Line Robichaud

Measuring social participation: reliability of the LIFE-H in older adults with disabilities

Purpose: Much more attention should be paid to instruments documenting social participation as this area is increasingly considered a pivotal outcome of a successful rehabilitation. The purpose of this study was to document the reliability of a participation measure, the Assessment of Life Habits (LIFE-H), in older adults with functional limitations. Methods: Eighty-four individuals with physical disabilities living in three different environments were assessed twice with the LIFE-H, an instrument that documents the quality of social participation by assessing a persons performance in daily activities and social roles (life habits). Results: The intraclass correlation coefficients (ICC) computed for intrarater reliability exceeded 0.75 for seven out of the 10 life habits categories. For interrater reliability, the total score and daily activities subscore are highly reliable (ICC ⩽ 0.89), and the social roles subscore is moderately reliable (ICC = 0.64). ‘Personal care’ is the category with the highest ICC, and for five other categories ICCs are moderate to high (< 0.60). Conclusion: LIFE-H is a valuable addition to instruments that mostly emphasize the concepts of function or functional independence. It is particularly meaningful to evaluate the participation of older adults in significant social role domains such as recreation and community life. It may be considered among the instruments having the best fit with the ICF definition of participation (the persons involvement in a life situation) and a majority of its related domains.

Short-Term Changes in and Predictors of Participation of Older Adults After Stroke Following Acute Care or Rehabilitation

Background. Stroke can lead to restrictions in participation in daily activities and social roles. Although considered an important rehabilitation outcome, little is known about participation after stroke and its predictors, and about the differences associated with the types of services provided following stroke. Objective . The aims of this study were 1) to follow and compare changes in participation of older adults discharged home after stroke from acute care or postacute rehabilitation, and 2) to identify the best predictors of participation after stroke from physical, cognitive, perceptual, and psychological ability measures taken shortly after discharge. Methods. Level of participation in daily activities and social roles of 197 older adults who had a stroke was evaluated at 2 to 3 weeks (T1), 3 months (T2), and 6 months (T3) after being discharged home from acute care (n = 86) or rehabilitation (n = 111). Physical, cognitive, perceptual, and psychological abilities were assessed at T1. Results. A significant increase in participation was found over time for both groups, mainly in the first 3 months. The best predictors of participation differed between the groups and between the daily activities and social roles domains. Walking and acceptance of the stroke or fewer depressive symptoms were the best predictors of the level of participation after stroke. Conclusions . Participation was not optimal at discharge because it continued to increase after the return home. The importance of psychological factors in participation after stroke is undeniable. Many predictors are amenable to interventions.

Quality of life indicators in long term care: Opinions of elderly residents and their families

Background. There are very few studies that have integrated the opinions of nursing home residents and their families into the process of developing valid outcome measures for the quality of life in long-term care facilities. Purpose. The objective of this study was to identify the interpersonal and environmental characteristics for the best substitute living environment, as perceived by recently (< 6 months) and not as recently (> 6 months of residency) admitted residents and their families. Methods. A qualitative research approach was used with 27 elderly residents and families from five nursing homes. Results. Of the 11 quality of life indicators identified by the participants, the three most important ones were being treated with respect, sympathetic involvement in relationships, and perceived competency through technical (nursing) acts and attitudes. Practice Implications. As nursing home residents age, substitute homes have to adapt if they are to continue offering opportunities for self-actualization and a continuing sense of identity. Opinions of elderly residents and their families are very helpful for occupational therapists particularly when designing programs in long-term care facilities.

Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia

BackgroundThis study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada.MethodsA total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics) and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work), from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA) appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a) agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b) agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic.ResultsInitially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88%) were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88%) of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out of 29 patients. Four indicators could be measured with the help of a validated questionnaire on patient satisfaction. Inter-observer reliability was moderate (Kappa = 0.57).ConclusionA multidisciplinary panel of experts judged a large majority of the initial indicators valid for use in integrated care systems for vulnerable older adults in Quebec, Canada. Most of these indicators can be measured using patient files or patient or caregiver interviews and reliability of assessment from patient-files is moderate.

Comparison and correlates of participation in older adults without disabilities

This study was conducted to compare, by age group and gender, the level of participation of older adults who had no disabilities, and to determine which characteristics are most associated with participation. This study involved 350 randomly recruited community-dwelling older adults. Participation in daily activities and social roles were measured with the Assessment of Life Habits (LIFE-H). Demographic, health-related and environmental data were also collected. A decline with age was observed in four of the six daily activities domains and two of the four social roles domains of participation. However, these lower scores are mainly explained by the 85+ group, which consistently scored lower than the 65-69-year-old group. No differences were found between the 65-69, 70-74 and 75-79 years old groups. Some participation domains differed according to gender. Satisfaction with participation was high and did not differ between age groups. Characteristics most associated with participation vary according to the domains; generally, age and marital status are the best determinants of participation. This study found that most of older adults have an unrestricted level of participation which decreases only late in the aging process. This reduction in participation in very old adults was not accompanied by a decrease in satisfaction, supporting the hypothesis that they can participate satisfactorily in valued activities.

Coping Strategies and Social Participation in Older Adults

Background: Social participation refers to daily activities, such as personal care and mobility, and social roles, such as interpersonal relationships and leisure. Although restrictions in participation in normal aging have been recognized, little research has been done to study the coping strategies used to alleviate those restrictions. Objective: The objective of the present study was to explore the relationships between cognitive and behavioural coping strategies and the social participation of community-dwelling older adults. Methods: The Assessment of Life Habits (LIFE-H) and the Inventory of Coping Strategies Used by the Elderly (ICSUE) were used to document social participation and coping strategies of 350 randomly recruited older adults living at home independently. Sociodemographic and health-related characteristics were also assessed. Regression analyses were performed to evaluate the relationship between social participation, coping strategies and the other variables. Results: Behavioural coping strategies were the most important factor associated with daily activities, social roles and total participation, followed by the type of living environment and age. These variables explained 33% (p = 0.04), 13% (p = 0.02), and 28% (p = 0.00) of the variance of the models, respectively. The absence of any relationship between the cognitive coping strategies and social participation was a striking result. Conclusion: Our study suggests expanding current geriatric approaches to integrate knowledge on useful, safe and appropriate behavioural changes and to help older people acquire such strategies when they are lacking.

A preventive program for community-dwelling elderly at risk of functional decline: a pilot study

A program has been designed to assess and survey community-dwelling elderly over 75, identified at risk of functional decline by a postal questionnaire. The objectives were to verify the acceptability and the feasability of the program and to explore its impact, mainly on the functional status. A randomized controlled study took place in an urban community where 99 participants were drawn from those having responded positively to two or more of the six questions asked in the postal questionnaire, previously studied in Sherbrooke, in 1992. The program consisted in a home visit by a nurse who administered a standardized assessment battery on risk factors identified specifically for functional decline. When problems were identified, experimental subjects were referred to their general practitioner or to other health professionals for diagnosis and interventions. The control subjects received the usual health services. Both process and outcome measures were utilized in the study. The process measures allowed to know whether the program was acceptable or not to subjects and if it was feasible when using the existing health care services. The outcome measures included the number of eliminated risk factors, the functional autonomy level, the general well-being, the perceived state of health and the social support. The results showed that the program was feasible to implement and acceptable by the subjects and by health professionals. After 6 months, study subjects did not loose autonomy whereas the control ones significantly declined (P<0.001). If preventive programs could be effective in reducing the loss of autonomy, the use and cost of health care services could also be reduced and the other health and wellfare problems could be also prevented.

Using the Montessori approach for a clientele with cognitive impairments: a quasi-experimental study design.

Background: The choice of activities responding to the needs of people with moderate to severe dementia is a growing concern for care providers trying to target the need for a feeling of self-accomplishment by adapting activities to the abilities of elderly patients. The activities created by Maria Montessori seem to be adaptable to this clientele. This study evaluates the short-term effects, as compared to regular activities offered in the milieu. Methods: This is a quasi-experimental study where each of the 14 participants was observed and filmed in two conditions: during Montessori activities, during regular activities, and one control condition (no activity). Results: The results show that Montessori activities have a significant effect on affect and on participation in the activity. They support the hypothesis that when activities correspond to the needs and abilities of a person with dementia, these positive effects are also observed on behaviours. Conclusions: This study enabled its authors to corroborate the findings presented in the literature and to contribute additional elements on the positive effects of the use of Montessori activities and philosophy. Used with people with moderate to severe dementia these allow the satisfaction of their basic psychological needs, their well being, and hence, on their quality of life.

Predictors of daily mobility skills 6 months post-discharge from acute care or rehabilitation in older adults with stroke living at home

Purpose. To determine the evolution of daily mobility skills from the timed up-and-go (TUG) upto 6 months after home return in older adults with stroke discharged from acute care or rehabilitation; and to identify the best predictive factors of the TUG at 6 months post-discharge. Methods. In this longitudinal prospective study, people with stroke aged 65 years or more and discharged home from an acute care hospital (n = 82) or a rehabilitation service (n = 109) were included. The TUG was measured at discharge (T1), and at 3 and 6 months post-discharge (T2 and T3). Correlations between the TUG at T3 and sociodemographic and clinical variables, as well as physical, cognitive, perceptual and psychological measures at T1, were used in a multiple regression model to identify the best predictors of TUG at T3. Results. TUG did not change between T1, T2 and T3 in the two groups of participants. The best predictors of TUG at T3 in participants from acute care were the use of a walking aid in daily life, age, deficits in oral expression and the presence of depressive symptoms. In participants from rehabilitation, predictors were the stage of motor recovery of the foot, the use of a walking aid in daily life, number of schooling years and memory impairments. Conclusion. Daily mobility skills, as assessed with the TUG, did not deteriorate upto 6 months after home return in older adults with stroke. The best predictor of the TUG at T3 is the use of a walking aid during daily life in participants from acute care, and motor recovery of the foot in participants from rehabilitation.

Provision of Rehabilitation Services in Québec Following Stroke: A Comparative Survey Conducted by Postal Questionnaire

Il n’existe pas de données sur l’offre de service en réadaptation pour les aînés ayant subi un accident vasculaire cérébral (AVC) selon le type de régions. Une enquête a permis de documenter l’offre des services de réadaptation proposés à la clientèle aînée de 65 ans et plus ayant subi un AVC. Au total, les répondants de 295 ressources localisées dans trois régions sociosanitaires du Québec ont complété un questionnaire postal décrivant les services offerts en termes de type d’interventions (associées à neuf aptitudes et à sept domaines de participation sociale) et de type de services (évaluation, réadaptation active, maintien). Les résultats indiquent que l’offre de services de réadaptation proposée par le plus grand nombre de ressources aux personnes âgées ayant subi un AVC concerne les aptitudes motrices et les déplacements. De façon inattendue, au niveau d’interventions associées à quatre aptitudes et à deux domaines de participation sociale, l’offre de services en réadaptation active apparaît plus élevée dans les régions incluant des zones rurales qu’en région métropolitaine. We conducted a survey to document the rehabilitation services available to clients aged 65 years and older who had suffered a stroke. In all, respondents– gleaned from 295 resources located in three health regions in the province of Québec– completed a postal questionnaire describing the services that they offer, in terms of type of intervention (related to nine capabilities and seven areas of social participation) and type of services (evaluation, rehabilitation, and support). The results show that most rehabilitation services offered to older people with stroke address motor skills and mobility. Somewhat unexpectedly, for four capability-related interventions and two social-participation-related interventions, there appear to be more active rehabilitation services offered in regions with rural areas than in metropolitan regions.