Charting recovery pathways in Sweden: The role of time, gender and meaningful activities.

Engagement in Meaningful Activities Among Residents with Dementia in Assisted Living

BackgroundEngagement in meaningful activity is beneficial for residents with dementia and is associated with improved quality of life. Meaningful activity refers to activities that provide meaning and value to the person and are tailored to individualized interests and preferences. The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. Specifically, it was hypothesized that function, pain, and behavioral symptoms would be associated with engagement in meaningful activity after controlling for residents’ age, gender, comorbidities, and cognition.MethodThis study included baseline data collected from the randomized controlled trial, Meaningful Activities for Managing Behavioral Symptoms of Distress (MAC‐4‐BSD). Assisted living residents were eligible if they were ≥55 years old, live in a participating setting, and screen positive for dementia based on the Saint Louis University Mental Status exam (SLUMS) and AD8 Dementia Screening Interview. Residents were excluded if they were enrolled in hospice, admitted for short term respite, or had a significant neurological condition not related to ADRD. Residents’ engagement in meaningful activity was evaluated based on the Engagement in Meaningful Activities Survey (EMAS). Stepwise linear regression was used to examine resident factors associated with engagement in meaningful activity.ResultA total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b = ‐2.1, p = .03). There were no associations between function and behavioral symptoms with engagement in meaningful activity (p>.05) and the model explained 6.1% of the variance in engagement in meaningful activity.ConclusionFindings from this study offer insights into residents’ engagement in meaningful activity in assisted living. Ongoing research is needed to consider the impact of the physical and social environment and other possible factors that may also be associated with meaningful activity.

Engaging in meaningful activities has been seen as an important way to sustain the well-being of older adults with disabilities and to achieve person-centered care. Yet, it is still unclear whether and to what extent meaningful activity engagement promotes well-being for community-dwelling older adults with disabilities, and how the environmental factors could affect these relationships. This study aims to investigate the relationship between meaningful activity engagement and psychological well-being, and to explore the moderated role of environmental factors (physical, attitudinal, service/support, policy). Survey data conducted in Taiwan between April and July of 2018 were analyzed by using multiple regression (N=1,244). Three types of meaningful activities (instrumental, social, and leisure) were identified based on a self-rated activity meaningfulness measure. Findings showed that higher levels of engagement in three types of meaningful activities were associated with better quality of life (QOL), but only engaging in meaningful leisure was associated with less depressive symptoms while adjusting functional status. Perceived better policy-related environment (e.g., long-term care services) could reinforce the positive effects of three types of meaningful activity engagement on QOL and depressive symptoms. Findings also indicated perceived attitudinal environment moderated the association between meaningful leisure activity engagement and QOL. These results established the influences of meaningful activity engagement on the well-being of community-dwelling older adults with disabilities and highlight the importance of age-friendly environment in supporting meaningful activity engagement and older adults’ well-being.

Objectives The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents’ age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living. Method This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity. Results A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= −2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity. Conclusion Findings from this study show that pain is a significant factor that is negatively associated with residents’ engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.

Background: Ventricular assist device (VAD) implantation requires adoption of complex self-management routines, including device monitoring, dressing changes, assessing for complications, and responding to acute events. While these lifestyle changes significantly alter daily life, little is known about how VAD recipients adapt to these changes and sustain participation in valued roles and routines post-VAD implantation. Research Question: How do adult VAD recipients continue to engage in meaningful activities after implantation? Methods: A qualitative descriptive study was conducted among 12 adult VAD recipients from an outpatient clinic in the Southeastern U.S. Participants completed a semi-structured interview discussing changes in their ability to engage in meaningful activities after implantation. Thematic analysis identified key themes and subthemes. Results: Participants (n=12; ages 39–76 years; 42% rural) were predominantly male (67%), with half identifying as non-Hispanic Black (50%). Two themes emerged reflecting the dual impact of VAD implantation: (1) VAD support enables patients to reengage in meaningful activities, relationships, and roles; and (2) Patients must identify and avoid activities that pose a threat to their safety and well-being. Participants described a renewed ability to engage in light hobbies and household tasks after implantation, largely due to improved physical functioning, symptom relief, and extended survival. These improvements also allowed some to reclaim disrupted family and community roles. However, these benefits came with the need for increased planning and caution to avoid potentially hazardous situations. This involved modifying or giving up physically demanding, water-based, or spontaneous activities, as well as aspects of certain self-care and social activities, due to safety concerns and physical limitations. Changes also affected their self-expression and identity, with challenges with their clothing, intimacy, and independence. Despite these limitations, many expressed gratitude for the life-sustaining benefits of the VAD. Conclusions: These findings offer guidance for clinicians to help patients anticipate both increased engagement in certain meaningful activities and the need for lifestyle changes to ensure safety. Additional research is needed to identify predictors of continued engagement in meaningful activities post-VAD and long-term effects on psychological and device-related outcomes.

We aimed to evaluate the short-term effects of community-based occupational therapy on health-related quality of life and engagement in meaningful activities among women with breast cancer. An open label randomized controlled trial study design was applied. The participants were members of various societies of women with cancer. In total, 22 women have participated in the study. Participants of the experimental group (n = 11) participated in a 6-week community-based occupational therapy program and the usual activities of various societies, whereas the control group (n = 11) women participated in the usual activities of the societies only. 1 of the participants withdrew during the course; therefore 21 completed the study successfully. Participants of both groups were assessed for health-related quality of life and the participants of the experimental group were assessed for engagement in meaningful activities. The evaluation was carried out during the nonacute period of the disease—at the beginning of the study and after 6 weeks. Women of the experimental group demonstrated statistically significantly better scores in the global quality of life, role functions, physical, emotional, cognitive, and social functions, fatigue, insomnia, financial impact, systemic therapy side effects, and breast symptoms scales compared to the control group participants (p < 0.05) after the 6 weeks, as measured by the EORTC QLQ-C30 questionnaire and its breast cancer module QLQ-BR23. Furthermore, women of the experimental group demonstrated significant greater engagement in meaningful activities when applying community-based occupational therapy (p < 0.05), as measured by using the Engagement in Meaningful Activities Survey (EMAS). The evaluation of the associations between the women's engagement in meaningful activities and changes in health-related quality of life showed that greater engagement in meaningful activities was associated with better emotional functions and a lower level of insomnia (p < 0.05). Based on the results of our study, we recommend applying occupational therapy in the field of community healthcare in order to maintain or improve breast cancer patients' health-related quality of life and suggest involving women into meaningful activities during community-based occupational therapy after clarifying which activities are important to them.

A key assumption of occupational therapy is that engagement in meaningful activities is fundamental to one's health and well-being. Preliminary findings suggest a link between childhood adversity and engagement in meaningful activity. Childhood adversity is also linked to attachment insecurity in adulthood, and both represent barriers to health and well-being. It is unknown whether attachment insecurity is associated with meaningful activity engagement or how attachment insecurity influences the relationship between childhood adversity and meaningful activity engagement. To investigate the association between attachment insecurity and meaningful activity engagement and the role of attachment insecurity in the relationship between childhood adversity and engagement in meaningful activities in adulthood. Cross-sectional online survey. Community. Community-dwelling adults ages 18 yr or older, healthy, and able to understand standard English to complete the questionnaires. Participants were recruited through snowball sampling. Participants answered demographic questions and completed three questionnaires: the Engagement in Meaningful Activities Survey, Risky Families Questionnaire, and Experiences in Close Relationships-Short Form. Participants (N = 329) completed at least two of the three surveys, with most (n = 312) completing all three. More insecurely attached participants reported less engagement in meaningful activities. Both attachment avoidance and attachment anxiety mediated the relationship between childhood adversity and meaningful activity engagement. The findings offer support for interrelations among childhood adversity, attachment insecurity, and engagement in meaningful activity. Further research is required to support the application of these findings in clinical settings. Plain-Language Summary: To our knowledge, this is the first study to establish a connection between attachment insecurity in adults and lower levels of engagement in meaningful activities during adulthood. The findings highlight the heightened vulnerability of adults who have a history of childhood adversity. The findings also emphasize the significance of (1) considering clients' childhood adversity and attachment patterns when assessing for and providing occupational therapy services and (2) advocating for the inclusion of trauma-informed practices for those with lower levels of meaningful occupational engagement.

BackgroundApathy, or reduction in goal directed behaviors, is common in assisted living (AL) residents with dementia. Meaningful activity, defined as participation in activities that are enjoyable, tailored to the individual’s interests and abilities, related to a personally relevant goal, engaging, and related to an aspect of an individual’s identity, may be a promising strategy for reducing apathy in AL residents with dementia. However, there is a dearth of evidence examining the relationship between engagement in meaningful activity and apathy among AL residents with dementia. The purpose of this study is to determine the relationship between engagement in meaningful activity and apathy among AL residents with dementia. We hypothesized that AL residents who have apathy would have lower levels of engagement in meaningful activity than those residents without apathy.MethodThis study was a secondary data analysis using baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC‐4‐BSD) of 71 residents from 5 AL communities in Maryland. Apathy was measured using the apathy subscale of the Neuropsychiatric Inventory Questionnaire (NPI‐Q). Meaningful activity was measured from the resident using the Engagement in Meaningful Activities Survey (EMAS). Descriptive statistics including means or frequencies were conducted to describe the sample. A one‐tailed independent samples t‐test was conducted to test the hypothesis.ResultParticipants were on average 85.39 (s.d. = 8.20) years old, with moderate to severe dementia (Saint Louis University Mental Status exam score average m = 6.76, s.d. = 6.06). The majority were female (n = 52) and White (n = 62). They had an average length of stay of 1.84 years (s.d. = 1.67) and 8.24 (s.d. = 2.62) comorbidities. Overall, 41% (n = 29) of the participants had apathy. The mean EMAS score was significantly lower (37.52, s.d. = 10.54) among those with apathy than among those without apathy (41.63, s.d. = 9.62) (t = 1.69, p&lt;.05).ConclusionIndividuals living with dementia in AL with apathy tend to spend less time engaged in meaningful activities. Interventions are needed to test if increasing engagement in activities that are considered meaningful by the resident can help reduce apathy in this population and thereby improve quality of life.

Each day, more than 10 Canadians die by suicide. Each suicide leaves entire communities to manage the traumatic aftermath of this loss. Individuals bereaved by suicide loss are at a higher risk of experiencing negative mental health outcomes. Current research suggests that engagement in meaningful activities may be an avenue to protecting mental health. It is important to understand if this is also the case for those experiencing bereavement post suicide loss. To date, there has not been a synthesis of the literature examining suicide loss and the nature and extent of engagement in meaningful activities post loss. 1) To describe the nature and extent of the peer-reviewed suicide loss and bereavement literature related to engagement in meaningful activities; and 2) to identify facilitators and barriers that may impact engagement in meaningful activities post loss. This paper describes a scoping review protocol that will be completed using stages identified by Arksey and O'Malley and updated by Levac and colleagues. Joanna Briggs Institute framework will also guide this review. Four electronic databases will be searched for suicide bereavement/loss concepts. Two reviewers will apply inclusion and exclusion criteria to identify articles discussing engagement in meaningful activities of everyday living post loss. Data will be descriptively summarized and analyzed using inductive content analysis. Results will be reported following PRISMA Extension for Scoping Reviews. A descriptive summary and conceptual map describing the current state of the peer-reviewed literature will be constructed. Experiencing a suicide loss increases the risk of negative mental health outcomes. A synthesis of literature is required to map the current available evidence related to suicide bereavement and engagement in meaningful activities, with potential implications for improving supports and services for those bereaved. This protocol is register with Open Science Framework Registries (10.17605/OSF.IO/M2NES).

An Expansive View of the Relationship Between Meaningful Activities and Health: A Call to Action.

Dementia is a progressive and neurodegenerative condition that leads to a gradual deterioration of the individual's functional capacity and social relations. Engaging in meaningful activities is considered an effective approach to maintaining and increasing the well-being of people living with dementia. Digital media has the potential to improve the quality of life for people living with dementia, allowing them to engage in activities that are personally meaningful. This study sought to understand the needs and preferences people with early-stage dementia living in Portugal have for receiving information on meaningful activities. It also explored their relationship with technologies and digital media. Focus groups and interviews were carried out with people living with dementia (n = 21), informal carers (n = 9) and healthcare professionals (n = 8). Descriptive statistics were used for sample characterization and the verbatim transcriptions of interviews and focus groups were subjected to inductive thematic analysis. We developed three main themes: (i) engagement of people living with dementia in meaningful activities; (ii) experiences of people living with dementia with technology and digital resources; and (iii) the importance of a support network. This last theme is associated with the first two. The study identified several meaningful activities, such as household chores and intellectual hobbies, some of which were mediated by technology. People living with dementia reported to primarily use digital media, particularly computers and smartphones, for socialization and entertainment. The barriers identified for technology use and engagement in meaningful activities were both related to mobility problems and cognitive complaints. The support network emerged as essential for the use of digital technologies and engagement in meaningful activities. This study highlights a need to further research and design digital media that offer the opportunity for people living with dementia to be informed and engaged in meaningful activities.

Introduction There is little research around recovery pathways and how they cluster together by individual and situational factors according to time in recovery. Method This paper uses a cluster analysis with data from the European Life in Recovery (LiR) survey to produce typologies of recovery pathways around stages of recovery: early (<1 year), sustained (1-5 years), and stable (>5 years). A secondary aim was to explore evidence of national variations among clusters. Results Cluster analysis identified five typologies of persons in recovery, broadly reflecting the three stages. ‘Early Recovery’ participants had the highest barriers and lowest strengths in recovery and were most likely to reside in Spain, Portugal and Poland. ‘Sustained with residual barriers’ participants were characterized by high strengths in active addiction but most barriers in recovery and mainly resided in the Netherlands and Belgium. ‘Stable With Lower Recovery Support’ reported higher barriers and lowest strengths in active addiction and were mainly from the Balkan countries. ‘Stable With Higher Recovery Support’ participants experienced the most barriers in active addiction but also the most strengths in recovery and were largely from the UK. ‘Mixed With Fewer Barriers’ showed the least barriers in recovery and the highest strengths in active addiction and were also mainly from the UK. Implications Structural and cultural factors (possibly including location) are essential in recovery journeys and that, while all recovery journeys are unique, are several clusters of characteristics can be identified as broadly consistent with the Betty Ford Institute stages approach of early, sustained and stable recovery.

BackgroundBelonging is closely associated with well-being, yet individuals with experiences of being unhoused are likely to experience social exclusion and challenges with developing a sense of belonging. Engagement in meaningful activity has been linked to belonging; however, there are no focused studies exploring experiences of how engaging in meaningful activities influences belonging. Meaningful activities are things we do that bring value to our lives.PurposeTo explore how engaging in meaningful activities may influence experiences of belonging following homelessness through a secondary analysis of qualitative interviews.MethodUsing interviews conducted in a community-based participatory action study exploring the transition to housing following homelessness (n = 19), we conducted a thematic analysis using the method described by Braun and Clarke. Participants were recruited through communication with local organizations supporting individuals with lived and living experiences of being unhoused as well as through presentations at drop-in organizations. An intentional effort was made to recruit diverse participants regarding housing status, age, and gender. Inductive analysis was used to conduct initial coding, focusing on belonging and engaging in meaningful activities. We then analyzed the codes abductively, using Bourdieu’s Social Capital Theory to inform this analysis.FindingsThe overarching essence generated in our analysis was: “I don’t feel like I belong…everything in the world is not for me…it’s for people with…enough money to…enjoy those things”. Within this overall essence, we generated three themes: 1) Human connection: “being where I am with people who care about me, I actually feel good”; 2) Social exclusion: being a “regular member of society”; and 3) Non-human connection: “my cats…are like my kids to me.” Participants described numerous contextual factors that challenged them as they sought belonging following homelessness, including financial limitations and other societal factors.ConclusionOur findings suggest that meaningful activity was an important pathway to belonging for participants in this study.

The challenges of simultaneously experiencing depressive disorders and autism spectrum conditions pose a significant threat to the well-being of young adult women. Previous research reports indicate that engagement in meaningful activities, specifically analysed in occupational therapy, can not only increase the effectiveness of the activities performed, but also have a positive impact on overall life satisfaction and mental health. The purpose of this study was to demonstrate the relationship between the severity of autistic traits, involvement in meaningful activities and depression in women. The following tools were used in the study: Short Autism Spectrum Quotient Test (AQ-10), Engagement in Meaningful Activities Scale (EMAS) and Beck Depression Inventory (BDI). The study involved 237 women aged 18 to 35 years (M = 21.1; SD = 1.93), who were divided into two subgroups based on AQ-10 indicators. The results revealed a linear relationship between the severity of autistic traits and involvement in meaningful activities and depressive symptoms. Additionally, a correlation was found between engagement in meaningful activities and depression. It was also identified that the intensification of autistic traits significantly differentiated the level of engagement in meaningful activities but did not differentiate the level of depression.

Engagement in meaningful activity is beneficial for assisted living (AL) residents with dementia and may help to reduce behavioral symptoms and improve quality of life. The purpose of this study was to test the feasibility and preliminary efficacy of a theory-based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD), for decreasing behavioral symptoms and increasing engagement in meaningful activity. It was hypothesized that residents exposed to MAC-4-BSD will demonstrate reduced behavioral symptoms, increased meaningful activity engagement and quality of life at 4 months compared to those exposed to education only. Using a cluster randomized controlled trial with repeated measures design, this study included 71 residents with dementia from 5 communities. Residents were evaluated at baseline and 4 months. Descriptive statistics were used to describe the sample and evaluate feasibility. Linear mixed models were used to determine effectiveness. Most participants were female (n=52, 73%), and White (n=62, 87%) with a mean age of 85 years (SD=8.2). The MAC-4-BSD intervention was feasible to implement with regard to delivery, receipt, and enactment. Preliminary effectiveness was demonstrated based on increased engagement in meaningful activity (b=7.69, p=.005), improved quality of life (b=3.74, p=.03), and decreased staff distress related to residents’ behavioral symptoms (b=-1.83, p=.037) among those exposed to MAC-4-BSD versus the control group. There was no change in the severity or number of behavioral symptoms. These findings demonstrate that engagement in meaningful activity is a promising approach that can be used to help improve the quality of life for AL residents with dementia.