur l’éducation afin de développer et de maintenir des environnements favorables au vieillissement et à la faible vision.To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken’s five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-visionfriendly environments.

Investigating the enabling factors influencing occupational therapists’ adoption of assisted living technology:

Introduction Research into technology adoption has focused on older adults’ motivations, with less exploration of the perspective of healthcare providers, including occupational therapists, who are often described as the gatekeepers to assisted living technology. Method This qualitative study utilized semi-structured interviews and focus groups with 20 occupational therapists in England and Scotland. The goal was to identify those enabling factors necessary for occupational therapists to adopt assisted living technology. Results Five themes emerged regarding the enablers needed to support the adoption of assisted living technology by occupational therapists, including: (1) a positive client–therapist relationship; (2) affordability; (3) time; (4) increased awareness, education, and training; and (5) usability features of the assisted living technology. Conclusion With an aging population and the increasing role that technology is playing globally in older adults’ lives, it has never been more important for occupational therapists to harness the potential of new, developing, and existing technologies to support people to live and age as well as possible. To accomplish this, however, requires that occupational therapists are equipped with the time, training, and education necessary to offer their clients assisted living technologies that are client-centered, usable, and affordable.