Robin Stadnyk

Risk: ‘I know it when I see it’: how health and social practitioners defined and evaluated living at risk among community-dwelling older adults

Older adults are increasingly choosing to stay and age in their home or other place where they normally live, even when a change in their health reduces their ability to live independently creating concerns about their safety. In this context, community practitioners need to be aware of risk assessment and management strategies as they support their clients’ choices when safety is a concern. This requires an understanding of living at risk and an ability to evaluate the client’s risk status. This article is based on a qualitative research study in which we interviewed 12 Canadian community practitioners in 2012 and explored how they defined, perceived, assessed and managed risk and how they balanced their client’s safety and autonomy. We used a grounded theory methodology to collect and analyse the data. We found that participants tended to define living at risk as a judgement about a client’s impairment within an environment that can cause an event that has an increased potential for a negative consequence. We also found practitioners evaluated the client’s risk by considering seven factors: the client’s capacity and their support, the occurrence, imminency and frequency of the event, the severity of the consequences, and the number of other events co-occurring. In this article, we show that practitioners are comprehensive in their evaluation of the client’s risk. Although practitioners saw risk and living at risk from a negative perspective, they were able to acknowledge that it could coexist along a continuum from safe to unsafe.

The influence of Driving Status on Transportation Challenges Experienced by Older Adults

We explored the severity, number, and reasons for transportation challenges experienced by older adult drivers, nondrivers who live with a driver, and nondrivers who do not live with a driver. A random sample of 1,670 Atlantic Canadian community-dwelling older adults completed a mailed survey. Drivers comprised 80% of the participants. Just more than one fifth of participants experienced at least occasional transportation challenges. Two thirds of nondrivers who lived with a driver reported having no transportation challenges. Almost half of the nondrivers who did not live with a driver indicated never experiencing transportation challenges, and 84% of drivers had no transportation challenges. Nondrivers who did not live with a driver experienced greater frequency and severity of transportation challenges. This research contributes to our understanding of the characteristics of older adults with different driving statuses and their transportation challenges, which can contribute to providing appropriate transportation supports for older adults in the future.

Improving quality of care in nursing homes: What works?

See related research article by Boorsma and colleagues at [www.cmaj.ca/lookup/doi/10.1503/cmaj.101498][1] and synopsis on page 1262. The research of Boorsma and colleagues,[1][2] published in this issue of CMAJ , is notable for framing its approach to intervention in a multidisciplinary chronic

Nursing-Home Resident Quality of Life: A Longitudinal Case Study Approach

ABSTRACT Longitudinal quality-of-life (QOL) research incorporating multiple perspectives can add to knowledge about how nursing home residents experience QOL, but these methods are seldom used. This study employed interviews and participant observation to conduct multiple-perspective, longitudinal case studies of six residents. Close, reciprocal relationships with staff members, staff knowledge of residents, and autonomy were fundamental to QOL. Autonomy was experienced through choice and self-advocacy. Changes in QOL over time related to changes in resident health status, acclimation to the setting and family member availability. Study results may have implications for staffing and staff training.

What is the Evidence and Context for Implementing Family-Centered Care for Older Adults?

ABSTRACT Aims: This project used the Promoting Action on Research Implementation in Health Services (PARIHS) knowledge translation framework to better understand the evidence and context for implementing family-centered care for older adults in rural home-based rehabilitative practices. Methods: A case-study design with multiple data collection methods was used to examine rural home-based rehabilitative care for older adults and their caregivers within one provincial healthcare system. Results: The study findings indicated therapists questioned whether their scope of practice should include addressing caregiver needs outside of implementing the therapists care plan for the client. Therapists also confirmed that multiple contextual levels influence the provision of family-centered care. Conclusions: The PARIHS framework made it easier for the academic and non-academic partners to collaborate; furthermore, the framework identified that the practitioners clinical experience is an essential component to evaluating and implementing evidence into practice.

Special Theme Issue: Canadian Contributions to the Field of Occupational Science

Robin L. Stadnyk With the increased ease and frequency of international collaborations, and the welcome presence of international student scholars studying in Canada, perhaps it is misleading to speak of Canadian contributions to occupational science. However, if we as proponents of occupational science believe that the environment or more specifically the geopolitical context influences the form, function and meaning of occupation, then it stands to reason that the country of origin might influence the foci of scholarship.

Factors affecting ability and satisfaction with social roles in persons with neurological conditions: The importance of mobility and stigma:

Introduction The accomplishment of social roles and the satisfaction derived from participating in social roles are two important concepts in occupational therapy. Despite their importance, not much is known about how the two concepts differ. The objective of this study was to explore and compare the clinical and environmental factors correlated with accomplishment and satisfaction in social roles. Method This secondary analysis used data from a nested mixed method study. Participants (n = 88) were Canadian adults, living with a range of neurological conditions. Linear regression analysis was used to identify factors that significantly affected the accomplishment and satisfaction of five social role domains (responsibility, interpersonal relationships, community life, employment and recreation). Results The variable of mobility was significantly associated with accomplishment of all five social role domains. Stigma, however, surfaced as the most important variable for satisfaction with social roles. It was significantly associated with all social role domains except employment. Conclusion From this analysis it appears that social role accomplishment and satisfaction have distinct correlates. Stigma is an important correlate of social role satisfaction that needs to be understood in more depth and addressed by occupational therapists so individuals with neurological conditions can maximize their satisfaction with social participation.