Exploring the Influence of a Daily Activities on the Quality of Life of Institutionalized Adults with Dementia

Statement of Purpose. In occupational science, the link between occupational engagement and quality of life (QoL) has been proposed (Carlson, Clark & Young, 1998). Many adults with dementia residing in an institutional home may experience occupational deprivation (Wilcock, 1998). While some studies have examined activities that residents with dementia engage in and their states of well- being as associated with QoL (Chung, 2004; Wood et al., 2009), the implementation of meaningful occupations and supportive environments has been neither consistently nor strongly associated with QoL outcomes. The purpose of this study was to explore the influence of daily activities on the QoL of residents with dementia, with particular attention to one activity, an equine-assisted intervention (EAI). Design. A mixed methods case study design. Participants. Six adults met these inclusion criteria: 1) diagnosed with mild-moderate stage dementia, 2) LTC resident at facility for four weeks or longer prior to the study, 3) not allergic to horses, 4) English-speaking, and 5) interest in or past experience with horses. Five key informants met these inclusion criteria: 1) administrator or caregiver from LTC or equine facility, and 2) English-speaking. Descriptions of Methods: Behavioral observational data were collected of the residents during activities using the Activity in Context and Time (Wood, 2005) and an instantaneous sampling strategy for eight weeks leading to 3,555 observations. Semi-structured interviews with key informants were gathered to obtain the informant’s perceptions of the resident’s daily lives and influence of environmental elements with QoL. The quantitative analysis of the behavioral observations consisted of descriptive statistics; the qualitative analysis of key informant interviews used a basic qualitative description approach. Report of Results. Quantitative findings indicated that residents demonstrated the most complex occupational engagement and highest levels of pleasure and conversation during EAI; these outcomes were infrequently expressed during other activities. Qualitative findings described interrelationships among person and environment characteristics that either supported or hindered QoL. Syntheses of findings illuminate EAI as the only activity that was associated with all optimal QoL indicators, indicative of a good fit, or a match between the resident’s adaptive behavior, affect and the environment. Implications. This study highlights qualities of EAI for facilitating occupationally enlivening experiences; optimistic caregiving culture, occupational needs of the person, and direct contact with nature. Further, findings indicate that the quality and consistency of presented opportunities tailored to residents’ preferences and past experiences are of paramount concern for supporting QoL. Lastly, findings draw attention to creating opportunities to enrich activities in which occupational deprivation prevails. Discussion Questions: How does understanding of occupational science benefit institutionalized people with dementia that may have limited occupational opportunities? How might we better identify and address the conditions that contribute to occupational deprivation for institutionalized people with dementia? Can a rigorous framework for a hierarchy of occupational transactions be developed for specific activities such as an equine-assisted intervention? Key Words: 1) Equine-assisted intervention 2) Environmental press 3) Activity situatio