Balancing struggles with desired results in everyday activities: strategies for elderly persons with physical disabilities

Abstract

The number of elderly persons with disabilities needing support with everyday activities increasing in Japan and around the world. Yet, engagement in everyday activities can support the quality of their daily life. Despite research focusing on reported meanings of people's actions, there is still limited knowledge on how engagement in everyday activity is enacted along with the meanings of persons' actions. The aim of the present study was to identify meanings of persons' actions within everyday activities of elderly Japanese with physical disabilities. Five elderly persons with physical disabilities living in the community participated in this study. Data were gathered by 10 participant observations of everyday activities supplemented with 13 unstructured interviews. Narrative analysis was used to identify meanings of persons' actions. The analysis identified an overall plot termed 'balancing struggles with desired results'. This plot illustrated that participants' and other involved individuals balanced problematic situations with finding situations that accommodated their needs. Meanings of these actions were further identified as three complementary strategies. Two of three strategies aimed to mitigate given problems, one by 'acting on a plan to achieve one's goals', the other by 'taking a step in a preferred direction by capitalising on emerging opportunities'. The third strategy focused on avoiding undesirable experiences by 'modifying problematic situations'. In conclusion, these findings call for care and rehabilitation providers' sensitivity to shifting foci of what matters in daily life's situations as well as aligning with persons' skills, resources and perspectives. Accordingly, the judicious and flexible use of these complementary strategies can enhance elderly persons' quality of daily living through everyday activities.

Cocreation from Emerging Opportunities: Occupational Therapists’ Perspectives on Supporting Older Persons, in Japan

“…Accordingly, this theme resonates the notion that finding meaning in occupations of daily living is important to health [29,30]. Nevertheless, these interpretations of the findings lend further support to the notion that participating in occupations can afford experiences of health, irrespective of older persons' capabilities to perform occupations or their status after incurring a disabling illness or injury [31]. Occupational Therapy International…”

“…Rather, occupational needs and preferences can change or emerge according to clients' evolving situations. An earlier study among elderly persons with physical impairments similarly concluded a judicious use of different approaches and warned against goals and treatment plans set in stone [ 31 ]. From a narrative perspective, this is in line with Josephsson and colleagues who argue that engaging in occupations creates situations for creatively exploring possibilities and meaning making [ 33 ].…”

“…Instead, occupational therapists should be open minded to twists and turns. As well, they should be open minded to the possibility that needs or preferences, goals, and plans emerge and wane with their own beginning and ends [ 31 , 35 ], some intentional and other by chance [ 35 ].…”

“…Third, pursuing long-term goals might run the risk of putting clients' health on hold until achieved. Instead, health can be promoted by drawing on powers of occupation, even when older persons are still recovering from disabling illness or injury [ 31 ].…”

Participation in Everyday Life Before and After a Housing Adaptation

“…Thus, as their health declined, additional HA or other interventions in the home were necessary to maintain their ability to perform and engage, particularly outside the home. Several studies have highlighted accessible home environments as an issue of social justice in recognizing each person's right to participate in everyday life with meaning and dignity (Bontje, Asaba, & Josephsson, 2016;Gibson et al, 2012;Sixsmith et al, 2014).…”