Sanetta H.J. du Toit

Dignity and respect: facilitating meaningful occupation for SeSotho elders

Abstract Aim: Frail and vulnerable adults are divested of meaningful encounters when modernization and urbanization force them to embrace an unconventional residential care environment as a home. The aim of this article is to report on a study of SeSotho elders living in residential care to illustrate how more meaningful and culturally relevant experiences could be facilitated for them. Methods. A content analysis was done of the individual opinions of 15 collaborators as a secondary scrutiny of information obtained during a nominal group process. Major findings. Findings revealed that elders were prone to experience loneliness, helplessness, and boredom due to situations dominated by occupational injustice. Co-occupations, training of staff, and environmental adaptations that allow a sense of interdependence could contribute in facilitating occupational justice for elders from a traditional South African indigenous background living in residential care. Principal conclusion. Human dignity and respect are upheld within residential care when elders have access to purposeful and meaningful activities of their choice that are culturally appropriate. Occupational therapists should advocate for doing, belonging, and becoming by facilitating meaningful occupational participation that is culturally relevant for their clients.

Meaningful engagement and person-centered residential dementia care: A critical interpretive synthesis

Abstract Background: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood. Aim: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia. Methods: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers. Results: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future. Conclusions: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history. Significance: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.

Embracing Cultural Diversity: Meaningful Engagement for Older Adults With Advanced Dementia in a Residential Care Setting

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities’ residents’ needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

Modified activities acted as a mediator to facilitate engagement and address the needs and personal preferences of people with dementia

Objective of review: To systematically appraise quantitative studies that evaluated one or more modifications to activities for increasing engagement and decreasing negative associated behaviours of persons with dementia. Design: Systematic review. Search strategies: Searches were conducted in PsychoINFO, PubMed and the Cochrane Library electronic databases for studies published between January 2000 and December 2011. Studies comprising the full spectrum of experimental design were included. Selection criteria: Eligible studies: (i) purposefully tested modifications to activity; (ii) involved adults over 60 with dementia/mild cognitive impartment who lived in the community or a residential care setting; (iii) involved purposeful, goal-directed and pleasurable activities; and (iv) reported on measures of participant engagement or behavioural outcomes. Studies were excluded if they reported on repetitive cognitive and physical exercise as activity, as this was reviewed previously. Methods of the review: Each study was coded according to 11 criteria established for the review. The coding scheme included type of modification used, outcome measures used, and who delivered the intervention (e.g. expert interventionist or formal or informal carers). Inter-rater agreement on coding was excellent (99.4% agreement on a subsample of 14 studies). Results: Twenty-eight articles met the inclusion criteria and in total 50 distinct modifications to activities were systematically evaluated and analysed. Modifications were categorised into four groups indicating that 22 (44%) related to changes to objects and property (e.g. activities chosen due to intrinsic interest), 6 (12%) evaluated changes to space/environmental demands (e.g. noise levels), 8 (16%) related to changes made to social demands (e.g. the use of praise or prompts) and 14 (28%) related to a combination of two or more activity modifications. No studies specifically evaluated modifications to the sequence and timing of the activities (e.g. changing the steps of an activity). Overall, no modifications to activities resulted in negative behavioural outcomes or decreased engagement. Modifications to objects and properties were the most predominant way of adapting activities, but had mixed results (i.e. some demonstrating positive outcomes and others showing no change). Although modifications to space and social demands were less frequently tested, outcomes yielded for this category were consistently positive. Author’s conclusions: There is growing evidence that a range of activity modifications can enhance engagement and decrease negative behaviours exhibited by people with dementia. Pinpointing specific strategies that facilitate engagement could support the development of more effective activity therapies for this population. Contact details of original author: infor@trahanbehavioralservices.com