Authors
- Jessen-Winge, Christina Occupational therapist, MSc, lecturer,
- Buch Holzt, Dorte Physiotherapist, MPH, lecturer
- Morville, Anne-Le Occupational therapist, MSc, lecturer
Abstract
Review objective/questions: The objective of the current review is to identify the types of occupations that are important in improving overall wellbeing amongst the elderly population.
It is assumed that conducting a systematic review with a qualitative approach will lead to a deeper understanding of how the independently-living elderly enhance their wellbeing through participation in occupations. Such a review will contribute to the knowledge and practice within the health promotion framework with the healthy elderly population. Thus the review will be of use to occupational therapists and others working with elderly people in terms of both theory and practice, as the knowledge will be grounded in the reality of human experience. The specific question to be addressed in this review is:
Which occupations do the independently-living elderly consider to enhance their overall wellbeing?
Background: An important health goal for elderly people in western countries is to maintain their ability to live independently and to function well.1 In the fields of social science and gerontology, concepts such as 'active aging' and 'successful aging' imply that 'doing' activities is closely related to wellbeing.3 Being active is an important factor in managing life and coping with the challenges related to advanced age.2
Activities are defined by all that people need, want or are obligated to do such as self-care, household tasks, leisure and social interactions with family and friends.4 When a person engages in and gives the activity a purpose, value or reason, the activity will become meaningful and can be defined as an occupation.5,6 Crepeau et al. stated that occupations "include the day-to-day activities that enable people to sustain themselves, to contribute to the life of their family and to participate in the broader society".7(p28) Thus, occupations are multifaceted phenomena as they provide meaning, identity and structure to a person's life.5 The one premise underpinning occupational therapy and occupational science is that the occupations in which people engage and their health are interrelated and this seems to be universal for the experience of wellbeing.8,9
The meaningfulness of the occupations in which a person engages throughout their lifespan changes over time.10 The occupations a young man at university may find meaningful will probably differ from those of an elderly man who is retiring from work. For the elderly, there are different factors influencing their engagement in occupations. Examples of these include the aging process, as well as the individual's history of occupations. Significant changes in external conditions, for example retirement, also have an impact on the occupations considered by an individual to be meaningful and in which they will subsequently engage.11 This complex interaction between external conditions of the individual's lifespan and the internal perceptions of those conditions,12 influences the way in which the individual perceives general wellbeing.10
Several studies indicate that engagement in social occupations seems to improve the wellbeing of the elderly.9,13-16 However, a Danish study showed that the majority of the elderly in their sample found physical and solitary occupations as being the most important for maintaining health and wellbeing.17 Productive activities such as remaining active in work or volunteering has also been indicated to have a positive effect on wellbeing.13,18 It is important for society in general, as well as social and health services in particular, to enable and assist the elderly in improving their health and enhance their general wellbeing. Conducting a systematic literature review on elderly persons' occupations from the perspective of the elderly will lead to a deeper understanding on how the elderly can maintain their well-being.
Article Content
Inclusion criteria
Types of participants
This review will consider studies that include independently-living elderly, aged 65 years and older residing in western countries including Europe, America and Australia. Western countries have been chosen because of their cultural homogeneity in relation to comparisons and considerations.
In this review, studies that include elderly participants with a known diagnosis or disease will be excluded.
Types of intervention(s)/phenomena of interest
This review will consider studies based on qualitative methodology that investigates the perspectives of independently-living elderly people, regarding occupations and quality of life. The focus will be on which occupations elderly people believe improve their overall wellbeing.
Types of studies
This review includes studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography and action research.
Search strategy
The search strategy aims to find primarily peer-reviewed published studies. A three-step search strategy will be utilized in this review. An initial search of MEDLINE, CINAHL, Nursing and Allied Health Source, PubMed, Web of science, Trip database and Opengrey will be undertaken, followed by an analysis of the key words contained in the title and abstract of relevant articles and of the index terms used to describe the article.
A second search using all identified keywords and index terms will then be undertaken across all included databases.
Third, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in Danish, Swedish, Norwegian and English will be considered for inclusion in this review. The Authors are fluent in writing and understanding Danish and English and in reading Swedish and Norwegian. Studies published up until 2013 will be considered for inclusion in this review.
The databases to be searched include:
Nursing and Allied Health Source
CINAHL
PubMed
Web of science
Trip database
Opengrey
Initial keywords to be used will be:
Elder*, aged, old age, 65+, retire*, occup*, activ*, daily life, quality of life, wellbeing, health*
(using MeSH words)
Assessment of methodological quality
Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendices I and II). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data collection
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix VI). The data extracted will include specific details about the phenomena of interest, population, study methods and outcomes of significance to the review question and specific objectives.
Data synthesis
Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the findings will be presented in narrative form.
References
1. Orellano E, Colo'n W, Arbesman M. Effect of Occupation-and Activity-Based Interventions on Instrumental Activities of Daily Living Performance Among Community-Dwelling Older Adults: A Systematic Review. The American Journal of Occupational Therapy; May/June 2012;66(3): 292-300 [Context Link]
2. Adams K, Leibbrand S, Moon H. A critical review of the litteratur on social and leisure activity and wellbeing in later life. Ageing and Society; 2011 May;31:683-712 [Context Link]
3. Wilcock, A. Occupational Persoective of Healt. SLACK Incorporated: 2006 [Context Link]
4. Fisher, A.G. Uniting Practice and Theory in an Occupational Framework. The American Journal of Occupational Thearpy; 1998 June; 52(7): 509 - 521 [Context Link]
5. Brown H, Hollis V. The Meaning of Occupation, Occupational Need, and Occupational Therapy in a Military Context. Phys.Ther; 2013;93(9):1244-1253 [Context Link]
6. Christiansen C, Baum, C. Occupational Therapy - performance, participation, and Well-being. SLACK Incorporated, 2005 [Context Link]
7. Crepeau EB, Cohn ES, Schell BAB. Willard & Spackman's Occupational Therapy.Philadelphia, PA: Lipplncott; 2003 [Context Link]
8. Townsend E, Polatajko H: Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & justice through Occupation. Ottawa, CAOT Publications ACE, 2007 [Context Link]
9. Jackson J, Carlson M, Mandel D, Zemke R, Clark F. Occupation in Lifestyle Redesign: The Well elderly study occupational therapy program. American Journal of Occupational Therapy, 1998 May; 52 (5): 326-36 [Context Link]
10. Kielhofner, G. A Model of Human Occupation. Theory and Applications. 2nd ed. Baltimore, MD: Williams & Wilkins, 1995 [Context Link]
11. Jonsson H. The first steps into the third age: the retirement process from a Swedish perspective. Occup Ther Int;2011;18(1):32-38 [Context Link]
12. Persson D, Erlandsson L-K, eklund M, Iwarsson S. Value dimensions, Meaning, and complexity in Human Occupation - A Tentative Structure for Analysis. Scandinavian Journal of Occupational Therapy; 2001;8: 7 - 18 [Context Link]
13. Stav W, Hallenen T, Lane,J, Arbesman, M. Systematic Review of Occupational Engagement and Health Outcomes Among Community-Dwelling Older Adults. The American journal of Occupational Therapy; 2012 May/June; 66(3):301 - 310 [Context Link]
14. Puts, M.E.T, Shekary, N, Widdershoven, G, Heldens, J, Lips, P & Deeg, D.J.H. What does quality of life mean to older frail and non-frail community-dwelling adults in the Netherlands? Quality of life Research; 2007;16: 263 - 277 [Context Link]
15. Borglin, G, Edberg, AK, Hallberg IR. The experience of quality of life among older people. J Ageing Studies; 2005;19: 201 - 220 [Context Link]
16. Bowling A, Gabriel Z, Dykes J, Dowding LM, Evans O, Fleissig A, et al. Let's ask them: a national survey of definitions of qualitaty of life ad its enhencement among people aged 65+ and over. Int. J Ageing Hum Dev; 2003; 56(4): 269 - 306 [Context Link]
17. Legarth KH, Ryan S, Avlund K. The Most Important Activity and the Reasons for that Experience Reported by a Danish Population at Age 75 Years. British Journal of Occupational Therapy; November 2005; 68(11); 501 - 508 [Context Link]
18. Menec H. The relation between everyday activities and successful aging: A 6-year longitudinal study. The Journals of gerontology; 2003;58B(2), S74-82, Oxford University Press, UK, Oxford, United Kingdom, Oxford [Context Link]
Appendix I: Appraisal instruments
Appendix II: Data extraction instruments
Keywords: Activities; independently living; elderly; meningful; values; health promotion