Engaging and achieving in later life: the importance of, and determinants affecting occupational participation with older adults, following discharge from hospital.

Ageing has been identified as a critical area of global health concern due to the projected numbers of people living longer. With increased age there is a likelihood of physical and cognitive decline, which in turn can lead to decreased participation of daily activities. Decline in participation for older adults has been identified as leading to compromised physical and mental health (including social isolation and depression) and can create an increased demand on health services. Participation (within one’s personal context and environment) in daily activities and occupations (all the things that people do in a day) is important for humans and perpetuates physical and psychological health and wellbeing. A stay in hospital for older adults following a significant health event can negatively impact their level of participation and can perpetuate a decline in their health status (physical or mental). Health professionals aim to support and increase return to participation in previous activities or occupations through rehabilitation programmes yet little is known about the determinants of participation and how the psychological approach of volition (the thinking process to elicit action) can be considered and enhanced in this recovery. Volition includes three concepts of i) personal causation – self-belief that one can achieve the activity, ii) values – being engaged in activities that are important to the person’s beliefs and values, and iii) interests – in the activities with a sense of enjoyment and satisfaction. There is a paucity of evidence that profiles participation of older adults living in the community, the impact of hospital on participation levels once discharged, the impact of volition on participation, and the enablers of, and barriers to, participation in activities or occupations following a stay in hospital. This thesis addressed the question of how participation in daily activities (occupational participation) was impacted following hospitalisation and explored why this occurs. A series of five studies were completed including a systematic review with meta-analysis to explore the impact of falls prevention interventions on participation amongst older adults (a high risk area for ageing adults), two cross-sectional studies to identify the determinants of participation and the associations between participation and volition, examination of psychometric properties for the newly developed Volition Scale, and a qualitative study to identity enablers of, and barriers to, participation following hospitalisation amongst older adults. The findings suggest that health professionals need to consider the psychosocial aspects of older adults when planning interventions to increase participation after a stay in hospital. These include screening for depressive symptoms and level of volition, awareness of falls history (incorporating fear of falling again), and identification and development of their personal life approach (optimistic or pessimistic), to optimise occupational participation following hospitalisation with an aim of increasing long-term health and wellbeing.