What If Deliberately Dying Is an Occupation?

In some legal and societal circumstances, people freely and capably plan, organize, and precipitate their own death. Drawing on published literature, we critically reflect on how deliberately ending one's own life fits with the current definitions of the concept of occupation. Using an occupational science and occupational therapy theoretical reflection, we argue that deliberately dying can for some people be considered a purposeful and meaningful occupation. Implications for such an occupational therapy practice are discussed: attending to the occupational needs of specific groups of people, reconsidering definitions and conceptual work, advocating for occupational justice in ending life activities, reflecting on ethical conundrums around self-harm activities within the scope of practice, and exploring deliberate death as a purposeful and meaningful occupation. Because deliberately dying is something that some people do, in this article we aim to open a dialogue within the field of occupational science and occupational therapy about this sensitive and potentially controversial issue.

Associations between community participation and types of places visited among persons living with and without dementia: risks perception and socio-demographic aspects.

INTRODUCTION: Increasingly, literature has focused on community participation in places visited by persons living with and without dementia. Earlier research indicates that multiple factors, including socio-demographic aspects and risk perception may influence community participation. AIM AND METHODS: This cross-sectional, explorative study aims to inquire into how places visited, socio-demographic aspects and risks perception are associated with self-rated community participation for persons living with and without dementia (n = 70) in Switzerland. Data was collected through face-to-face interviews with questionnaires (ACT-OUT, MoCA, sociodemographic). First, we investigated whether the number of places visited was correlated with self-rated participation; then we added socio-demographic and risks perception factors with a bivariate analysis; and searched for a model using multinomial logistic regressions. RESULTS: For the group of participants living with dementia, risks of falling (p = .014) and of getting lost (p = .037) were significantly associated with self-rated participation. For the group of participants living without dementia, visiting places outside the home was significantly associated with self-rated participation, especially visiting places in domain D/places for recreational and physical activities (p = .005). DISCUSSION AND CONCLUSIONS: The results of exploring multiple factors and searching for a model highlights the complexity of community participation as a construct. Risks and visiting places for recreational and physical activities seem to play a role in self-rated participation. Mobile interviews might be better suited to gain in-depth understanding on community participation for persons living with dementia.

Interpersonal Perception of Time-Use Patterns in Romantic Relationships: Protocol for the IP-COUPLES Study.

BACKGROUND: Perceptual congruence has been defined as the level of agreement between partners on various aspects of their shared lives, including perceived engagement in individual and jointly performed activities. While the level of adjustment made by partners to such activities is thought to contribute to a couple's sense of mutuality, perceptions of time use concerning activity engagement has yet to be considered. As such, this study will determine the level of perceptual congruence between partners with respect to perceived time use in their respective and shared activities. OBJECTIVE: The primary objective of the IP-COUPLES study is to determine the similarities and differences between partners in terms of their perceptual congruence with respect to independent and jointly performed activities. This study will also examine the association between independent and joint activities in terms of perceptual congruence of time use and the strength of this association. METHODS: This descriptive observational study includes 100 couples from Western Switzerland who are recruited using snowball sampling methods. The Life Balance Inventory (LBI), a self-report questionnaire that captures activity configuration congruence, will measure independent and joint perceptions of both time use allocated to daily activities and corresponding satisfaction. Due to COVID-19, the protocol can be administered virtually by the primary investigator. The mean scores of perceptual congruence variables will be used for analysis, namely perceived congruence of time use in terms of independent and jointly performed activities. For the first objective, an independent t test will be used for each variable to compare the mean score between activities on the LBI. For the second objective, the correlations between the mean scores for these activities will be calculated for each variable using the Pearson correlation. RESULTS: The IP-COUPLES study protocol was developed in 2019 and 2020. Enrollment began in June 2020. Data collection will continue until October 2021 to account for time needed for recruitment due to the COVID-19 pandemic crisis. Analysis and presentation of results are expected in 2022. CONCLUSIONS: This study is exploratory, as it is the first to our knowledge to investigate how perceived time-use patterns with respect to independent or jointly performed activities are similar or different among romantic couples. By investigating the interpersonal perception of time-use patterns among couples, the IP-COUPLES study is an important first step to understanding how romantic partners' daily activities are contributing to the level of satisfaction as a partner and as a couple and to the sense of mutuality between partners in a romantic relationship. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21306.

Visiting Out-of-Home Places When Living With Dementia: A Cross-Sectional Observational Study: Visiter des lieux hors du domicile lorsque l'on vit avec une démence: étude transversale observationnelle.

BACKGROUND.: Persons living with dementia face a reduction of their life space outside home and disengagement from participation, linked to places visited. PURPOSE.: This study explored stability and change in perceived participation in places visited outside home and its relationship with occupational gaps among older adults. METHOD.: Older adults living with (n = 35) or without (n = 35) dementia were interviewed using the Participation in ACTivities and Places OUTside Home (ACT-OUT) questionnaire and the Occupational Gaps Questionnaire (OGQ). Data analysis used descriptive and inferential statistics. FINDINGS.: The group of people living with dementia reported significantly fewer places (p < .001) visited than the comparison group and having abandoned more places visited (p < .001) than the comparison group. The number of occupational gaps was significantly different between groups (p < .001). IMPLICATIONS.: Participation outside home is not influenced in a uniform and straightforward way for persons living with dementia; the shrinking world effect appears differently in relation to types of places.

Familiarity and participation outside home for persons living with dementia.

Familiarity is important for persons living with dementia who participate outside home. When familiarity is challenged, such participation may be difficult. This ethnographic study clarifies how familiarity is experienced by persons with dementia in performing activities and visiting places, and how familiarity contributes to maintaining participation outside home. Nine participants were interviewed in their home and while visiting familiar places. Data were content analysed using a constant comparative method. The findings suggest that persons with dementia experience familiarity as continuous and whole, through occurrences that support personal territories. Landmarks and objects enhance the experience of familiarity. Familiarity that is continuously challenged may render participation outside home fragile.

Development of a Questionnaire to Evaluate Out-of-Home Participation for People With Dementia.

OBJECTIVE: We describe the development of a questionnaire, Participation in Activities and Places Outside Home (ACT-OUT), for older adults with cognitive impairment and align it to people with mild- to moderate-stage dementia. METHOD: ACT-OUT was developed in a cross-cultural collaboration in combination with three rounds of cognitive interviews in Switzerland with 26 older adults without cognitive impairment and five older adults with dementia. Qualitative data from the interviews were analyzed using a constant comparison approach. RESULTS: The final ACT-OUT Version 1.0 consists of three parts: (1) questions targeting places older adults visit; (2) questions on aspects influencing participation, such as transportation, familiarity, and risk perception; and (3) questions on perception of self. CONCLUSION: The development of an instrument such as ACT-OUT is more a cyclical than a linear process. This study is a first step toward a more systematic evaluation of out-of-home participation among older adults with and without dementia.

Assistive Technology Addressing Safety Issues in Dementia: A Scoping Review.

Safety is an issue for older adults with dementia because they are at risk for various incidents. Intelligent assistive technology (IAT) may mitigate risks while promoting independence and reducing the impact on the caregiver of supporting a relative with dementia. The aim of this scoping review was to describe IATs and to identify factors to consider when selecting one. A systematic search was performed of the scientific and gray literature published between 2000 and 2015. A total of 31 sources were included. Four types of IATs were identified as addressing safety issues in dementia: monitoring technologies, tracking and tagging technologies, smart homes, and cognitive orthoses. Characteristics of the device and ethical considerations emerged as key factors to consider when selecting one. IATs yield promising results but pose various challenges, such as adapting to the evolution of dementia. Further research on their actual impact is needed.

Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial.

BACKGROUND: Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward. METHODS: A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later. RESULTS: Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items. CONCLUSIONS: ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.

[Home care situations : discontinuity of trajectories]. / Situations de soins à domicile : discontinuité des trajectoires.

Introduction :The aging of the population in Western Europe led to a substantial increase of home-based care services. These services are quite simple in nature, but very complex to provide in the community. Little is known about how they are actually provided.Aim :By the mean of trajectory and arc of work analysis, the aim of this qualitative sociological study is to understand how support and care activities are ran in their local context.Method :Eight home care situations where observed during a period of three months, in three different home-based centers of one French speaking canton of Switzerland. Data collection included semi-structured and ethnographic interviews, service documents, key reference documents and observation of work practices in natural settings.Results :Data analysis showed that the standardization of evaluation practices - and a common frame of reference oriented by administrative principles - limited the possibility to problematize situations as a whole, from a caring point of view. As a consequence, services are mainly delivered in a fractionated way - and work organization is presently driven by compliance concerns.Conclusion :The ongoing standardization of care processes is a challenge to individualized and community-based care.

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review.

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.

[The use of touch with a demented elderly resident: multifaceted evidence]. / Toucher un résident âgé atteint de démence: une évidence aux multiples facettes.

BACKGROUND: The use of touch and simple massage are first-line non-pharmacological interventions used in the comprehensive care for the elderly with dementia (EWD). CONTEXT: These acts have positive effects on both the level of anxiety and self-esteem of EWD. Nevertheless, they are not carried out by all caregivers in the same manner. OBJECTIVES: This study seeks to describe the representations of EWD's caregivers and their perceptions of practice of touch with this population. It will also highlight their ways of coping with any difficulties encountered. METHOD: It is based on a qualitative analysis of 31 semi-structured interviews (17 nurses and 14 health care assistants) conducted with caregivers working primarily with elderly patients with dementia. RESULTS: The results indicate that touch, although well integrated in all activities of personal care, is not considered as a care intervention in itself. It is subject to multiple influences. Indeed, on the one hand, the representations those caregivers have of the elderly patient with dementia overlap with those of their roles and skills and change the type of touch and their intentions when they touch. On the other hand, the emotions generated by the "dirty" work and the aggressiveness of the elderly patient with dementia sometimes make it difficult to touch them. DISCUSSION: The perspective of caregivers is essentially self-referenced and touch does not appear as an indicator of institutional norms.

[Q-sort, a useful research method in care in cases of psychiatric nursing of the aged]. / Le Q-sort, un outil pour la recherche en soins le cas des représentations chez les infirmiers en psychiatrie de l'âge avancé.

Q-sort is a research method which allows defining profiles of attitudes toward a set of statements, ordered in relation to each other. Pertaining to the Q Methodology, the qualitative analysis of the Q-sorts is based on quantitative techniques. This method is of particular interest for research in health professions, a field in which attitudes of patients and professionals are very important. The method is presented in this article, along with an example of application in nursing in old age psychiatry.

Redução da estigmatização e da discriminação das pessoas idosas com transtornos mentais: uma declaração técnica de consenso / Reducing stigma and discrimination against older people with mental disorders: a technical consensus statement

A Organização Mundial da Saúde (OMS) e a Seção de Psiquiatria da Pessoa Idosa da Associação Mundial de Psiquiatria (AMP), em colaboração com um grupo interdisciplinar de representantes das principais associações internacionais e organizações não-governamentais implicadas na saúde mental das pessoas idosas, publicaram três declarações técnicas de consenso sobre a psiquiatria da pessoa idosa (1), a organização dos cuidados em psiquiatria da pessoa idosa (2) e o ensino da psiquiatria da pessoa idosa (3). O Dia Mundial da Saúde 2001, cujo tema foi "Não à exclusão, sim aos cuidados", deu origem a uma nova reunião de consenso sobre o tema da estigmatização e discriminação das pessoas idosas com transtornos mentais. Essa nova reunião foi realizada em Lausanne nos dias 8 e 9 de outubro de 2001 e produziu uma declaração técnica de consenso. O texto inicial foi publicado pela OMS e AMP em inglês. Este artigo apresenta a versão em português desse documento.

This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatization of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatization; and (iii) promoting and suggesting policies, programs and actions to combat this stigmatization.

The changing context of Western European healthcare systems: convergence versus divergence in nursing problematics.

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.

Reducing stigma and discrimination against older people with mental disorders: a technical consensus statement.

This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different Regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatisation of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatisation; and (iii) promoting and suggesting policies, programmes and actions to combat this stigmatisation.