Occupational participation postdischarge. adults: A mixed methods study. Elizabeth Pritchard PhD Candidate NZAOT Conference 2012

Transcription

1 Occupational participation postdischarge in older adults: A mixed methods study Elizabeth Pritchard PhD Candidate NZAOT Conference 2012

2 Overview Study context Definition of occupational participation Incidence and costs of falls Current research and gap identification Study design and methodology Future research

3 Acknowledgements Primary supervisor: Associate Professor Terry Haines Secondary supervisor: Associate Professor Ted Brown

4 Introduction of context Ageing Post discharge Health outcomes Occupational participation

5 Occupational participation is... engaging in work, play or activities of daily living that are part of one s socio-cultural context and that are desired and/or necessary to one s wellbeing (Kielhofner, 2008, p. 101)

6 Incidence and costs of falls - older adults Incidence > 65 years 1 in 3 fall per year > 80 years 1 in 2 fall per year Injury Mortality 40-60% require medical intervention 36.8 per 100,000 population (Alexander, Rivara, & Wolf, 1992; Campbell & Roberston, 2007; Centers for Disease Control and Prevention, 2006 ; Mahoney, Sagar, Dunham, & Johnson, 1994) Costs: NZD - $373 million (NZ) to $36 billion (US)

7 Current research Intervention Reduced RATE of falls Exercise - group & home Tai chi Vitamin D supplements Home safety - high risk only Cataract surgery - first eye Medication review Reduced RISK of falls Reduced RISK of harm (Gillespie, Robertson, Gillespie, Lamb, Gates, Cumming, & Rowe, 2010) Problems: Sustainability adherence, funding (Horne, Speed, Skelton, & Todd, 2009; McInnes & Askie, 2004; Robertson & Campbell, 2009)

8 Research question How can engagement in occupational participation of older adults who are discharged from hospital following a significant health event be enhanced; and does this improve their health outcomes? Literature review & meta-analysis Cross sectional study Mixed methods study Systematic literature review Pilot study

9 Study design and methodology Mixed methods QUAL + quant Purposive sampling (n=24) Recruitment; acute hospital, (through occupational therapists and nurse managers) Data gathering Measurement tools

10 Inclusion criteria 65 years & over Current hospital in-patient Planned discharge home Understand and converse in English Without significant cognitive impairment

11 Exclusion criteria 64 years & under Not returning home Transferred to sub-acute for rehabilitation Unable to converse in English With significant cognitive impairment

12 Analysis Qualitative: thematic framework analysis Quantitative: regression analysis Analysis will be done separately then partially mixed at the end

13 Conceptual diagram developed

14 Potential positive health outcome Hospital admission Occupational participation pre-hospital S 1 H O S P I T A L I S A T I O N? Impact on participation S 2? Decreased Function? Mental health/ wellbeing? Increased Falls S 3

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16 Rārangi pukapuka Alexander, B. H., Rivara, F. P., & Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health, 82(7), Campbell, A. J., & Robertson, M. C. (2007). Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age and Ageing, 36(6), Centers for Disease Control and Prevention. (2006). Morbidity and Mortality Weekly Report (Vol. 55). Gillespie, L. D., Robertson, C. M., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., & Rowe, B. H. (2010, 2010//). Interventions for preventing falls in older people living in the community. Kielhofner, G. (2008). A model of human occupation : Theory and application (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Horne, M., Speed, S., Skelton, D., & Todd, C. (2009). What do communitydwelling Caucasian and South Asian year olds think about exercise for fall prevention? Age and Ageing, 38(1), Mahoney, J., Sager, M., Dunham, N. C., & Johnson, J. (1994). Risk of falls after hospital discharge. Journal of the American Geriatrics Society, 42(3), McInnes, E., & Askie, L. (2004). Evidence review on older people's views and experiences of falls prevention strategies. Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing, 1(1), Robertson, M. C., & Campbell, A. J. (2008). Optimisation of ACC s fall prevention programmes for older people, final report. Dunedin:New Zealand.