EMERGING PRACTICE AREA IMPLICATIONS FOR AN Kathy … · to make home modifications . ² A home modification specialty team comprised of an occupational therapist and contractors who

Slide 1

HOME MODIFICATION DECISION MAKING IN WELL OLDER ADULTS: IMPLICATIONS FOR AN EMERGING PRACTICE AREA

Kathy Subasic, PhD, OTR/L, CAPS

AOTA 2016 Conference

April 8, 2016

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Slide 2

Notes

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Slide 3

Notes

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Method 1

■ Qualitative research design

– Explore a problem or issue in depth

– Address topics in detail by talking directly with individuals in their own environments.

– Participants tell their own stories in a realistic setting

■ (Creswell, 2007)

■ Grounded theory approach

– Researcher focuses on the daily life of individuals and everyday life situations

– Used to study processes and what characterizes a concept

– Symbolic Interactionism

– Result is a substantive theory grounded in the data

■ (Creswell, 2007; Meriam, 2002)

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Method 2

Participants

■ Purposeful Sampling

■ 65+, Community-dwelling, Independent, 12 females, 7 males, (5 couples)

■ Active, Well-educated, Home-owners, Baltimore County

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Method 3

Data Collection■ Interview

– Interview Guide

■ Demographic Questionnaire

■ Observation Template

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Method 4

Data Analysis■ Grounded Theory Techniques

– Strauss & Corbin (1998)

– Charmaz (2006)

■ Transcripts, Field notes, Memos, Demographic Data

■ Open, Axial, & Selective Coding

– Constant Comparative Analysis

– Memos & Diagrams

– Paradigm (Conditions, Interactions & Emotions, Consequences)

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Method 5

Trustworthiness & Quality■ Multiple data sources = Triangulation of data

■ Audit Trail

■ Memos

– analytical, procedural, theoretical

■ Peer debriefing

■ Focus group

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Slide 9

RESULTS

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Slide 10

Core Category Categories SubcategoriesConditions

Kathy Subasic,

PhD, OTR/L, CAPS

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Planning the Future

Weighing the Decision

Stay Go

Modification No

modification

Leaving instead of making

a modification

Waiting for an

event to occur

Information

gathering

Stay but likely to

go in future

Believing little or

no change is

needed

Stay indefinitely

Decision-Making

Process


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Leave house in

less than 5 years

= Go

Leave home in 5

to 10 years

Stay in home as

long as possible

Made Home

Modification 0 2 13

Considering Home

Modification 0 1 2

Did Not Make

Home Modification 2 1 1

Time Planning to be in the Home Compared with Modification Action

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Decision Making:

Stay or Go

Health Status

Connected to Home

FinancesHome Offers

Control

Support Network

Decision Making: Home

Modification

Health Status

Home Environment

Finances

Participation

Existing Knowledge

Temporal Aspects

Weighing the Decision

Knowledge & Awareness

Final DecisionInformation Gathering

Theory of Home

Modification

Decision-making:

Well Older Adults


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Slide 14

Health Status

Getting Older

Physical Ability

Health of Spouse

Adequate Health to

Stay

Connected to Home

Nostalgia

Practical

Comfort

Desire

Home Offers

Control

Freedom

SpacePrivacy

Finances

Cost Effective

ResourcesPaying for Assistance

Support Network

Considering Need for Future

Assistance

Current Available Support

Not Depending on Children

Not Wanting to

Burden Children

Decision Making -

Stay or Go:

Conditions &

Properties


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Health Status

Anticipating Decline

Awareness of Getting

Older

Declining Abilities

Accident or Illness

Concern of Falling

Not Having Full Control

Too Old

Finances

Timing of Modification

Paying for the Work

Weighing the Benefit

Home Resale Implications

Existing Knowledge

Aging Parent

Renovation Experience

Professional Career

Decision Making –

Home Modification:

Conditions & Properties 1


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Slide 16

Home Environment

Home Layout

Home Maintenance

Keeping Active

Aesthetics

Participation

Continued Independence

Make Daily Activities

Easier

Enhanced Safety

Temporal Aspects

Waiting for an Event to

Occur

Anticipating the Future

Timing of the Modification

Decision Making –

Home Modification:

Conditions & Properties 2


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Slide 17

Viewing Home Modification as a Benefit

Modification is a Benefit

Fall risk awareness

Increased efficiency with

houehold activities

Continued independence

Enhance confidence

Enhance safety

Make daily activities

easier


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Conclusions 1■ Participants demonstrated a pattern of taking responsibility for self-managing their

lives.

■ The state of an older adult’s health will influence decision-making

■ Well older adults with an internal locus of control take responsibility for the state of their health.

– Plan for the future

– Often includes making a home modification

– Legitimate need may need to exist – Waiting for the Future

■ Well older adults who are part of the Baby Boomer generation or who were born on the cusp of that generation, may be better educated, more assertive, and more internally driven than the older generation.

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Slide 19

Conclusions 2

The PEO Model may be useful for occupational therapists to use

to facilitate well older adult decision-making concerning aging-in-

place and the use of home modification.

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Slide 20

Implications■ Practice

■ There is a gap in services targeted

toward well older adults who desire

to make home modifications.

– A home modification specialty

team comprised of an

occupational therapist and

contractors who are Certified

Aging-in-Place Specialists can

fill this gap.

– Community-based Education

Programs

■ Decision-making Process

■ Home Modification Process

■ Research

– Similar study with well older

adults with different

characteristics

– Investigate characteristics of

well older adults compared

with home modification

decision-making process

– Perceived role of home

modifications

– Outcomes study of

occupational therapy-based

education program

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Recommendations■ Advanced training & education

■ Widen the scope of occupational therapy home modification services

■ Advocate for well older adults who want to make home modifications to facilitate aging-in-place

■ Include well older adult decision-making content in occupational therapy curricula

■ Understand the roles of other professionals invested in providing aging-in-place services to well older adults

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Slide 22

This presentation was based on the presenter’s dissertation completed in partial fulfillment for the PhD in Occupational Therapy, Occupational Therapy Department, College of Health Care Sciences, Nova Southeastern University, Ft. Lauderdale, FL.

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Slide 23

Acknowledgements: Dissertation Committee Members

■ Rachelle Dorne, Ed.D., OTR/L – Chairperson

■ Cathy Peirce, PhD., OTR/L – Dissertation Committee Member

■ Janet DeLany, D.Ed., OTR/L, FAOTA – Dissertation Committee Member

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References■ Beck, L. E. (1998). Development through the lifespan. Needham Heights: Allyn & Bacon.

■ Carter, S. E., Campbell, E. M., Sanson-Fisher, R. W., Redman, S., & Gillespie, W. J. (1997). Environmental hazards in the homes of older people. Age And Ageing, 26(3), 195-202.

■ Chen, S.-l., Brown, J. W., Mefford, L. C., La Roche, A., McLain, A. M., Haun, M. W., & Persell, D. J. (2008). Elders' decisions to enter assisted living facilities: a grounded theory study. Journal of Housing for the Elderly, 22(1/2), 86-103. doi: 10.1080/02763890802097094

■ Chippendale, T. L., & Bear-Lehman, J. (2010). Enabling "aging in place" for urban dwelling seniors: An adaptive or remedial approach? Physical & Occupational Therapy in Geriatrics, 28(1), 57-62. doi: 10.3109/02703180903381078

■ Clark, F., Jackson, J., Carlson, M., Chou, C., Cherry, B. J., Jordan-Marsh, M., & ... Azen, S. P. (2012). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 randomised controlled trial. Journal of Epidemiology & Community Health, 66(9), 782-790 9p. doi:10.1136/jech.2009.099754

■ Clark, J. P., Hudak, P. L., Hawker, G. A., Coyte, P. C., Mahomed, N. N., Kreder, H. J., & Wright, J. G. (2004). The moving target: A qualitative study of elderly patients' decision-making regarding total joint replacement surgery. Journal of Bone & Joint Surgery, American Volume, 86(7), 1366-1374.

■ Copolillo, A. E. (2001). Use of mobility devices: the decision-making process of nine African-American older adults. Occupational Therapy Journal of Research, 21(3), 185-200.

■ Creswell, J. W. (2007). Qualitative inquiry and research design (2nd ed.). Thousand Oaks: Sage.

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References

■ Dahlin-Ivanoff, S., Haak, M., Fänge, A., & Iwarsson, S. (2007). The multiple meaning of

home as experienced by very old Swedish people. Scandinavian Journal of Occupational

Therapy, 14(1), 25-32. doi: 10.1080/11038120601151714

■ Fange, A., & Iwarsson, S. (2005a). Changes in accessibility and usability in housing: an

exploration of the housing adaptation process. Occupational Therapy International, 12(1),

44-59.

■ Fange, A., & Iwarsson, S. (2005b). Changes in ADL dependence and aspects of usability

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■ Gitlin, L. N., Schemm, R. L., Landsberg, L., & Burgh, D. (1996). Factors predicting assistive device use in the home by older people following rehabilitation. Journal of Aging and Health, 8(4), 554-575.

■ Gladden, J. C. (2000). Information exchange: Critical connections to older adult decision-making during health care transitions. Geriatric Nursing, 21(4), 213-218. doi: 10.1067/mgn.2000.109577

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References■ Haak, M., Fange, A., Iwarsson, S., & Ivanoff, S. D. (2007). Home as a

signification of independence and autonomy: experiences among very old Swedish people. Scandinavian Journal of Occupational Therapy, 14(1), 16-24. doi: 10.1080/11038120601024929

■ Haak, M., Ivanoff, S. D., Fange, A., Sixsmith, J., & Iwarsson, S. (2007). Home as the locus and origin for participation: experiences among very old Swedish people. OTJR: Occupation, Participation & Health, 27(3), 95-103.

■ Hazen, M. M., & McCree, S. (2001). Environmental support to assist an older adult with independent living: Safety and activity accommodation in a senior's home. Journal of Housing for the Elderly, 14(1-2), 27- 52.

■ He, W., Sengupta, M., Velkoff, V. A., & DeBarros, K. A. (2005). 65+ in the United States: 2005. Washington, DC: U.S. Government Printing Office Retrieved from http://www.census.gov/prod/2006pubs/p23-209.pdf.

■ Hwang, E., Cummings, L., Sixsmith, A., & Sixsmith, J. (2011). Impacts of home modifications on aging-in-place. Journal of Housing for the Elderly, 25(3), 246-257. doi: 10.1080/02763893.2011.595611

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Slide 27

References■ Iwarsson, S. (2005). A long-term perspective on person-environment fit and ADL

dependence among older Swedish adults. The Gerontologist, 45(3), 327-336. doi: 10.1093/geront/45.3.327

■ James, B.D., Boyle, P.A., Bennett, J.S., & Bennett, D.A. (2012). The impact of health and financial literacy on decision making in community-based older adults. Gerontology, 58, 531-539.

■ Johansson, K., Lilja, M., Petersson, I., & Borell, L. (2007). Performance of activities of daily living in a sample of applicants for home modification services. Scandinavian Journal of Occupational Therapy, 14(1), 44-53. doi: 10.1080/11038120601094997

■ Kraskowsky, L. H., & Finlayson, M. (2001). Factors affecting older adults' use of adaptive equipment: Review of the literature. American Journal of Occupational Therapy, 55(3), 303-310.

■ Kruse, R. L., Moore, C. M., Tofle, R. B., LeMaster, J. W., Aud, M. A., Hicks, L. L., . . . Mehr, D. R. (2010). Older adults' attitudes toward home modifications for fall prevention. Journal of Housing for the Elderly, 24(2), 110-129. doi: 10.1080/02763891003757031

■ Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9-23.

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Slide 28

References■ Merriam, S. B. (2002). Qualitative research in practice: Examples for discussion and

analysis. San Francisco: Josey-Bass.

■ McNulty, M. C., Johnson, J., Poole, J. L., & Winkle, M. (2003). Using the Transtheoretical Model of change to implement home safety modifications with community-dwelling older adults: an exploratory study. Physical & Occupational Therapy in Geriatrics, 21(4), 53-66.

■ Moser, A., Houtepen, R., van der Bruggen, H., Spreeuwenberg, C., & Widdershoven, G. (2009). Autonomous decision making and moral capacities. Nursing Ethics, 16(2), 203-218. doi: 10.1177/0969733008100080

■ Naik, A. D., & Gill, T. M. (2005). Underutilization of environmental adaptations for bathing in community-living older persons. Journal Of The American Geriatrics Society, 53(9), 1497-1503. doi: 10.1111/j.1532-5415.2005.53458.x

■ Newton, R. A. (2006). Prevention of falls at home: Home hazard and safety assessment and management. Annals of Long Term Care, 14(11), 28-33.

■ Oswald, F., Jopp, D., Rott, C., & Wahl, H.-W. (2011). Is aging in place a resource for or risk to life satisfaction? Gerontologist, 51(2), 238-250. doi: 10.1093/geront/gnq096

■ Oswald, F., Wahl, H.-W., Schilling, O., Nygren, C., Fange, A., Sixsmith, A., . . . Iwarsson, S. (2007). Relationships between housing and healthy aging in very old age. Gerontologist, 47(1), 96-107.

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Slide 29

References■ Perez, F. R., Fernandez-Mayoralas, G., Rivera, F. E. P., & Abuin, J. M. R.

(2001). Ageing in place: Predictors of the residential satisfaction of elderly. Social Indicators Research, 54(2), 173-208.

■ Petersson, I., Kottorp, A., Bergstrom, J., & Lilja, M. (2009). Longitudinal changes in everyday life after home modifications for people aging with disabilities. Scandinavian Journal of Occupational Therapy, 16(2), 78-87. doi: 10.1080/11038120802409747

■ Scott, A. H., Butin, D. N., Tewfik, D., Burkhardt, A., Mandel, D., & Nelson, L. (2001). Occupational therapy as a means to wellness with the elderly. Physical and Occupational Therapy in Geriatrics, 18(4), 3-22.

■ Scott, T. L., Gazmararian, J. A., Williams, M. V., & Baker, D. W. (2002). Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care, 40(5), 395-404.

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Slide 30

References■ Sheffield, C., Smith, C. A., & Becker, M. (2013). Evaluation of an agency-based occupational

therapy intervention to facilitate aging in place. Gerontologist, 53(6), 907-918 12p. doi:geront/gns145

■ Stark, S. (2004). Removing environmental barriers in the homes of older adults with disabilities improves occupational performance. OTJR: Occupation, Participation & Health, 24(1), 32-39.

■ Stark, S., Landsbaum, A., Palmer, J. L., Somerville, E. K., & Morris, J. C. (2009). Client-centred home modifications improve daily activity performance of older adults. Canadian Journal of Occupational Therapy, 76, 235-245.

■ Stav, W. B., Hallenen, T., Lane, J., & Arbesman, M. (2012). Systematic review of occupational engagement and health outcomes among community-dwelling older adults. American Journal of Occupational Therapy, 66(3), 301-310 10p. doi:10.5014/ajot.2012.003707

■ Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff, B., Agree, E., & ... Gitlin, L. N. (2011). Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. Journal of The American Geriatrics Society, 59(12), 2314-2320 7p. doi:10.1111/j.1532-5415.2011.03698.x

■ Tse, T. (2005). The environment and falls prevention: Do environmental modifications make a difference? Australian Occupational Therapy Journal, 52(4), 271-281. doi: 10.1111/j.1440-1630.2005.00525.x

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Slide 31

References

■ Wagnild, G. (2001). Growing Old at Home. Journal of Housing for the Elderly, 14(1/2), 71-84.

■ Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165(17), 1946-1952.

■ Yuen, H. K., & Carter, R. E. (2006). A predictive model for the intention to implement home modifications: a pilot study. Journal of Applied Gerontology, 25(1), 3-16.

■ Zamora, H., & Clingerman, E. M. (2011). Health literacy among older adults: A systematic literature review. Journal of Gerontological Nursing, 37(10), 41-51. doi: 10.3928/00989134-20110503-02

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Slide 32

Nothing great is ever achieved without much enduring

Saint Catherine of Sienna

Thank you!

Questions

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Documents

EMERGING PRACTICE AREA IMPLICATIONS FOR AN Kathy … · to make home modifications . ² A home modification specialty team comprised of an occupational therapist and contractors who