Rationale: A 'patient-oriented' research paradigm, also known as patient and public engagement, has infiltrated the field of health sciences and continues to spread. At first blush, it is difficult to reprove anything labelled 'patient-oriented'; however, the patient-oriented paradigm may easily become an ideological 'good', leading to unintended consequences that may well prove more detrimental than beneficial.While patient-oriented research has its roots in more radical forms of patient and public engagement, its recent instantiation betrays its roots and forecloses on more radical forms of engagement, such as critical participatory research.Aim and Objectives: The objective of this article is to deconstruct the patientoriented research narrative and to demonstrate how such a discourse imposes itself as a dominant approach in health sciences.Approach: Following Derrida's deconstructive approach, we bring to light the unexamined presuppositions, false pretences, and presumed 'goodness' and 'naturalness' of patient-oriented discourse.Discussion: By deconstructing the patient-oriented narrative we demonstrate how pre-existing power structures (biomedical, economic, etc.) shape the conduct of the approach and serve to depoliticize the truly participatory aspects of research. Rather than being modelled on the evidence-based movement or seen as its natural 'evolution', patient-oriented research should resist by affirming itself as a radical form that is both participatory and emancipatory.
BackgroundParticipation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers.MethodsA qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods.ResultsAged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility.ConclusionsThis study highlights the complexity of older adults’ participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults’ health and well-being. Discrepancies in the various actors’ perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.
Introduction: To promote active and healthy ageing, it is important to foster social participation. Although well positioned to do so, few community occupational therapists intervene to address social participation, and no review of promising and current practices is available. This study synthesised knowledge on community occupational therapy practices fostering older adults' social participation. Method: A scoping review involved searches in eight databases using 49 keywords. Studies were selected by two reviewers and content-analysed following PRISMA guidelines. Results: Of the 32 selected studies, most involved descriptive (n ¼ 11; 34%), randomised controlled trial (n ¼ 9; 28%) or quasiexperimental (n ¼ 7; 22%) designs, and were conducted mainly in the USA (n ¼ 8; 25%), Canada (n ¼ 6; 19%) and Sweden (n ¼ 6; 19%). Twenty promising practices combined multi-component interventions (n ¼ 11; 55%), or involved group (n ¼ 5; 25%) or individual (n ¼ 4; 20%) sessions. Promising practices improved participation in social activities (n ¼ 13; 65%), social interactions (n ¼ 6; 30%), self-rated health (n ¼ 6; 30%) and quality of life (n ¼ 6; 30%), and reduced health-care costs (n ¼ 4; 20%). Facing organisational and systemic barriers, current practices rarely incorporated these possibilities. Conclusion: Efforts to foster older adults' social participation appear to be cost-effective but need to be further incorporated into practice. Research should engage community stakeholders in implementing these possibilities.
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