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Continuity of identity through meaningful occupation : the experience of older adults living in long-term care facilities Caron, Staci

Abstract

Disability often accompanies aging due to multiple impairments commonly experienced by older adults. Many older people admitted to Long-Term Care (LTC) facilities experience loneliness, helplessness, and boredom, which often lead to depression (Thomas, 1996). Yerxa (1998) explored the relationship between health and the human spirit for occupation, where occupation was considered the self-initiated, self-directed, productive daily activity that provides individuals with a sense of identity and purpose in life, which, in turn, contributes to their health. Through qualitative research, this study aimed to contribute to the understanding of meaningful occupational engagement for older adults living in LTC facilities. A narrative approach using in-depth semi-structured interviews was used to explore the meaning of occupation for nine residential care facility residents, specifically through their current and past occupations and related perceptions of health, aging, and the LTC facility environment. Continuity theory and the emergent discipline of occupational science provided a conceptual approach to this research. Findings of the study showed that the meaning of occupation was shaped within the context of participants' experience of living in a LTC facility, including their perceived losses, functional constraints, and afforded opportunities. Four themes of meaningful occupation emerged from the data; 1) reliance: maintaining a sense of independence within a supportive environment, 2) relationships: maintaining and fostering social relationships, 3) rewards: doing things that have purpose and contribute personally and socially, and 4) reflection: reflecting on life's experiences, accomplishments, and regrets. These themes were closely linked to an additional theme concerning the preservation and expression self-identity. Participants' chose to occupy themselves with activities that provided continuity with previous occupations, defining their sense of self. Rehabilitation therapists and other professionals who work with elderly residents are called to be innovative and flexible in designing programs and carrying out daily care activities within LTC facilities, in a manner that enables continuity for each resident and is tailored to fit with his or her sense of self. Study findings have implications for occupational therapy practice and social planning for the aging population. Understanding the meaning that occupations have for older adults, and how engagement in them reflects a continuity of identity involves an appreciation of their "life contexts". Environments that provide opportunity for choice and self-determination can enable older adults to maintain necessary connections between their past, present, and future, engage in meaningful occupations, and in turn, foster healthy expressions of themselves as capable and worthy.

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