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Slide 1
HOME MODIFICATION DECISION MAKING IN WELL OLDER ADULTS: IMPLICATIONS FOR AN EMERGING PRACTICE AREA
Kathy Subasic, PhD, OTR/L, CAPS
AOTA 2016 Conference
April 8, 2016
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Slide 2
Notes
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Slide 3
Notes
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Method 1
■ Qualitative research design
– Explore a problem or issue in depth
– Address topics in detail by talking directly with individuals in their own environments.
– Participants tell their own stories in a realistic setting
■ (Creswell, 2007)
■ Grounded theory approach
– Researcher focuses on the daily life of individuals and everyday life situations
– Used to study processes and what characterizes a concept
– Symbolic Interactionism
– Result is a substantive theory grounded in the data
■ (Creswell, 2007; Meriam, 2002)
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Slide 5
Method 2
Participants
■ Purposeful Sampling
■ 65+, Community-dwelling, Independent, 12 females, 7 males, (5 couples)
■ Active, Well-educated, Home-owners, Baltimore County
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Slide 6
Method 3
Data Collection■ Interview
– Interview Guide
■ Demographic Questionnaire
■ Observation Template
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Slide 7
Method 4
Data Analysis■ Grounded Theory Techniques
– Strauss & Corbin (1998)
– Charmaz (2006)
■ Transcripts, Field notes, Memos, Demographic Data
■ Open, Axial, & Selective Coding
– Constant Comparative Analysis
– Memos & Diagrams
– Paradigm (Conditions, Interactions & Emotions, Consequences)
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Slide 8
Method 5
Trustworthiness & Quality■ Multiple data sources = Triangulation of data
■ Audit Trail
■ Memos
– analytical, procedural, theoretical
■ Peer debriefing
■ Focus group
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Slide 9
RESULTS
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Slide 10
Core Category Categories SubcategoriesConditions
Kathy Subasic,
PhD, OTR/L, CAPS
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Slide 11
Planning the Future
Weighing the Decision
Stay Go
Modification No
modification
Leaving instead of making
a modification
Waiting for an
event to occur
Information
gathering
Stay but likely to
go in future
Believing little or
no change is
needed
Stay indefinitely
Decision-Making
Process
Kathy Subasic, PhD, OTR/L, CAPS
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Slide 12
Leave house in
less than 5 years
= Go
Leave home in 5
to 10 years
Stay in home as
long as possible
Made Home
Modification 0 2 13
Considering Home
Modification 0 1 2
Did Not Make
Home Modification 2 1 1
Time Planning to be in the Home Compared with Modification Action
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Slide 13
Decision Making:
Stay or Go
Health Status
Connected to Home
FinancesHome Offers
Control
Support Network
Decision Making: Home
Modification
Health Status
Home Environment
Finances
Participation
Existing Knowledge
Temporal Aspects
Weighing the Decision
Knowledge & Awareness
Final DecisionInformation Gathering
Theory of Home
Modification
Decision-making:
Well Older Adults
Kathy Subasic, PhD, OTR/L, CAPS
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Slide 14
Health Status
Getting Older
Physical Ability
Health of Spouse
Adequate Health to
Stay
Connected to Home
Nostalgia
Practical
Comfort
Desire
Home Offers
Control
Freedom
SpacePrivacy
Finances
Cost Effective
ResourcesPaying for Assistance
Support Network
Considering Need for Future
Assistance
Current Available Support
Not Depending on Children
Not Wanting to
Burden Children
Decision Making -
Stay or Go:
Conditions &
Properties
Kathy Subasic, PhD, OTR/L, CAPS
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Slide 15
Health Status
Anticipating Decline
Awareness of Getting
Older
Declining Abilities
Accident or Illness
Concern of Falling
Not Having Full Control
Too Old
Finances
Timing of Modification
Paying for the Work
Weighing the Benefit
Home Resale Implications
Existing Knowledge
Aging Parent
Renovation Experience
Professional Career
Decision Making –
Home Modification:
Conditions & Properties 1
Kathy Subasic, PhD, OTR/L, CAPS
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Slide 16
Home Environment
Home Layout
Home Maintenance
Keeping Active
Aesthetics
Participation
Continued Independence
Make Daily Activities
Easier
Enhanced Safety
Temporal Aspects
Waiting for an Event to
Occur
Anticipating the Future
Timing of the Modification
Decision Making –
Home Modification:
Conditions & Properties 2
Kathy Subasic, PhD, OTR/L, CAPS
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Slide 17
Viewing Home Modification as a Benefit
Modification is a Benefit
Fall risk awareness
Increased efficiency with
houehold activities
Continued independence
Enhance confidence
Enhance safety
Make daily activities
easier
Kathy Subasic, PhD, OTR/L, CAPS
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Slide 18
Conclusions 1■ Participants demonstrated a pattern of taking responsibility for self-managing their
lives.
■ The state of an older adult’s health will influence decision-making
■ Well older adults with an internal locus of control take responsibility for the state of their health.
– Plan for the future
– Often includes making a home modification
– Legitimate need may need to exist – Waiting for the Future
■ Well older adults who are part of the Baby Boomer generation or who were born on the cusp of that generation, may be better educated, more assertive, and more internally driven than the older generation.
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Slide 19
Conclusions 2
The PEO Model may be useful for occupational therapists to use
to facilitate well older adult decision-making concerning aging-in-
place and the use of home modification.
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Slide 20
Implications■ Practice
■ There is a gap in services targeted
toward well older adults who desire
to make home modifications.
– A home modification specialty
team comprised of an
occupational therapist and
contractors who are Certified
Aging-in-Place Specialists can
fill this gap.
– Community-based Education
Programs
■ Decision-making Process
■ Home Modification Process
■ Research
– Similar study with well older
adults with different
characteristics
– Investigate characteristics of
well older adults compared
with home modification
decision-making process
– Perceived role of home
modifications
– Outcomes study of
occupational therapy-based
education program
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Slide 21
Recommendations■ Advanced training & education
■ Widen the scope of occupational therapy home modification services
■ Advocate for well older adults who want to make home modifications to facilitate aging-in-place
■ Include well older adult decision-making content in occupational therapy curricula
■ Understand the roles of other professionals invested in providing aging-in-place services to well older adults
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Slide 22
This presentation was based on the presenter’s dissertation completed in partial fulfillment for the PhD in Occupational Therapy, Occupational Therapy Department, College of Health Care Sciences, Nova Southeastern University, Ft. Lauderdale, FL.
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Slide 23
Acknowledgements: Dissertation Committee Members
■ Rachelle Dorne, Ed.D., OTR/L – Chairperson
■ Cathy Peirce, PhD., OTR/L – Dissertation Committee Member
■ Janet DeLany, D.Ed., OTR/L, FAOTA – Dissertation Committee Member
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Slide 24
References■ Beck, L. E. (1998). Development through the lifespan. Needham Heights: Allyn & Bacon.
■ Carter, S. E., Campbell, E. M., Sanson-Fisher, R. W., Redman, S., & Gillespie, W. J. (1997). Environmental hazards in the homes of older people. Age And Ageing, 26(3), 195-202.
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■ Chippendale, T. L., & Bear-Lehman, J. (2010). Enabling "aging in place" for urban dwelling seniors: An adaptive or remedial approach? Physical & Occupational Therapy in Geriatrics, 28(1), 57-62. doi: 10.3109/02703180903381078
■ Clark, F., Jackson, J., Carlson, M., Chou, C., Cherry, B. J., Jordan-Marsh, M., & ... Azen, S. P. (2012). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 randomised controlled trial. Journal of Epidemiology & Community Health, 66(9), 782-790 9p. doi:10.1136/jech.2009.099754
■ Clark, J. P., Hudak, P. L., Hawker, G. A., Coyte, P. C., Mahomed, N. N., Kreder, H. J., & Wright, J. G. (2004). The moving target: A qualitative study of elderly patients' decision-making regarding total joint replacement surgery. Journal of Bone & Joint Surgery, American Volume, 86(7), 1366-1374.
■ Copolillo, A. E. (2001). Use of mobility devices: the decision-making process of nine African-American older adults. Occupational Therapy Journal of Research, 21(3), 185-200.
■ Creswell, J. W. (2007). Qualitative inquiry and research design (2nd ed.). Thousand Oaks: Sage.
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Slide 25
References
■ Dahlin-Ivanoff, S., Haak, M., Fänge, A., & Iwarsson, S. (2007). The multiple meaning of
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■ Gitlin, L. N., Schemm, R. L., Landsberg, L., & Burgh, D. (1996). Factors predicting assistive device use in the home by older people following rehabilitation. Journal of Aging and Health, 8(4), 554-575.
■ Gladden, J. C. (2000). Information exchange: Critical connections to older adult decision-making during health care transitions. Geriatric Nursing, 21(4), 213-218. doi: 10.1067/mgn.2000.109577
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Slide 26
References■ Haak, M., Fange, A., Iwarsson, S., & Ivanoff, S. D. (2007). Home as a
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■ Haak, M., Ivanoff, S. D., Fange, A., Sixsmith, J., & Iwarsson, S. (2007). Home as the locus and origin for participation: experiences among very old Swedish people. OTJR: Occupation, Participation & Health, 27(3), 95-103.
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Slide 27
References■ Iwarsson, S. (2005). A long-term perspective on person-environment fit and ADL
dependence among older Swedish adults. The Gerontologist, 45(3), 327-336. doi: 10.1093/geront/45.3.327
■ James, B.D., Boyle, P.A., Bennett, J.S., & Bennett, D.A. (2012). The impact of health and financial literacy on decision making in community-based older adults. Gerontology, 58, 531-539.
■ Johansson, K., Lilja, M., Petersson, I., & Borell, L. (2007). Performance of activities of daily living in a sample of applicants for home modification services. Scandinavian Journal of Occupational Therapy, 14(1), 44-53. doi: 10.1080/11038120601094997
■ Kraskowsky, L. H., & Finlayson, M. (2001). Factors affecting older adults' use of adaptive equipment: Review of the literature. American Journal of Occupational Therapy, 55(3), 303-310.
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■ Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9-23.
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Slide 28
References■ Merriam, S. B. (2002). Qualitative research in practice: Examples for discussion and
analysis. San Francisco: Josey-Bass.
■ McNulty, M. C., Johnson, J., Poole, J. L., & Winkle, M. (2003). Using the Transtheoretical Model of change to implement home safety modifications with community-dwelling older adults: an exploratory study. Physical & Occupational Therapy in Geriatrics, 21(4), 53-66.
■ Moser, A., Houtepen, R., van der Bruggen, H., Spreeuwenberg, C., & Widdershoven, G. (2009). Autonomous decision making and moral capacities. Nursing Ethics, 16(2), 203-218. doi: 10.1177/0969733008100080
■ Naik, A. D., & Gill, T. M. (2005). Underutilization of environmental adaptations for bathing in community-living older persons. Journal Of The American Geriatrics Society, 53(9), 1497-1503. doi: 10.1111/j.1532-5415.2005.53458.x
■ Newton, R. A. (2006). Prevention of falls at home: Home hazard and safety assessment and management. Annals of Long Term Care, 14(11), 28-33.
■ Oswald, F., Jopp, D., Rott, C., & Wahl, H.-W. (2011). Is aging in place a resource for or risk to life satisfaction? Gerontologist, 51(2), 238-250. doi: 10.1093/geront/gnq096
■ Oswald, F., Wahl, H.-W., Schilling, O., Nygren, C., Fange, A., Sixsmith, A., . . . Iwarsson, S. (2007). Relationships between housing and healthy aging in very old age. Gerontologist, 47(1), 96-107.
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Slide 29
References■ Perez, F. R., Fernandez-Mayoralas, G., Rivera, F. E. P., & Abuin, J. M. R.
(2001). Ageing in place: Predictors of the residential satisfaction of elderly. Social Indicators Research, 54(2), 173-208.
■ Petersson, I., Kottorp, A., Bergstrom, J., & Lilja, M. (2009). Longitudinal changes in everyday life after home modifications for people aging with disabilities. Scandinavian Journal of Occupational Therapy, 16(2), 78-87. doi: 10.1080/11038120802409747
■ Scott, A. H., Butin, D. N., Tewfik, D., Burkhardt, A., Mandel, D., & Nelson, L. (2001). Occupational therapy as a means to wellness with the elderly. Physical and Occupational Therapy in Geriatrics, 18(4), 3-22.
■ Scott, T. L., Gazmararian, J. A., Williams, M. V., & Baker, D. W. (2002). Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care, 40(5), 395-404.
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Slide 30
References■ Sheffield, C., Smith, C. A., & Becker, M. (2013). Evaluation of an agency-based occupational
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■ Stark, S. (2004). Removing environmental barriers in the homes of older adults with disabilities improves occupational performance. OTJR: Occupation, Participation & Health, 24(1), 32-39.
■ Stark, S., Landsbaum, A., Palmer, J. L., Somerville, E. K., & Morris, J. C. (2009). Client-centred home modifications improve daily activity performance of older adults. Canadian Journal of Occupational Therapy, 76, 235-245.
■ Stav, W. B., Hallenen, T., Lane, J., & Arbesman, M. (2012). Systematic review of occupational engagement and health outcomes among community-dwelling older adults. American Journal of Occupational Therapy, 66(3), 301-310 10p. doi:10.5014/ajot.2012.003707
■ Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff, B., Agree, E., & ... Gitlin, L. N. (2011). Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. Journal of The American Geriatrics Society, 59(12), 2314-2320 7p. doi:10.1111/j.1532-5415.2011.03698.x
■ Tse, T. (2005). The environment and falls prevention: Do environmental modifications make a difference? Australian Occupational Therapy Journal, 52(4), 271-281. doi: 10.1111/j.1440-1630.2005.00525.x
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Slide 31
References
■ Wagnild, G. (2001). Growing Old at Home. Journal of Housing for the Elderly, 14(1/2), 71-84.
■ Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165(17), 1946-1952.
■ Yuen, H. K., & Carter, R. E. (2006). A predictive model for the intention to implement home modifications: a pilot study. Journal of Applied Gerontology, 25(1), 3-16.
■ Zamora, H., & Clingerman, E. M. (2011). Health literacy among older adults: A systematic literature review. Journal of Gerontological Nursing, 37(10), 41-51. doi: 10.3928/00989134-20110503-02
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Slide 32
Nothing great is ever achieved without much enduring
Saint Catherine of Sienna
Thank you!
Questions
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