Therapeutic aspects of engagement in occupations : In the context of day care for older people and patients in palliative care

Sammanfattning: The overall aim of this thesis was to identify and describe therapeutic aspects of engagement in occupations in day-care programs designed for older people with chronic conditions or patients in palliative care. The thesis includes four studies. In Study I the aim of the study was to conduct a phenomenological investigation of elderly persons positive experiences of spending time in a community-based activity center and of being engaged in occupations (n=9). This study was based on qualitative interviews analyzed using the Empirical Phenomenological Psychological Method (EPP). Study II aimed to identify characteristics of the elderly people living in their own homes and participating in social day centers compared with the participants of a rehabilitative day center, emphasizing on perceived functioning and competence in daily life. Twelve social day center participants and 12 rehabilitative day center participants answered two questionnaires; the sickness impact profile (SIP) and the occupational self-assessment (OSA). In Study III the aim was to investigate how people with incurable cancer engage in and undertake activities in their everyday lives. The study was based on qualitative interviews (n=47) with the data analysis conducted concurrently with the data collection according to the techniques of grounded theory. Study IV aimed to study the outcomes of palliative day-care, in terms of health-related quality of life, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30), and emotional well-being, using the Mood Adjective List (MACL), of cancer patients participating in a palliative day-care program (n=23) for 5 weeks, compared with a group of palliative cancer patients (n=12) not participating in day-care. The findings in Study I describe the phenomenon of the experience of being occupied and spending time at a community-based activity centre as a safe and familiar setting to attend on a regular basis; doing was absorbing and gave pleasure; it was a challenge to be able to accomplish something; and the activity center was a meeting-place where doing is shared with others. In Study II the results show that the majority of participants from both the social activity centers and the rehabilitative day center were elderly persons living alone who experienced severely restricted physical function. A significant difference between the groups was that those who attended the social day center perceived better psychosocial function than the group attending the rehabilitative center. Study III shows how the participants, despite experiencing the threat of progressive loss of functioning, strove to remain involved in everyday life and how a driving force for continued involvement in everyday life was created. The possibility of doing was crucial in this process. In Study IV the participants in the day care group and the comparison group reported similar levels of perceived functioning and symptoms, as measured by the EORTC QLQ-30, with no significant differences between the groups. However, the daycare group reported higher levels of emotional well-being as measured by the MACL than the comparison group reported, however these differences were not statistically significant. In conclusion, the thesis describes what therapeutic engagement in occupations can be and also the conditions for therapeutic engagement in occupations in the context of day-care programs. The studies also indicate that well-being could be influenced through engagement in occupations although no improvements are made with respect to the medical condition.