This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

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Wednesday, 11 April 2012

J is for Jackson...

Jeanne Jackson’s chapter entitled “Living a Meaningful Existence in Old Age’ in the book Occupational Science- the Evolving Discipline, edited by Ruth Zemke & Florence Clark (1996) describes a pilot study she carried out with a group of older people with disabilities looking at the strategies they used to adapt to age and disability.

It is a detailed read, but fascinating. I will try to give enough of a flavour to encourage you to read it! I was interested in the study as it was used in designing the Well Elderly Study programmes that became Lifestyle Redesign®, the focus of my study visit to Los Angeles earlier this year.

Jackson describes 7 adaptive strategies that the group had adopted:

  1. Personal Themes of Meaning as Motifs for Occupation- for many people this meant a religious belief, but for others it was more about their self image e.g. as always having been someone who cooked for large numbers. Individuals found ways to incorporate these motifs from their previous life into the present..
  2. Risk and Challenge in Occupation- individuals welcomed the opportunity to try new things, to risk failure and to take on challenges. This did not have to be on a frequent basis, the opportunity now and again was often enough.
  3. Activity Patterns and Temporal Rhythms- people developed routines that seemed to provide stability and security in day-to-day life. They paced their days and allowed time for tasks that were more difficult due to disabilities.
  4. Control- independence and autonomy were highly valued. Even when physical help was required with daily living tasks, a sense of control was maintained by holding onto the ‘power’ to make decisions or give instructions. Others found independence by engaging in activities that allowed them to be alone and have some peaceful time. The issue seemed to be being able to choose what to do or not do, rather than physical independence.
  5. Maintaining Continuity Through Spatial, Social and Cultural Connectedness- an important sense of continuity from the past into the present is maintained through connections with cultural ideas, rituals and values, with ongoing relationships with others and with place. Household objects are often an important means of preserving identity for older people.
  6. Acknowledging Identity Through the Celebration of Occupations- Jackson talks about the notion of ‘dramas of honor’, celebrations of everyday accomplishments that allow people to feel noticed and respected.
  7. Advocating Social Change- the group in the study were an advocacy group aiming to improve medical care for older people. This was an important role for the members.

Jackson concludes with some recommendations for Occupational Therapists to:
·      Respect and support patients as occupational beings
·      Be very attentive to where and how patients want to have control over their lives.
·      Support patients in maintaining ‘temporal continuity’
·      View activity more broadly, not only as physical doing.
·      Cherish people’s need to have everyday accomplishments acknowledged and have the chance to experience success and failure.
·      See adaptive strategies as a means for individuals to interact with their personal environments and to transform their situations.

This is a very brief overview of a thought-provoking study. At the end of the chapter are some discussion questions, such as asking us to think about how we might, as OTs, help patients achieve some of these ends.

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