Ingeborg Nilsson

Occupational Justice—Bridging theory and practice

The evolving theory of occupational justice links the concept to social justice and to concerns for a justice of difference: a justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences. The purpose of this descriptive paper is to inspire and empower health professionals to build a theoretical bridge to practice with an occupational justice lens. Using illustrations from a study of leisure and the use of everyday technology in the lives of very old people in Northern Sweden, the authors argue that an occupational justice lens may inspire and empower health professionals to engage in critical dialogue on occupational justice; use global thinking about occupation, health, justice, and the environment; and combine population and individualized approaches. The authors propose that taking these initiatives to bridge theory and practice will energize health professionals to enable inclusive participation in everyday occupations in diverse contexts.

Evaluating leisure activities in the oldest old

Aim. To determine whether the Modified NPS Interest Checklist (MNPS) could be developed as a tool with linear measures of four dimensions of leisure: Interest, Performance, Motivation, and Well-being. Methods. A cross-sectional descriptive study including 156 volunteers born between 1904 and 1917 and living in urban or rural northern Sweden. Each participant was individually interviewed at her/his place of residence. Subsequent data were subjected to a series of Rasch analyses using FACETS. Major findings. The items and persons demonstrated acceptable goodness-of-fit across all four dimensions in the MNPS checklist. The Rasch equivalent of Cronbachs alpha was 0.98 for items, and ranged from 0.66 to 0.75 for persons. Principal conclusion. The MNPS shows evidence for acceptable internal scale validity, person response validity, and scale reliability. This study provides initial evidence that the MNPS is a valid tool for measuring leisure among the oldest old. While this study provides the first psychometric examination of an assessment designed to evaluate different dimensions of leisure, more research is needed to further assess validity and reliability of this tool with the elderly and with other groups.

Occupational Engagement and Life Satisfaction in the Oldest-Old: The Umeå 85+ Study:

This study was designed to evaluate whether the level of occupational engagement is related to life satisfaction among the oldest-old. The study was performed as part of a cross-sectional study of individuals 85 years and older in northern Sweden. The results revealed significant correlations between life satisfaction and engagement in both leisure and activities of daily living, and the effect sizes were interpreted as medium. This study adds some support to earlier findings that a higher level of task performance is related to a higher level of life satisfaction. The results also give some clinical evidence to support a client-centered approach that includes consideration of leisure tasks a person is motivated to perform.

Focus on Leisure Repertoire in the Oldest Old: The Umeå 85+ Study

This study elucidates the oldest olds’ leisure repertoire and how this repertoire varies due to gender, where they live, and cognitive status. A validated 20-item leisure interest checklist with four subscales was used to measure leisure participation and investigate the leisure repertoire among participants. The oldest old were most likely to be interested in, perform, be motivated for, and perceive well-being from social activities, cultural activities, and TV/video/movies. The respondents were least likely to be interested in, perform, be motivated for, and perceive well-being from equipment sports and ball games. Some gender, geographic differences, and differences in cognitive status were found. The oldest old were more likely to endorse the same activities across all subscales of the checklist, but the linear magnitude varied across sub-scales. The relationships between performance and the other subscales suggested that a sense of engagement or participation is related to actual performance.

Agent-Supported Assessment for Adaptive and Personalized Ambient Assisted Living

Existing approaches to ambient assisted living (AAL) often fail to consider a human agent’s needs from a holistic perspective. In particular the regular assessment of their changing abilities, skills and limitations are often treated as a separate matter in healthcare, thereby affecting the possibilities to provide support tailored to their current condition. Therefore, the objective of thiswork is to integrate assessment done by the healthcare professional into the framework of AAL.We propose a framework based on a model for activity-centered modeling of knowledge and interaction tailored to users (ACKTUS) and an egocentric interaction model. We exemplify the interaction between system modules as agent dialogues in assessment and adaptation for supporting an older adult in a home environment.

Occupational Well-Being among the Very Old

Background: Limited knowledge is available on how very old people orchestrate and carry out their occupational life to achieve a sense of occupational well-being. Study objectives: To highlight very old persons’ ways of describing and discussing their occupational engagement in relation to a sense of occupational well-being. Methods: Qualitative interviews were conducted with 48 men and women between 90 and 98 years of age in their urban homes. Data were analysed using qualitative content analysis. Results: The results show that occupational engagement in relation to the surrounding world and occupational engagement unconstrained by space and time were important in achieving occupational well-being. The surrounding world involves having contact with family, friends, and society as well as living up to a shared norm of being independent. Unconstrained by space and time includes thinking, planning and creating a narrative of life based on the past, present and future. Limitations: The present study contributes to the body of knowledge focusing on occupational engagement and how it is linked to health through occupational well-being among older people, however; it is not known to what degree the respondents were experiencing healthy ageing. Recommendations: Future studies should further develop the understanding of doing in relation to being among older people.

Occupation-focused interventions for well older people: An exploratory randomized controlled trial

Abstract Objective: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions. Methods: One hundred and seventy seven persons, 77–82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen’s d, were calculated. Results: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small. Conclusions: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.

Geriatric Rehabilitation: Elderly Clients' Experiences of a Pre-discharge Occupational Therapy Group Programme

This study describes how elderly people, temporarily living in a pre-discharge community rehabilitation centre, may experience participation in an in-patient occupational therapy programme built around group activities. The group activity programme was comprised of five sessions, each focusing on a theme chosen to encourage reflection and mutual sharing of experiences and support. Data were collected through interviews with each of the three participants immediately after each of the five group sessions. The resultant 15 interviews were analysed by adopting a Grounded Theory approach. The results show that the ways in which the participants experienced participating in the group activity programme can be described from two distinct core categories: experiences of activation and experiences of transformation . The category of activation emerged from their experiences of a creative force whilst engaged in performing the activities and from their discovery that the group was a good place for learning . Engagement in the group activities also seemed to bring about a transformation in the participants in that their experiences triggered reflection and adaptation , which contributed to a change in attitude and a personal synthesis where their new discoveries were internalized. The study shows the potential a group activity programme in occupational therapy has in triggering an adaptational and reflective process within elderly people facing discharge from hospital. Hence, group activity interventions in occupational therapy are suggested as one possible way to support the elderly person in the discharge process from hospital to the home.

Towards user-authored agent dialogues for assessment in personalised ambient assisted living

Existing approaches to ambient assisted living AAL often fail to consider a human agents needs from a holistic perspective. In particular, the regular assessment of their changing abilities, skills and limitations are often treated as a separate matter in healthcare, thereby affecting the possibilities to provide support tailored to their current condition. Therefore, the objective of this work is to integrate assessment done by the healthcare professional into the framework of AAL. We use a case scenario as base for domain experts in their development of the interaction between software agents and with the older adult in assessment and adaptation for supporting him/her in a home environment. The potentials in allowing professionals author and design the dialogue systems as part of a meta-design process is evaluated and discussed.

Measuring perceived meaningfulness in day centres for persons with mental illness

Abstract Rationale: As support in leading a meaningful and active life, a person with mental illness is often given the opportunity to attend a day centre. However, few studies have investigated the meaningfulness perceived by the person visiting a day centre. For such a purpose, a self-report instrument was developed. Aims: To explore whether perceived meaningfulness, as expressed in the recently developed instrument Evaluation of Perceived Meaning in Day Centers (EPM-DC), could be viewed as one dimension and also to investigate the psychometric properties of this instrument. Methods: Persons with mental illness attending five day centres in Sweden participated and completed the questionnaire. The data were analysed by Rasch analysis. Major findings: The study showed that the concept captured in the instrument could be viewed as unidimensional and the result gave preliminary evidence for sound psychometric properties. Principal conclusion: The results indicate promising signs of validity and reliability, but the suitability of self-reporting may be questioned.