Occupational engagement among older people is important to investigate as older people are the fastest growing segment in our society, and because occupational engagement is viewed within occupational therapy as one of the basic premises for health. Three perspectives of engagement are highlighted in this thesis: evaluation of occupational engagement, the repertoire of occupational engagement, and finally, the relation between occupational engagement and life satisfaction. The overall aim of this thesis was to study aspects of occupational engagement among older people, with a special focus on evaluation of the experiences of an occupation-based group programme, evaluation of leisure, the leisure repertoire, and the relation between occupational engagement and life satisfaction. The thesis is comprised of four studies which all contribute in different ways to an increasing understanding of occupational engagement among older people. In the first study (Study I), three older persons participated in a group activity programme and were interviewed about their experiences of occupational engagement. The qualitative interviews were done with each participant after each group session, in total 15 interviews. The other three studies (Studies II-IV) were based on a subgroup of a population studied in a cross-sectional population-based study, the Umeå 85+ study. Very old people with an MMSE score of 20 or more were included in Studies II, III, and IV (n=156). During home visits, they were interviewed about their occupational engagement (ADL and leisure) and their life satisfaction. The qualitative interviews analysed using a Grounded theory approach, revealed two different dimensions of experiences while engaged in a group programme. The participants described experiences of activation, with a creative force and a place for learning, but also experiences of transformation with reflection, adaptation, and finally, a personal synthesis. Evaluation of occupational engagement through measurement using the modified NPS Interest Checklist (MNPS) was made possible using Rasch analysis. The results revealed preliminary evidence for internal scale validity and person response validity. Scale and person reliability were Rasch equivalents of Cronbach alpha of .98 for items and .66 to .75 for persons, respectively. In their leisure repertoire, very old people were more likely to endorse Social and Cultural activities and least likely to endorse Ballgames and Equipment sport. Traditional gender differences and some differences between older persons in rural versus urban areas and between persons with different cognitive levels were also found. Finally, significant correlations were found between life satisfaction and both engagement in ADL (r =.31) and engagement in leisure (r =.34) among very old people. A forced entry regression revealed that both variables together explained slightly more (12.4%) than leisure alone (11.2%). As a conclusion and in relation to evaluation of occupational engagement during therapy, the experiences of engagement are described by the respondents from both a perspective of action and a perspective of inner reflection, and together they might support the developmental process among older people. Through using Rasch analysis, it was possible to convert ordinal data into linear measures and also to organize leisure occupations into a hierarchical repertoire of engagement. This repertoire gives further understanding for specific tasks and about the general relation between leisure dimensions. Finally, the contribution of occupational engagement to life satisfaction is likely essential, but explains only about 12% of total life satisfaction among very old people.

This thesis contributes to the feminist economics' literature on caring labour with an empirical study of aged care nursing. This study critiques the positivist paradigm of neoclassical economics and argues that the Cartesian dualisms deeply embedded in both neoclassical economics and medicine result in an undervaluing of caring labour. Data was collected from nurses and managers working in residential aged care facilities in metropolitan Adelaide. Qualitative methods are utilised to uncover the role of nursing culture, underpinned by notions of gender, embedded in aged care nurses' work. This study explores how dualistic constructs such as love versus money and public versus private have become central to nursing work and impact on the way nurses' work is valued in residential aged care. The feminist economics' concept of provisioning provides a framework in which nurses' work can be valued. This framework is used to present a matrix to illustrate how nurses' work crosses these dualisms and uses a 'web of meaning' as a conceptual device to explain the inter-connectedness of nurses' work. The feminist economics' concept of provisioning is used as a means of overcoming the limitations that a dualistic world view has imposed on understanding the complexities of paid caring work. The empirical evidence presented in this thesis shows that aged care nurses do both nursing work and training in unpaid time and are vulnerable to exploitation. The remuneration they are paid is inadequate when the difficulty of the work they do and the level of responsibility they take is recognised. Their work contains a strongly non-commodified element, where the development of two-way relationships between nurses and the people they care for, their relatives and friends, other staff and the wider community are important. A key conclusion is that nurses focus on the intrinsic rewards of their work, which are undermined because aged care nursing is under-resourced. In particular, nurses do not have enough time to be caring which impacts negatively on their job satisfaction and the level of care they can provide.

This project explored the values considered by elderly people, their younger relatives, and health professionals in decisions about residential long - term care, aiming to contribute to the literature on prospectively held values. The mixed methods design utilised a medical record review of 60 frail elderly hospital patients, a stratified survey of 3,015 adults in the South Australian community, and interviews with 36 stakeholders ( 10 elderly people, 10 younger relatives, and 18 health professionals ). The medical record review confirmed that the hospital patients and their outcomes resembled those described internationally. It was used to develop a hypothetical vignette, used in the later studies. Survey responses suggested that when considering a hypothetical long - term care decision, community members put the elderly person ' s physical health and safety first. Situational variables ( the elderly person ' s autonomy, environmental adaptation, and caregiver burden ) appeared secondary, albeit less so with increasing age of the respondent. Thematic analysis of the interviews demonstrated that elderly stakeholders considering a hypothetical decision were more likely to mention autonomy values, and less likely to mention safety values, than were relatives or health professionals. However, elderly stakeholders were also more likely to suggest restrictive solutions, such as residential placement and proxy decision - making. This finding raised methodological issues concerning ' third person ' vignettes, in that respondents might be responding as proxy decision - makers, rather than as if the hypothetical decision applied to themselves. The project confirmed that, in this context, prospectively held values resembled the retrospectively described values identified by McCullough, Wilson, Teasdale, Kolpakchi and Shelly ( 1993 ). Hence, the retrospective literature could be applied. The project supported the importance and complexity of psychosocial predisposing factors when applying the Andersen Behavioral Model ( Andersen, 1995 ) to long - term care decisions. Additionally, the Ecological Theory of Aging ( Nahemow, 2000 ) and the MacArthur Model of Successful Aging ( Andrews, Clark, & Luszcz, 2002 ) were found to be relevant to long - term care decisions for individuals and populations. It was concluded that both clinically, and at a policy level, discussions of long - term care could be more effective if they focussed on maintenance of elderly people ' s autonomy and control, rather than on their physical health and safety. / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2006.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1997. / Includes bibliographical references.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2004. / Title from first page of PDF document. Includes bibliographical references (p. 35-37).