Persons With Dementia and Their Caregivers' Perceptions About Occupational Therapy and Telehealth: A Qualitative Descriptive Study.

Occupational therapy (OT) services provided in the home to a person with dementia can decrease caregiver burden by targeting home modifications, functional performance, and safety. One method to deliver these services is through telehealth. The use of telehealth is expanding rapidly, but there is a current lack of evidence to support the use of telehealth to deliver OT services to persons with dementia. The purpose of this study was to identify the perceptions of persons with dementia and their caregivers about the use of telehealth to receive OT services. A qualitative descriptive design was used. Results provided themes in three domains: dementia journey, skills for technology use, and perceptions of OT. Each participant identified a unique journey through awareness, challenges, and adaptive strategies as they adjusted to a life with dementia. The skills for technology focused on current usage and perceptions about technology. Participants had limited knowledge of OT but did appreciate the role it has in dementia care. The themes identified in the study provide support for further exploration of the use of telehealth in OT for persons with dementia and their caregivers.

Effectiveness of Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Function of People With Traumatic Brain Injury: A Systematic Review.

After traumatic brain injury (TBI), many people experience significant motor function impairments. To help occupational therapy practitioners make informed decisions in choosing treatment strategies to improve clients' motor function, we undertook a systematic review and synthesized applicable findings of intervention studies. Of 2,306 articles identified in the literature search, we reviewed 47 full-text articles, of which 16 met approved criteria. We found moderate evidence that various exercise programs increase motor function and limited evidence that people with TBI can benefit from rehabilitation and computer-based programs. We offer implications for practice, education, and research.

Showering habits: time, steps, and products used after brain injury.

OBJECTIVE: This pilot study describes the showering habits of people with brain injury (BI) compared with those of people without BI (WBI). METHOD: The showering habits of 10 people with BI and 10 people WBI were measured and compared. A videotaped session recorded and documented the shower routine. RESULTS: The BI group spent longer time showering, used more steps, and used fewer products than the WBI group. A moderately significant relationship was found between time and age (r = .46, p = .041). Similarly, we found significant correlations between number of steps and number of products used (r = .64, p = .002) and between the number of products used and education (r = .47, p = .044). CONCLUSION: Results suggest that people with BI have showering habits that differ from those WBI. Correlations, regardless of group, showed that older people showered longer, and people with more education used more showering products.

Race/ethnicity and outcomes following inpatient rehabilitation for hip fracture.

BACKGROUND: Hip fracture results in severe and often permanent reductions in overall health and quality of life for many older adults. As the U.S. population grows older and more diverse, there is an increasing need to assess and improve outcomes across racial/ethnic cohorts of older hip fracture patients. METHODS: We examined data from 42,479 patients receiving inpatient rehabilitation for hip fracture who were discharged in 2003 from 825 facilities across the United States. Outcomes of interest included length of stay, discharge setting, and functional status at discharge and 3- to 6-month follow-up. RESULTS: Mean age was 80.2 (standard deviation [SD] = 8.0) years. A majority of the sample was non-Hispanic white (91%), followed by non-Hispanic black (4%), Hispanic (4%), and Asian (1%). After controlling for sociodemographic factors and case severity, significant (p <.05) differences between the non-Hispanic white and minority groups were observed for predicted lengths of stay in days (Asian: 1.1; 95% confidence interval [CI], 0.5-1.7; non-Hispanic black: 0.8; 95% CI, 0.6-1.1), odds of home discharge (Asian: 2.1; 95% CI, 1.6-2.8; non-Hispanic black: 2.0; 95% CI, 1.8-2.3; Hispanic: 1.9; 95% CI, 1.6-2.2), lower discharge Functional Independence Measure (FIM) ratings (non-Hispanic black: 3.6; 95% CI, 3.0-4.2; Hispanic: 1.6; 95% CI, 0.9-2.2 points lower), and lower follow-up FIM ratings (Hispanic: 4.4; 95% CI, 2.8-5.9). CONCLUSIONS: Race/ethnicity differences in outcomes were present in a national sample of hip fracture patients following inpatient rehabilitation. Recognizing these differences is the first step toward identifying and understanding potential mechanisms underlying the relationship between race/ethnicity and outcomes. These mechanisms may then be addressed to improve hip fracture care for all patients.

Ethnic differences in discharge destination among older patients with traumatic brain injury.

UNLABELLED: Ethnic differences in discharge destination among older patients with traumatic brain injury. OBJECTIVE: To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI). DESIGN: A retrospective analysis. SETTING: Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003. PARTICIPANTS: Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic). RESULTS: Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors. CONCLUSIONS: Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.

Becoming "at home" in assisted living residences: exploring place integration processes.

OBJECTIVES: This study explores the roles of place attachment, nonfamily social involvement, place valuation, and individual characteristics in the process of becoming at home in assisted living residences. METHODS: Purposive sampling and cross-sectional data by means of a questionnaire completed by current assisted living residents in four states (N = 297) were used to estimate a structural equation model to explain becoming at home. RESULTS: Place attachment to town and community is a necessary but not sufficient explainer of older adults' process of becoming at home. Nonfamily social involvement plays a pivotal role through which place attachment works to explain becoming at home. Both place valuation and nonfamily social involvement exhibit direct positive effects on the outcome. DISCUSSION: Findings support a transactional interpretation of assisted living as home. The relationship between place attachment to one's community and full integration into assisted living is more complex than currently acknowledged.