Positive Ageing in Residential Care
O'Sullivan, Grace, Hocking, Clare, New Zealand Journal of Occupational Therapy
Evidence shows that participation in occupations promoting physical activity, social stimulation and a sense of identity, slow age related decline and enhance functional capacity. Drawing on that knowledge and experiences in practice, the authors propose that given purposeful occupations older people in residential care homes could live each day with a sense of dignity and satisfaction. Instead, many people in care experience a level of occupational deprivation that undermines personal health and well-being. This situation is described as neglect. It can arise from social attitudes, inadequate funding and inappropriate systems of care. This is contrary to current New Zealand government policy on positive ageing.
Health, well-being, older people, dementia, neglect
O'Sullivan, G. & Hocking, C. Positive ageing in residential care. New Zealand Journal of Occupational Therapy, 53 (1), 17-23
Visions "begin in the minds eye, they begin with imagination and the belief that what's merely an image can one day be made real" (Kouzes & Posner, 1997, p. 93). Visions are ideas or concepts. This article presents a vision, for frail older people and those with dementia who live in residential care homes and private hospitals in New Zealand, and the service providers whose job it is to care for them. It is grounded in experiences of working in residential care settings for older people and given urgency by recent discussion of occupational deprivation (Townsend & Wilcock, 2004). The essence of the vision presented here is that, like other members of society, residents of rest homes and those receiving private hospital care have the right to engage in a range of occupations which sustain well-being and provide a sense of satisfaction, regardless of age or impairment. The vision is underpinned by the belief that participation in valued occupations enables older people to achieve the best possible level of functioning, while maintaining their existing skills and abilities. At the heart of this vision is the belief that optimum functioning is achieved by having something to do and, what is more, that "life is given meaning by what we do" (Fine & Kirkland, cited in Minor, 1997, p. 364). Can the vision become reality?
This article raises the ethical issues of attitudinal, environmental, social and healthcare barriers which limit occupational choice for older people who live in a residential home. Understanding occupational deprivation as something not done, that could have been done, is in line with current definitions of child abuse that encompass caregivers doing something or allowing something to occur that puts a child at risk (Peterson, Kohrt, Shadoin, & Authier, 1995). Bourke (2005) alleges "elder abuse or neglect is the term used when older people experience harmful physical, psychological ... and social effects as a result of the behaviour of another person with whom they have a trusting relationship" (p. 103). Neglect by omission is a largely unrecognized, and often unintentional, form of abuse. However, lack of intent does not render neglect any less abusive.
To support this viewpoint, findings linking activity and health are outlined, and attitudes and practical strategies that could enable people who live in residential care homes to engage in occupations of their choice are identified. The argument is based on research which shows being physically active is associated with improved length and quality of life, as well as playing an important role in maintaining older people's health and ability to function effectively (Loland, 2004). Although evidence regarding the importance of activity in health maintenance is accumulating, this approach to care appears to be largely unexplored in residential homes in New Zealand.
Instead of encouraging participation in the everyday occupations that older people normally engage in, in the authors' experience, many New Zealanders cling to the attitude that older people are being cared for when things are done for them. …