Abstract
Participation in meaningful occupations promotes self-confidence, self-esteem, overall health, and healthier life transitions. Due to significant life changes brought by neurocognitive ...disorders older adults living with neurocognitive disorders as well as caregivers may undergo some disruption in their occupational participation. Few interventions have focused on their ability to engage in meaningful occupations independently and together to successfully orchestrate their life to meet their own occupational needs. The goal of this study was to document the priority needs of older adults living with neurocognitive disorders and caregivers to promote occupational participation, to guide us in the development of an intervention. To this end, a rapid literature review was conducted. Three databases (Medline, PsycInfo and CINAHL) were searched. Studies were included if they used qualitative methods, included community-based individuals and were available in English or French. A total of 20 studies met the inclusion criteria. Two needs were prioritized in the literature by both older adults living with neurocognitive disorders and caregivers: 1) to continue participating in daily activities and social roles (e.g., maintain the connection with the community, use everyday technology), 2) to educate the public about the disease (e.g., bring awareness, knowledge, and understanding of dementia among the community at large). In the presentation we will discuss how the results will inform the development of an occupational-based intervention to promote meaningful occupations.
Abstract Filiatrault J, Gauvin L, Richard L, Robitaille Y, Laforest S, Fournier M, Corriveau H. Impact of a multifaceted community-based falls prevention program on balance-related psychologic ...factors. Objective To assess the impact of a multifaceted falls prevention program including exercise and educational components on perceived balance and balance confidence among community-dwelling seniors. Design Quasi-experimental design. Setting Community-based organizations. Participants Two hundred community-dwelling adults aged 60 years and over recruited by community-based organizations. Intervention A 12-week multifaceted falls prevention program including 3 components (a 1-hour group exercise class held twice a week, a 30-minute home exercise module to be performed at least once a week, a 30-minute educational class held once a week). Main Outcome Measures Perceived balance and balance confidence. Results Multivariate analysis showed that the program was successful in increasing perceived balance in experimental participants. However, balance confidence was not improved by program participation. Conclusions A multifaceted community-based falls prevention program that was successful in improving balance performance among community-dwelling seniors also had a positive impact on perceived balance. However, the program did not improve participants' balance confidence. These results suggest that balance confidence has determinants other than balance and that new components and/or modifications of existing components of the program are required to achieve maximal benefits for seniors in terms of physical and psychologic outcomes.
Background: Although sexuality can be affected post-stroke, few individuals receive sexual rehabilitation because of clinicians' lack of knowledge regarding evidence-based interventions.
Objective: ...To document and describe the best available evidence supporting interventions that target post-stroke rehabilitation of sexuality.
Methods: This systematic review searched the databases Medline, Embase, Psycinfo, CINAHL, Web of science, PEDRO and OTSeeker up to 29 May 2020. Inclusion criteria were: published studies with a sample composed of ≥ 50% stroke clients and describing an intervention that could be applied by an allied health professional. Data was extracted according to the PRISMA guidelines by two independent reviewers. Interventions were described according to the Template for intervention description and replication checklist.
Results: Among the 2446 articles reviewed, 8 met the inclusion criteria. Two randomized controlled trials (RCT) and one non-RCT showed improvement in sexual functioning and satisfaction following a 30-45-minute structured rehabilitation program. Two other RCT showed significant improvement in sexual functioning with physical therapy oriented toward 1) structured physical and verbal sexual counseling and 2) pelvic floor muscle training. Three studies showed that interdisciplinary sexual rehabilitation improved satisfaction and sexual functioning; implementation of an interview script for clinicians improved the proportion of clients who addressed sexuality from 0 to 80% in 10 months; and two-day couple retreats improved perceived intimacy between couples.
Conclusions: This review highlights promising interventions that could orient future research and improve the access to sexual rehabilitation services for post-stroke, with structured sexual rehabilitation and pelvic floor muscle training being the most strongly supported.
Active aging is a concept that lacks consensus. The WHO defines it as a holistic concept that encompasses the overall health, participation, and security of older adults. Fernández-Ballesteros and ...colleagues propose a similar concept but omit security and include mood and cognitive function. To date, researchers attempting to validate conceptual models of active aging have obtained mixed results. The goal of this study was to examine the validity of existing models of active aging with epidemiological data from Canada.
The WHO model of active aging and the psychological model of active aging developed by Fernández-Ballesteros and colleagues were tested with confirmatory factor analysis. The data used included 799 community-dwelling older adults between 65 and 74 years old, recruited from the patient lists of family physicians in Saint-Hyacinthe, Quebec and Kingston, Ontario.
Neither model could be validated in the sample of Canadian older adults. Although a concept of healthy aging can be modeled adequately, social participation and security did not fit a latent factor model. A simple binary index indicated that 27% of older adults in the sample did not meet the active aging criteria proposed by the WHO.
Our results suggest that active aging might represent a human rights policy orientation rather than an empirical measurement tool to guide research among older adult populations. Binary indexes of active aging may serve to highlight what remains to be improved about the health, participation, and security of growing populations of older adults.
Abstract
Purpose: The Upper Limb Functional Index (ULFI) is a self-report questionnaire assessing activity limitations and participation restrictions resulting from an upper limb musculoskeletal ...disorder (MSD). A French Canadian version of the ULFI (ULFI-FC) has recently demonstrated good internal consistency, and convergent validity, as well as clinical applicability in a rehabilitation context where clinicians have important time constraints. This study aimed to examine the test-retest reliability and responsiveness of the ULFI-FC. Methods: In order to study the ULFI-FC's responsiveness, 60 participants completed the ULFI-FC and a French Canadian version of the DASH (DASH-FC) twice at an interval of two to six weeks, based on the evolution of their upper limb MSD. Half of the sample also completed the ULFI-FC three days after the second assessment for the test-retest reliability analysis. Results: The ULFI-FC demonstrated high test-retest reliability (ICC = 0.92-0.97) and good internal responsiveness (Cohen's d = 0.49-0.62; standardized responsive means = 0.60-0.88). External responsiveness was further supported by moderate correlations of change scores with the DASH-FC (r = 0.42-0.64). Conclusions: Study findings support the use of the ULFI-FC in rehabilitation as an outcome measure to monitor activity limitations and participation restrictions among French-speaking patients presenting with upper limb MSD.Implications for RehabilitationThe ULFI-FC is a reliable and valid tool with good responsiveness to change for assessing activity limitations and participation restrictions in adults presenting with upper limb musculoskeletal disorders.This tool can thus be useful in clinical and research settings.By exploring meaningful activities that are affected by patients' upper limb musculoskeletal disorders, the tool's Patient Specific Index is particularly relevant for clinicians adhering to a patient-centered approach.
This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to ...improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services.
The fear of falling can be manipulated by introducing a postural threat (e.g., an elevated support surface) during stance and gait. Under these conditions, balance parameters are altered in both ...young and elderly individuals. This study aimed to dissociate the physical and psychological aspects of the threat and show the impact of a verbal warning cue of imminent perturbation during gait among young and elderly healthy participants. Ten young subjects (29.4 ± 3.9 years) and ten subjects aged over 65 years (72.9 ± 3.5) participated in the study. Spatiotemporal and balance parameters were quantified during eight consecutive gait cycles using a motion analysis system and an instrumented treadmill. These parameters were compared twice in the control trial and before/after a verbal warning cue of imminent perturbation during gait (“postural threat”) in perturbation trials and between groups using repeated measure ANOVAs. Results: The verbal cue yielded reduced step length (
p
= 0.008), increased step width (
p
= 0.049), advanced relative position of the center of mass (
p
= 0.016), increased stabilizing force (
p
= 0.003), and decreased destabilizing force (
p
= 0.002). This warning effect was not observed in the older participant group analyses but was found for three participants based on individual data analyses. The warning effect in younger participants was not specific to impending perturbation conditions. Most gait and balance parameters were altered in the older group (
p
< 0.05) versus the younger group in each condition, regardless of the warning cue. A psychological threat affects gait and balance similarly to a physical threat among young participants but not among most older participants.
Background: Recent studies show that fear of falling, a frequent fear of community-dwelling seniors, can have a negative impact on their health and quality of life. When fear of falling is intense, ...it can prompt individuals to limit or avoid certain activities. This activity restriction can lead to premature physical and functional decline and, ultimately, increase the risk for falls. Although activity avoidance/restriction is a common strategy used by seniors to cope with fear of falling, they may use other strategies as well to cope with this fear. However, these other strategies have received little attention to date. Objective: This study aimed at examining and comparing coping strategies used by seniors with and without fear of falling. It also examined if fear of falling is an independent correlate of the use of coping strategies among seniors. Methods: 288 seniors aged 65 years or over and going through the normal aging process were assessed during structured home interviews. Fear of falling was assessed through a single question (Are you afraid of falling?) and a 4-category response scale (never, occasionally, often, very often). Coping strategies used by participants were assessed with the Inventory of Coping Strategies Used by the Elderly. Results: Findings show that seniors with fear of falling use several coping strategies other than activity avoidance/restriction in their daily functioning. Compared with nonfearful seniors, they tend to use a wider range of coping strategies and use them more frequently. Results also indicate that fear of falling is an independent correlate of diversity and frequency of use of behavioral coping strategies. Conclusion: This study suggests that fall prevention practitioners and researchers should document the range and frequency of use of strategies that seniors may employ to cope with fear of falling. These data could help improve interventions and evaluative research in the domain of fall prevention.
Introduction: Peer-led health promotion programs rely on community members to promote health-enhancing changes among their peers. Such programs are growing in popularity and, as a useful and relevant ...strategy to promote older adults' social participation, have shown benefit to participants' physical and psychological health. Little is known, however, about the experience of older adults involved as peer educators in health promotion programs. Methods: Using an exploratory qualitative design, semi-structured interviews were conducted with 7 older adults, aged between 62 and 76 years, involved as peer educators in one or two health promotion programs. Qualitative analysis rested on a mixed (inductive and deductive) approach. The deductive analysis relied on the Do-Live-Well model-an occupation-based framework with roots in health promotion. Findings: Engaging as peer educators allowed participants to express their identity, develop their capabilities, experience pleasure, and contribute to society. They perceived their involvement in this occupation as beneficial for their physical, psychological, and cognitive health. Personal and social forces (e.g., skills acquired through previous work experiences, social support) were considered facilitators to enable older adults to engage as peer educators. Conclusion: Being facilitators in peer-led health promotion programs provides an opportunity for older adults to engage in a meaningful occupational experience that can lead to positive health outcomes, while advancing health promotion messages among their peers.
Objective: The objective of this study was to identify individual and environmental correlates of fear of falling among community-dwelling seniors. Method: The study sample involved 288 ...community-dwelling adults aged 65 years or older going through the normal aging process. Fear of falling and a series of individual and environmental characteristics were measured with a questionnaire during home interviews. Results: Multivariate logistic regression procedures showed that the strongest correlates of fear of falling are gender, support from a spouse or partner, and residential area. Being a female as well as living in a smaller city or rural area were shown to be risk factors for fear of falling, whereas the availability of support from a spouse or partner was a protective factor. Discussion: Findings from this study suggest that researchers should adopt an ecological perspective to understanding the phenomenon of fear of falling among seniors and collect data on a broader range of individual and environmental factors.
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