Title

A challenging exploration of the occupational experiences of an elderly person with dementia

1

Location

Pre-function area and Great Room 1B

Start Time

19-10-2017 7:00 PM

End Time

19-10-2017 9:00 PM

Session Type

Poster

Abstract

Statement of Purpose: In Occupational Science, there are limited studies addressing the occupational experiences of people with difficulty communicating because of cognitive impairment.

This study’s aim was to explore the occupational experiences of a person with dementia through a story constructed using their daily life.

Method: Participants included nine elderly residents and care staff at a Long-Term Care Facility for dementia patients in Japan but focused on just one resident, an elderly woman in her 80’s with severe Vascular Dementia and impaired communication skills - although capable of talking by repeating familiar words while smiling and using hand gestures.

Data collection occurred 40-times (about 150 hours) via fieldwork at that facility over 2 years by 2 researchers, including a medical anthropologist. Facility records, staff and family interviews were triangulated with field notes, which included actions, verbal/non-verbal interactions, and settings.

Data analysis of field notes used narrative methodology (Josephsson and Alsaker, 2014) and narrative-in-action (Alsker, Josephsson, & Dickie, 2013) to identify significant occupational events and plots, focusing on sequence of actions, interactions and verbal/non-verbal expressions.

Researchers and staff conducted debriefing meetings with researchers interpreting the data using a back-and-forth analytical process in consideration of similar occupational settings, cultural perspectives and personal life history.

Results: From the data, three plots were constructed; (a) comfort response when treated like a child, (b) caring for and warming to weaker residents and staff by connecting to her past life, (c) straining to follow the lead of less-affected residents.

Discussion/implications: The “narrative-in-action” concept explains how narrative meaning occurs in and through occupation (Alsker et al., 2013). Limitations in understanding the occupational experiences of the participant existed because of single verbal/non-verbal expressions. However, three plots could be constructed through sequences of those expressions and interactions. Additionally, all plots were constructed based on her agency, which she used to engage in her occupations of caring of others and finding pleasure in connecting to others, suggesting that the response of others toward her expressions might shape her method of constructing plots tied to the transformation of her occupational experiences.

Contribution to OS: This study suggests that using narrative analysis and narrative-in-action concepts - observation of verbal/non-verbal expressions including cultural perspectives and life histories - may expand the possibility of constructing a story that interprets the occupational experiences of people with dementia. Furthermore, this narrative approach can explain the transformative processes of daily occupations.

Key words: dementia; older adults, occupational experience

References

Alsker, S., Josephsson, S., & Dickie, A. V. (2013). Exploring the transactional quality of everyday occupations through narrative-in-action: meaning-making among women living with chronic conditions. In M.P. Cutchin & V. A. Dickie (Eds.), Transactional perspectives on occupation (pp.65-77). Springer, USA: New York. doi: 10.1007/978-94-007-4429-5

Josephsson, S. & Alsaker, S. (2014). Narrative methodology. In S. Nayar & M. Stanley (Eds.). Qualitative research methodologies for occupational science and therapy (pp.70-83). Routledge, UK: London.

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Oct 19th, 7:00 PM Oct 19th, 9:00 PM

A challenging exploration of the occupational experiences of an elderly person with dementia

Pre-function area and Great Room 1B

Statement of Purpose: In Occupational Science, there are limited studies addressing the occupational experiences of people with difficulty communicating because of cognitive impairment.

This study’s aim was to explore the occupational experiences of a person with dementia through a story constructed using their daily life.

Method: Participants included nine elderly residents and care staff at a Long-Term Care Facility for dementia patients in Japan but focused on just one resident, an elderly woman in her 80’s with severe Vascular Dementia and impaired communication skills - although capable of talking by repeating familiar words while smiling and using hand gestures.

Data collection occurred 40-times (about 150 hours) via fieldwork at that facility over 2 years by 2 researchers, including a medical anthropologist. Facility records, staff and family interviews were triangulated with field notes, which included actions, verbal/non-verbal interactions, and settings.

Data analysis of field notes used narrative methodology (Josephsson and Alsaker, 2014) and narrative-in-action (Alsker, Josephsson, & Dickie, 2013) to identify significant occupational events and plots, focusing on sequence of actions, interactions and verbal/non-verbal expressions.

Researchers and staff conducted debriefing meetings with researchers interpreting the data using a back-and-forth analytical process in consideration of similar occupational settings, cultural perspectives and personal life history.

Results: From the data, three plots were constructed; (a) comfort response when treated like a child, (b) caring for and warming to weaker residents and staff by connecting to her past life, (c) straining to follow the lead of less-affected residents.

Discussion/implications: The “narrative-in-action” concept explains how narrative meaning occurs in and through occupation (Alsker et al., 2013). Limitations in understanding the occupational experiences of the participant existed because of single verbal/non-verbal expressions. However, three plots could be constructed through sequences of those expressions and interactions. Additionally, all plots were constructed based on her agency, which she used to engage in her occupations of caring of others and finding pleasure in connecting to others, suggesting that the response of others toward her expressions might shape her method of constructing plots tied to the transformation of her occupational experiences.

Contribution to OS: This study suggests that using narrative analysis and narrative-in-action concepts - observation of verbal/non-verbal expressions including cultural perspectives and life histories - may expand the possibility of constructing a story that interprets the occupational experiences of people with dementia. Furthermore, this narrative approach can explain the transformative processes of daily occupations.

Key words: dementia; older adults, occupational experience