Occupation

Abstracts Thursday 30th June 2016
interest in major trauma, in particular complex musculoskeletal
injuries, as well as being passionate about the OT profession.
Session 42
The lifestyle matters study – results from an
randomised controlled trial
Mountain G, Chatters R, The University of Sheffield
Background: The Well Elderly studies, undertaken in the US,
were concerned with the efficacy of a health promoting
intervention (Lifestyle Redesign) which aimed to maintain
or improve quality of life through an occupational approach
towards maintenance of wellbeing in later life [1, 2]. In the UK
we developed and tested an intervention inspired by Lifestyle
Redesign (Lifestyle Matters) within a randomised controlled
trial (RCT). The primary aim was to identify the clinical and cost
effectiveness of Lifestyle Matters.
Methods: 288 participants aged 65 years or over and living
independently in Sheffield or North Wales were recruited to the
two-arm (usual care and intervention) RCT. The intervention
involved weekly facilitated sessions over 4 months at a local
venue. The primary outcome measure was SF-36 Mental Health
(MH) dimension at 6 months post randomisation. Secondary
outcomes included EQ-5D and other dimensions of the SF-36.
A cost effectiveness analysis was undertaken of the incremental
cost per Quality Adjusted Life Years (QALYs) of the intervention
compared with usual care. Economic and clinical effectiveness
was estimated via intention to treat (ITT) analyses and measured
via questionnaires at baseline, 6 and 24 months. Qualitative
interviews with participants were undertaken at 6 and 24
months.
Results/Conclusion: 262 subjects were included in the ITT
analysis. The mean difference in SF-36 MH scores at 6-months
were 2.3 points (95 CI -1.3 to 5.9 P=0.209). No statistically
significant differences were observed for the primary outcome
or any of the secondary outcomes at 6 months. The mean
difference in QALY was 0.036, with no statistical differences
between the two groups.
We found no evidence of population benefit as measured by
the selected outcome measures. However the qualitative aspect
of the research highlighted the significant benefits derived by
some participants. Recruitment of participants was a particularly
challenging aspect of the research.
References
[1] Clark, F, Azen, SP, Zemke, R, Jackson, J, Carlson, M, Mandel,
D, Hay, J, Josephson, K, Cherry, B, Hessel, C, Palmer, J, Lipson, L.
1997. Occupational therapy for independent-living older adults:
a randomised controlled trial. Journal of the American Medical
Association. 278(16), 1321–26
[2] Clark, F, Jackson, J, Carlson, M, Chou, CP, Cherry, BJ,
Jordan-Marsh, M, Knight, BG, Mandel, D, Blanchard, J, Granger,
DA, Wilcox, RR, Lai, MY, White, B, Hay, J, Lam, C, Marterella,
A, Azen, SP. 2012. Effectiveness of a lifestyle intervention in
promoting the well-being of independently living older people:
results of the Well Elderly 2 Randomised Controlled Trial. J
Epidemiol Community Health.66(9), 782–90
Keywords
Older people, Research, Innovative practice, Inter-agency
Contact E-mail Addresses
r.chatters@sheffield.ac.uk
Author Biographies
Gail is Professor of Health Services Research (assisted living
research) within the Rehabilitation and Assistive Technologies
Group and member of the CLAHRC YH Telehealth and Care
Technologies (TaCT) theme and Frail and Elderly theme. She
also has an honorary chair in Occupational Therapy research
at Sheffield Hallam University, is Research Associate in the
Lab4living design and health collaboration (wwwlab4living.
org) and is also visiting Professor at the University of Ulster. Gail
worked as an occupational therapist for over 13 years before
commencing a research career at the University of Leeds.
Robin Chatters is a Clinical Trials Study Manager at the School
of Health and Related Research, The University of Sheffield, UK.
He has been involved in the design, set-up and management of
a number of studies involving older adults, including the Lifestyle
Matters Study, a randomised controlled trial to determine the
benefit of an occupational therapy based programme for people
aged 65 years and older, and SAFER 2 (Support and Assessment
for Fall Emergency Referrals), a study looking to improve the
care paramedics provide to older adults or call 999 for a fall. His
research interests include clinical trial design and methodology.
Thursday 30th June 2016
Session 45.1
Cultural safety for Australian Aboriginal people with
dementia
Simpson T, Curtin University
Just 3% of Australia’s population identify as Aboriginal
(Australian Bureau of Statistics 2012) but the rate of dementia
within this group is up to five times that of the non-Aboriginal
population (Radford et al. 2015). Aboriginal people are likely
to have experienced discrimination, segregation and forced
separations as a result of government policies and social
attitudes during their lifetimes.
Cultural safety is more than cultural awareness and sensitivity.
It is about explicitly acknowledging the lived experience of the
person (Nguyen 2008). When working with and caring for
people with dementia it is essential to have an understanding
of the person’s history and background in order to provide
appropriate interventions and avoid reactionary behaviour.
Gathering this information can be difficult when there is a
significant difference between the culture and lived experience
of the health professional and that of the person with dementia
and their family.
The Western Australia Dementia Training Study Centre
(WADTSC) has created a training program for health
professionals working with Aboriginal people with dementia.
This includes a specifically designed documentation record which
facilitates the use of yarning” or narrative assessment which
is conducive to the Aboriginal way of doing things (Bessarab
2012). The person with dementia and their family can work
with the health professional to develop a record of the person’s
story including the effects of political policy, historical and
social events which will have shaped their experiences and may
therefore impact on their experience with dementia. The freeflowing
document enables all parties to contribute to the record
which includes relating the individual’s life story to a timeline of
seminal events and policies in recent Australian history.
Lessons from this project can be developed for use with other
cultural groups particularly those who have experienced
traumatic events such as recent migrants to Europe.
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