Occupational Engagement among Older People : Evaluation, Repertoire and Relation to Life satisfaction

Abstract: Occupational engagement among older people is important to investigate as older people are the fastest growing segment in our society, and because occupational engagement is viewed within occupational therapy as one of the basic premises for health. Three perspectives of engagement are highlighted in this thesis: evaluation of occupational engagement, the repertoire of occupational engagement, and finally, the relation between occupational engagement and life satisfaction. The overall aim of this thesis was to study aspects of occupational engagement among older people, with a special focus on evaluation of the experiences of an occupation-based group programme, evaluation of leisure, the leisure repertoire, and the relation between occupational engagement and life satisfaction. The thesis is comprised of four studies which all contribute in different ways to an increasing understanding of occupational engagement among older people. In the first study (Study I), three older persons participated in a group activity programme and were interviewed about their experiences of occupational engagement. The qualitative interviews were done with each participant after each group session, in total 15 interviews. The other three studies (Studies II-IV) were based on a subgroup of a population studied in a cross-sectional population-based study, the Umeå 85+ study. Very old people with an MMSE score of 20 or more were included in Studies II, III, and IV (n=156). During home visits, they were interviewed about their occupational engagement (ADL and leisure) and their life satisfaction. The qualitative interviews analysed using a Grounded theory approach, revealed two different dimensions of experiences while engaged in a group programme. The participants described experiences of activation, with a creative force and a place for learning, but also experiences of transformation with reflection, adaptation, and finally, a personal synthesis. Evaluation of occupational engagement through measurement using the modified NPS Interest Checklist (MNPS) was made possible using Rasch analysis. The results revealed preliminary evidence for internal scale validity and person response validity. Scale and person reliability were Rasch equivalents of Cronbach alpha of .98 for items and .66 to .75 for persons, respectively. In their leisure repertoire, very old people were more likely to endorse Social and Cultural activities and least likely to endorse Ballgames and Equipment sport. Traditional gender differences and some differences between older persons in rural versus urban areas and between persons with different cognitive levels were also found. Finally, significant correlations were found between life satisfaction and both engagement in ADL (r =.31) and engagement in leisure (r =.34) among very old people. A forced entry regression revealed that both variables together explained slightly more (12.4%) than leisure alone (11.2%). As a conclusion and in relation to evaluation of occupational engagement during therapy, the experiences of engagement are described by the respondents from both a perspective of action and a perspective of inner reflection, and together they might support the developmental process among older people. Through using Rasch analysis, it was possible to convert ordinal data into linear measures and also to organize leisure occupations into a hierarchical repertoire of engagement. This repertoire gives further understanding for specific tasks and about the general relation between leisure dimensions. Finally, the contribution of occupational engagement to life satisfaction is likely essential, but explains only about 12% of total life satisfaction among very old people.