Elderly disabled persons in the home setting : aspects of activities in daily life

The overall aim of this thesis was to explore and describe elderly disabled persons' activities in daily life in the home environment from an occupational perspective and, secondly to describe occupational therapy interventions provided to elderly disabled persons in their home setting.

Study I explored and described elderly persons' performance in ADL, and occupational therapy interventions provided. Most of the participants wanted to engage in more activities than they were judged to have the capacity and/or environmental support for. Hobby activities outside/inside the home, taking a bath or shower, washing clothes, and cooking were activities presenting significant problems. Participants who received occupational therapy experienced problems regarding self-care. Assessment and assistive devices were the most common occupational therapy interventions provided in the study. Study II focused on participants from study I that had an elevator in their housing and their need for mobility support in the environment. Social contacts in the home and weekly shopping were activities where no major difference could be seen between those elderly persons who needed assistance using the elevator and those who managed the elevator alone. Mobility was not only related to a person's bodily function but also to social support from the environment.

Study III explored and described occupational therapy intervention patterns over two periods. Treatment/training, prevention in everyday activities and information/consultation increased from period I to period 2, while interventions concerning assistive devices decreased. Treatment/training during both periods concerning leisure/recreation activities, whilst interventions concerned consultation seemed to be changing over time from focusing on clients to relatives and home help staff. Study IV aimed at uncovering and interpreting elderly disabled persons' experiences, values and meanings of being engaged in daily occupations. Themes related to participation against the odds, retreat from occupation, the need for an invitation from others, and personal meanings related to capacities for occupations were uncovered. The findings suggest that for occupational therapy it is important to distinguish between when a person has made a conscious choice to withdraw from occupational life and when a person, for example, has too few occupational choices.

Study V described and evaluated a clinical attempt to change occupational therapy practice when reporting clients between occupational therapists in the chain of care. The ADL taxonomy was used as an instrument for transferring the information. It was seen as useful for this purpose but there was still a need for reporting clients orally. Aspects of temporality, structure, professionalism and the instrument's usefulness overall influenced the transfer of information. Systematic discharge planning schemes, written and formally structured information, feedback loop for communication, and collaboration with the clients and their families in the discharge process are suggested as guidelines for the transfer of information. Implications of the studies for occupational therapy for elderly disabled persons in the home setting are proposed in the discussion section.

List of scientific papers

I. Borell L, Lilja M, Carlsson-Alm S, Törnquist K, Ståhl E (1995). Community-based occupational therapy: a study of elderly people with home help in a social-welfare district in Stockholm. Scand J Occup Ther. 2(3-4):138-144.
https://doi.org/10.3109/11038129509106806

II. Lilja M, Borell L (1997). Elderly people's daily activities and need for mobility support. Scand J Caring Sci. 11(2):73-80.
https://pubmed.ncbi.nlm.nih.gov/9256808

III. Lilja M, Borell L (2000). Occupational therapy practice patterns with older Swedish persons at home. Can J Occup Ther. 68(1):51-9.
https://pubmed.ncbi.nlm.nih.gov/11233689

IV. Borell L, Lilja M, Anderson-Sviden G, Sadlo G (2000). Occupations and signs of reduced hope - an explorative study of older adults with functional impairments. Am J Occup Ther. [Accepted]

V. Lilja M, Nygård L, Borell L (2000). The transfer of information about geriatric clients in the occupational therapy chain of care: an intervention study. Scand J Occup Ther. 7(2):51-9.
https://doi.org/10.1080/110381200750018841