What is the impact of dementia on occupational competence, occupational participation and occupational identity for people who experience onset of symptoms while in paid employment? A scoping review

Abstract

Background/aim Engagement in meaningful occupation, including paid work is considered an important determinant of health, impacted by injury or illness. Dementia is one neurodegenerative syndrome with potential to compromise capacity for remaining engaged in paid employment. In response to ‘ageing’ populations globally, policy shifts within developed economies are increasing workforce participation for those over 45 years and eligibility ages for retirement pensions. Dementia onset is not limited to ‘older age’, consequently an increased impact of dementia is likely for both older workers and those experiencing younger onset dementia. Therefore, identifying and addressing workforce participation issues confronting people with dementia is becoming increasingly important for occupational therapy practice. Method This scoping review draws on peer reviewed literature to explore the impact of dementia on workers across the three domains of occupational engagement: occupational competence; occupational participation; and occupational identity using the Model of Human Occupation (MOHO). International studies published in English including full‐text translations between 2000 and 2017 were identified from an incremental search of electronic databases (Web of Science; Scopus; Proquest; MEDLINE; CINAHL; and Health Business Elite) and hand searched reference lists. Results Six relevant papers were identified and retained for analysis, all reporting qualitative studies. Data were collated under the three domains of occupational engagement and further organised into emergent subcategories. While evidence was limited, person‐centred approaches addressing dementia‐related changes in occupational competence; workforce participation choices; and redefinition of occupational identity may mitigate negative experiences associated with transitioning from paid worker roles. Conclusion There is a significant need for further research exploring the impact of dementia on engagement in paid work. Occupational therapists have an important part to play in enabling access to person‐centred interventions that promote continued engagement in meaningful occupational roles, including opportunities to extend workforce participation and engage in supported transitions to retirement.

Dementia in the workplace: implications for career development practice

“…The extant research on the workplace experiences of people living with dementia in the UK highlights the potential for continued employment post-diagnosis (although it may not be suitable for all people living with dementia) and the national legal and international human rights imperative to support employees living with dementia (Egdell et al, 2018;Ritchie et al, 2018). For many, the symptoms of dementia are often (initially) noticed in the workplace, for instance, as a person slower in completing tasks (Andrew et al, 2019;Chaplin & Davidson, 2016;Evans, 2019;Ohman et al, 2001;Ritchie et al, 2015;Ritchie et al, 2018;Williams et al, 2018). Symptoms that have a detrimental effect on employee performance might not be attributed to a pathological cause such as dementia and an individual can be perceived as a "poor worker" (Andrew et al, 2019;Evans, 2019;Ohman et al, 2001;Ritchie et al, 2018).…”

“…For many, the symptoms of dementia are often (initially) noticed in the workplace, for instance, as a person slower in completing tasks (Andrew et al, 2019;Chaplin & Davidson, 2016;Evans, 2019;Ohman et al, 2001;Ritchie et al, 2015;Ritchie et al, 2018;Williams et al, 2018). Symptoms that have a detrimental effect on employee performance might not be attributed to a pathological cause such as dementia and an individual can be perceived as a "poor worker" (Andrew et al, 2019;Evans, 2019;Ohman et al, 2001;Ritchie et al, 2018). International evidence (Australia, Sweden, UK, USA) suggests that employers may not have the awareness that dementia is a workplace issue, policies to support employees living with dementia may be lacking, and adjustments that could facilitate the continued employment of the individual might not be put in place (Andrew et al, 2019;Chaplin & Davidson, 2016;Cox & Pardasani, 2013;Egdell et al, 2021;Ritchie et al, 2018;Williams et al, 2018).…”

“…Symptoms that have a detrimental effect on employee performance might not be attributed to a pathological cause such as dementia and an individual can be perceived as a "poor worker" (Andrew et al, 2019;Evans, 2019;Ohman et al, 2001;Ritchie et al, 2018). International evidence (Australia, Sweden, UK, USA) suggests that employers may not have the awareness that dementia is a workplace issue, policies to support employees living with dementia may be lacking, and adjustments that could facilitate the continued employment of the individual might not be put in place (Andrew et al, 2019;Chaplin & Davidson, 2016;Cox & Pardasani, 2013;Egdell et al, 2021;Ritchie et al, 2018;Williams et al, 2018). The consequences of this lack of support results in a workplace exit for many employees living with dementia.…”

“…The consequences of this lack of support results in a workplace exit for many employees living with dementia. Individuals may either be forced to leave work when they disclose their diagnosis of dementia to their employer or will have left work before diagnosis because of increasing stress and deteriorating performance (Andrew et al, 2019;Chaplin & Davidson, 2016;Ritchie et al, 2018). This unplanned and/or sudden loss of a job has detrimental social, emotional and financial effects for the individual and their family (Harris & Keady, 2009;Ohman et al, 2001;Ritchie et al, 2018;Roach et al, 2016;Roach & Drummond, 2014).…”

“…Indeed UK law, as well as international human rights standards, require that people living with dementia are afforded the right to employment on an equal basis with others and are supported through reasonable accommodations/adjustments (Egdell et al, 2018). However, research from a number of different national contexts (Australia, Sweden, UK, United States of America (USA)), highlights that the continued labour market participation of people living with dementia, facilitated by reasonable adjustments or redeployment, may not be considered and as such, employers may fail to meet their legal and human rights obligations (Andrew et al, 2019;Chaplin & Davidson, 2016;Egdell et al, 2021;Ritchie et al, 2018;Williams et al, 2018). Many individuals leave the workplace before, or on receipt of, a diagnosis of dementia.…”