Occupational participation through community mobility among older men and women

Sammanfattning: The overall aim of the present thesis was to explore and characterise occupational participation and community mobility from an occupational perspective of health and well-being, and to elucidate potential barriers and facilitators for occupational participation and community mobility in older men and women.In Study I, questionnaires were sent to a sample of older citizens (75+) in three Swedish mid-sized municipalities. This survey focused on actual and preferred travel opportunities and was returned by 957 persons (response rate 46%). Although older people appreciated the existing travel opportunities, there was evidence of restricted community mobility for some sub-groups of older people, due to various perceived barriers. More efforts must be put into accessibility improvements including usability from the perspective of older people.In Study II nine focus group interviews with a total of 42 participants (20 men) were conducted, focusing on older peoples’ motives for, and experiences of, community mobility and occupational participation outside the home. The main category “Continuing mobility and occupational participation outside the home in old age is an act of negotiation” summarised the findings. This main category was abstracted from the generic categories “Occupational means and goals”, “Occupational and mobility adaptation” and “Occupational barriers and facilitators”, and their subcategories. Community mobility was identified as an important occupation that in itself also facilitated occupational participation outside the home. Individual community mobility seemed to be influenced by, for example, age and gender, as well as habits acquired over time. Furthermore, community mobility was negatively affected not only by physical barriers, but also by social and attitudinal barriers in the public environment.Study III identified and described older people’s viewpoints on community mobility and occupational participation in older age through a Q-methodology study conducted with 36 participants, including men and women, both drivers and non-drivers. Three viewpoints were found and assigned content-descriptive denominations; viz.: “Prefer being mobile by car”, “Prefer being mobile by public transport” and “Prefer flexible mobility”. Unfortunately, the existing demand-responsive Special Transportation Systems was not considered an attractive enough alternative by any of the participants. Thus, intermediate community mobility options are needed for those who no longer can drive or use public transport. InStudy IV factors associated with community mobility, and decreased community mobility over time, for older men and women were described. Data were based on the Gender study “Aging in men and women: a longitudinal study of gender differences in health behaviour and health among elderly” and collected through surveys in 1994 and 2007. The base-line sample consisted of 605 twin-pairs, i.e., 1,210 individuals, aged 69-88, and the follow-up of 357 individuals (165 men and 192 women), aged 83-97. This surveycovered health and health-related issues including community mobility and occupational participation. Continuing community mobility was cross-sectionally (at follow-up) and prospectively (from baseline to follow-up) associated with better self-reported subjective health rather than self-reported health conditions for both men and women. For men, community mobility was also cross-sectionally associated with few or non-existant depressive symptoms, while reduced community mobility was prospectively associated with higher age for women. Consequently, interventions aiming to enable community mobility must move beyond interventions directed towards health conditions and instead target subjective health and well-being.