| 1. |
- Iwarsson, Susanne, et al.
(författare)
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ADL dependence in the elderly population living in the community: the influence of functional limitations and physical environmental demand
- 1998
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Ingår i: Occupational Therapy International. - : Wiley. - 1557-0703 .- 0966-7903. ; 5:3, s. 173-193
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Tidskriftsartikel (refereegranskat)abstract
- Empirical research elucidating the relationships between aspects of functional competence and environmental factors is lacking. This study aimed to analyse how functional limitations in the individual and housing accessibility problems influence ADL dependence in the elderly population, and to test Lawton's docility hypothesis. Data were collected from 133 Swedish subjects aged 75–84, who were living in the community. The main finding was that dependence in ADL correlated highly significantly with housing accessibility problems. The results also revealed significantly more ADL disability in the group of respondents in whom the heaviest environmental demands were identified, supporting the docility hypothesis. Although the study had limitations because the data required the use of non-parametric statistics, so restricting possible interpretations of the effects of geriatric comorbidity, the results indicated that interventions such as housing adaptations ought to be most effective with frail individuals. To promote independence in the general population, society has to work towards more accessible housing. More research is needed considering more environmental dimensions and elderly people's subjective apprehension of their housing environment.
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| 2. |
- Iwarsson, Susanne, et al.
(författare)
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Development of a novel instrument for occupational therapy assessment of the physical environment in the home - A methodologic study on “The Enabler”.
- 1996
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Ingår i: Occupational Therapy Journal of Research. - : SAGE Publications. - 0276-1599. ; 16:4, s. 227-244
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Tidskriftsartikel (refereegranskat)abstract
- Occupational therapy assessment of the physical environment in the home in relation to the functional capacity of an individual is essential prior to environmental adaptations to reduce handicap. Standardized methods for research and clinical use are in great demand. To introduce and develop a new instrument for occupational therapy assessment, the novel ideogram “The Enabler” was translated into Swedish and revised. It was first tested in practice by occupational therapists in primary health care. After further revisions of “The Enabler” and pre-teaching of raters, each of 30 individuals in their home environments was assessed by two independent raters. Reliability was evaluated using the kappa statistic. After only a few lessons in advance, the raters were able to administer the assessment in practice in a reliable way, agreement between raters was very good to good, k̄ = 0.68–0.87. The Swedish revised version of “The Enabler” is a useful tool for occupational therapy home evaluation and research.
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| 3. |
- Iwarsson, Susanne
(författare)
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Environmental influences on the cumulative structure of instrumental ADL: an example in osteoporosis patients in a Swedish rural district
- 1998
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 1477-0873 .- 0269-2155. ; 12:3, s. 221-227
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The ADL Staircase is a hierarchical instrument for the assessment of dependence/independence in personal and instrumental activities of daily living (P-ADL and I-ADL). Previous results indicated that environmental factors might affect assessment results, and revisions for use in rural areas have been tested with a gerontological population sample. OBJECTIVE: To investigate further the cumulative structure of I-ADL in osteoporosis patients in a Swedish rural district. METHOD: Patients were interviewed consecutively concerning their pre-injury dependence in P-ADL and I-ADL, using a revised version of the ADL Staircase (n = 276). RESULTS: In contrast to results from urban areas, 'transportation' was the activity generating the most dependence among the respondents. In addition, different gender-specific cumulative orders among I-ADL were demonstrated. Guttman's scaling analysis confirmed the cumulativity of the revised scale (C of R = 0.94/0.97, C of S = 0.77/0.88). CONCLUSION: Environmental factors influence the validity of instruments as well as the prevalence of disability.
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| 4. |
- Iwarsson, Susanne, et al.
(författare)
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Housing standards, environmental barriers in the home, and subjective general apprehension of housing situation among the rural elderly.
- 1996
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1651-2014 .- 1103-8128. ; 3:2, s. 52-61
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe housing standards, physical environmental barriers in the homes and housing accessibility in relation to elderly people’s subjective general apprehension of their housing situation. By means of a novel instrument for home assessments, the Enabler, a rural population sample of individuals aged 75-84 years was surveyed. The results demonstrated that the respondents lived in houses with high housing standards. However, in every home assessed, physical environmental barriers were found. The environmental barrier that was predicted to cause the heaviest environmental demand of all, in relation to the prevalence of functional limitations and dependence on assistive devices for mobility in the sample investigated, was “Lack of handrails at WChath-tubkhower”. The respondents’ subjective general apprehension of their housing was very positive, and not correlated to housing accessibility. In conclusion, inaccessible housing represents a potential public health problem, since it threatens the activity level of older persons. However, other aspects of housing seem to be more important to the elderly people themselves. Housing accessibility problems are currently overlooked but are important to future public planning concerning housing for the elderly
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| 5. |
- Iwarsson, Susanne, et al.
(författare)
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Occupation and survival: a 25-year follow-up study of an aging population
- 1998
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Ingår i: American Journal of Occupational Therapy. - 0272-9490. ; 52:1, s. 65-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In this retrospective study of an elderly population cohort living in a defined Swedish rural area, the relationship between occupation and survival as a measure of objective health was investigated. The cohort has been followed for 25 years. METHOD: On the basis of the baseline socioeconomic interview from assessments performed when the participants were 67 years of age, an index of active participation in daily occupation was devised. The index was used to investigate the covariation between generic everyday occupation and long-time survival. RESULTS: For the female participants, Kaplan-Meier curves demonstrated differences in survival between the "less active" and "more active," and Cox regression survival analyses resulted in a significant covariance between occupation and survival. For the male participants, no such differences were found. CONCLUSION: The significant results for the women implied support for the core assumption of occupational therapy that a relationship exists between occupation and health. The lack of differences in survival among more active and less active men demonstrates the complexity of studying occupation.
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| 6. |
- Iwarsson, Susanne, et al.
(författare)
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Occupation: Construct validity and empirical testing of predicting factors in an aging population.
- 1999
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Ingår i: Occupational Therapy International. - : Wiley. - 1557-0703 .- 0966-7903. ; 6:2, s. 77-89
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Tidskriftsartikel (refereegranskat)abstract
- The models and theories of occupational therapy and occupational science to a great extent lack empirical support. We need an increased understanding of the construct of occupation and its predicting factors. The objectives of this study were to explore the construct of occupation in an ageing population, and to test the construct's relationships with underlying performance components and environmental influences. Applying a post hoc design to a comprehensive data set from a general population cohort, the Latent Variable Path Analysis with Partial Least Squares estimation procedure (LVPLS) was used for reiterative modelling, using a hypothesized model founded in the rehabilitation context as the starting point. A household and work-related occupation variable was verified, and an acceptable model established. The results indicate that the construct of occupation can be explored with the LVPLS method, but the construct is complex and can only partly be subjected to empirical testing with a quantitative approach. The results demonstrate the feasibility of establishing a model based on general population data, maintaining the main structures of a model founded in the rehabilitation context. Empirical studies of the factors predicting occupation are valuable in order to develop and strengthen our theoretical models and taxonomies.
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| 7. |
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| 8. |
- Iwarsson, Susanne, et al.
(författare)
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Quality of life in the elderly population: an example exploring interrelationships among subjective well-being, ADL dependence, and housing accessibility.
- 1997
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Ingår i: Archives of Gerontology and Geriatrics. - 1872-6976. ; 26:1, s. 71-83
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Tidskriftsartikel (refereegranskat)abstract
- During recent decades, research on quality of life has gained increasing interest. In gerontology, the assessment of objective as well as subjective dimensions is recommendable, and the most innovative research will involve the study of the interrelationships of several components. In empirical research objective environmental factors have rarely been explored. The aim of this study was to explore the interrelationships among subjective well-being, dependence in activities of daily living (ADL), and objective housing accessibility in the elderly population in ordinary housing. A random sample of 133 subjects aged 75-84 was multi-dimensionally assessed. The Gothenburg Quality of Life Instrument, a revised version of the ADL Staircase and the Enabler were administered at home-visits. Most of the subjects rated their general well-being as high. One-third were independent in ADL, and 1/5 did not have any objective housing accessibility problems. Different aspects of physical well-being covaried significantly with ADL dependence, but even more strongly with objective housing accessibility. Theoretically, the results relate to the Lawton model of ;The Good Life'. In conclusion, inaccessible housing represents a potential health problem, since it threatens the independence and subjective well-being of elderly people. The results presented in this study provided increased knowledge of importance for geriatric rehabilitation and society planning to meet the needs of senior citizens.
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| 9. |
- Iwarsson, Susanne, et al.
(författare)
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Staff and administration perspectives in a one-year geriatric rehabilitation developmental process
- 1999
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Ingår i: Scandinavian Journal of Caring Sciences. - 1471-6712. ; 13:4, s. 240-246
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Tidskriftsartikel (refereegranskat)abstract
- A health care reform for senior citizens took effect in 1992 in Sweden. Shortcomings as regards geriatric rehabilitation were identified and, in 1995, governmental grants were assigned to local developmental projects. The aim of this study was to report the staff and administration perspectives in a geriatric rehabilitation developmental process over a 1-year period. In all, 782 staff and 45 administration respondents took part. The investigation was based on questionnaires and series of interviews. Significant positive changes with respect to collaboration between the authorities involved were demonstrated at the administrative level, while the most positive results at staff level concerned competence development in the group of employees without college education. A positive process as regards geriatric rehabilitation has started in the study district, indicating that governmental grants assigned for the stimulation of developmental activities are beneficial. Official goals for geriatric rehabilitation, points of departure for the organization of rehabilitation services and the content of general and specialized rehabilitation programmes are pinpointed as some of the areas deserving further attention.
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| 10. |
- Iwarsson, Susanne
(författare)
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The Housing Enabler: An objective tool for assessing accessibility.
- 1999
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Ingår i: British Journal of Occupational Therapy. - 1477-6006. ; 62:11, s. 491-497
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes an instrument - the Housing Enabler - used in the assessment of housing accessibility. The tool was developed from the original Enabler idea by Steinfeld et al (1979), resulting in an instrument for reliable assessment of the accessibility of the housing environment and the immediate outdoor environment in terms of occupational therapy. Apart from a description of the instrument itself, this paper presents theoretical bases, studies completed, and current and future considerations of importance for occupational therapy practice and research. The outcome of a Housing Enabler assessment makes the concept of accessibility concrete and allows for individual as well as group analyses. In conclusion, the Housing Enabler is a useful and reliable instrument for research, practice and education. It offers a wide range of applications and is well suited for the current development of community-based occupational therapy.
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