Older adults participation in occupation in the context of home based rehabilitation

Abstract: The overall aim of this thesis was to enhance the occupational therapy knowledge base concerning how older adults with disabilities experience participation in occupation during and after home-based rehabilitation, with a special focus on the perceived influence of the environment. Listening to the subjective experiences of older adults can generate new knowledge about how home-based rehabilitation services can support participation in occupation, which is a stated aim in occupational therapy. The thesis included four studies. The participants were older adults over 65 years of age who received home-based rehabilitation after an acute illness or accident. Study I was a focus group study focusing on how the environment, in terms of physical, social, attitudinal and societal aspects, may influence participation in occupation. Study II identified 91 participants perceived influence of environmental factors on their opportunities for participation by using a questionnaire. Study III-IV used a qualitative, in depth-approach to explore how three older adults with disabilities participated and engaged in occupations (study III), and how they perceived, collaborated and made use of the staff s services (IV) during the six months-period they received home-based rehabilitation. The findings in study I showed that the participants perceived environmental pressure to concentrate on performing personal care instead of participating in chosen occupations. However, social environments such as family enabled participation while encounters with the societal environment (e.g. healthcare services) often were perceived as a hindrance. The findings in study II supported these results and identified that the participants perceived social environments as mainly facilitating participation. Surprisingly, physical environments in general were perceived as facilitators or not influencing, although societal environments were perceived more positively than in study I. In study III the findings revealed that participation was perceived both as being an agent in daily life, and as a strong engagement which occasionally became the agent and governed the participants participation in daily life. In study IV five modes of perceiving and making use of staffs services were identified, namely as persons to make small talk with, as discussion partners, as advisors or instructors, as teachers and finally as people who carried out tasks efficient ly. In conclusion, the findings showed that in order to support participation in occupation among older adults who receive home-based rehabilitation, it is important to focus on their engagement in social environments. Agency was a strong feature in the participants perception of participation, and came to fore when the healthcare system was perceived as a hindrance for participation. The findings suggest that it is important to acknowledge the possibility that both staff and the system may be a hindrance for exerting agency. Finally, the fact that the findings showed a variation in how the participants made use of the services from the staff suggests that giving older adults the opportunity to make use of the staff services in different ways during the rehabilitations period may promote agency, and consequently participation in occupation.