The objective of this instrumental case study was to explore interrelationships among routine activity situations on 2 Alzheimer's special care units (SCUs) and 2 resident quality-of-life (QoL) indicators: daily time use and emotional well-being. Fourteen residents participated. We collected data across four 12-hr days using computer-assisted direct observations and computed associations of activity situations with QoL indicators and mean durations of QoL indicators in activity situations and daily by facility. We compared mean durations of QoL indicators across facilities and analyzed time-use profiles of 2 residents. We found that participants' capacities for activity engagement and emotional vitality were infrequently expressed at both SCUs. Diminished QoL was attributable to participants' dementia-related impairments coupled with insufficient attention to their occupational needs, initiatives, and capacities. Findings call for occupational therapists' involvement as educators, mentors, and consultants to enhance the effectiveness of routine activity situations in promoting QoL through everyday occupations.
Strategies identified by participants were more relational than procedural in nature, indicating the need for occupational therapists working with care partner dyads to consider historical routines, social connectedness, and needs of the care partnership in addition to functional abilities of the care recipient when addressing community mobility.
PWA were able to provide information about their current and preferred involvement in life activities through use of the LIV Cards. Family members did not predict activity choices and desires of PWA with full accuracy. The LIV Cards appear to be a viable tool for setting goals and discussing life priorities of PWA.
Shifting definitions of health and well-being, prompted by the World Health Organization's International Classification of Functioning (2001), have stimulated changes in traditional clinician-client relationships in rehabilitation. Among these changes, in keeping with the concept of client-centered care, is a trend toward more collaborative goal-setting and joint determination of intervention plans. Evidence suggests that supporting clients' autonomy in prioritizing personally meaningful goals leads to increased engagement in intervention, less emotional anxiety about the rehabilitation process, and improved treatment outcomes. Supporting people with aphasia in a process of collaborative goal formulation may also serve to alter treatment priorities so that they address more relevant communication challenges embedded in post-rehabilitation life.
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