PR 00166 - Explore

What is the problem/issue you are trying to address?

Autonomy generally decreases with aging, as a consequence of the wide range of physical, cognitive, emotional, and/or social changes. This loss of autonomy is even more important for people with neurocognitive pathologies (Jekel et al., 2015). However, these changes being characterized by interindividual heterogeneity, the assessment of the elderly people’s autonomy in performing physical activities should therefore be specific and personalized in order to target their needs and to develop appropriate services.  Presently, in the specialize home managed by AFEJI, the outdoor or indoor activities proposed to elderly adults are based on what the majority can perform. As a result, elderly adults with more preserved mobility do not always have the possibilities to perform activities that they would like to do. In the same vein, other elderly adults despite their reduced mobility, with some adaptation would have been able to perform a wide range of activities. We address here, the heterogeneity in the capacities and desires of elderly adults with regard to physical activities.

Pilot aim

The aim of this exploration phase is two fold, first to perform a personalized screening of activities that elderly adults residing in specialized homes would like to engage in and secondly to explore the feasibility of providing to each elderly adult, the activity or activities that he/she would like to perform despite the limitations due to their pathologies other limitations such as lack of finance, of space, staff,…etc.

The screening of the desired activities was performed using enquiries/interviews and information on the mobility was obtained by observing the person in his/her daily life, evaluations with validated tools, and exchange with the nursing staff. We (UPJV) developped a specific material, a questionnaire ( QUETAL:QUestionnaire d’EvaluaTion des Activités de Loisirs) to obtain information about recreational activities during different periods of  life (•During active life,

,Since retirement and Since arrival in the specialized house) and to propose activities that coincide best with the lifestyle and the desires (cf questionnaire sent to BU) For each elderly adult in AFEJII home and in the neigbourhood of Amiens (UPJV), We gathered information on the Nature of the activity; Frequency of the activity; Current motivation for the activity; Order of preference for the activities

Stakeholders on your pilot

The loss of autonomy in instrumental and leisure activities, is generally the result of an imbalance between the capacities of an individual and the social and material resources available. Considering that elderly adults with neurocognitive disorders have reduced capacities, a strategy to help them in performing their desired activities, targets social and material resources. For this purpose, stakeholders have been consulted. In order to be implicated during this exploratory phase.

Pilot beneficiaries

The pilot study targets elderly adults residing in specialized homes due to severe neurocognitive conditions. This pilot aims at providing a personalized screening of activities that elderly adults in specialized homes would like to perform irrespective of their capacities. Actually, activities proposed to elderly adults in many homes, are usually in-group or according to what the majority want (and not according to what he/she wants).

Ideas generated

Identification of  a huge number of activities pertaining to WELLBIENG and the widely desired activities by most older and elderly adults concerned (semi leisure category, outdoor category, games, Media,  art,…). Most of the identified activities (see the data from the Questionnaire) were not those initially listed in the SAIL project. For instance, Gardening was highly requested by old and elderly adults.

Values for selection

The activities that old and elderly adults appeared to value most (revealed by the explore phase, see data of screening questionnaire) were unfortunately not taken into consideration by AFEJII. The initially defined activities were kept for practical reasons (for instance, some of the activities were already well implemented in the daily practice of the establishment.

Acceptability

Acceptability by participants was difficult to evaluate due to severe cognitive difficulties. Participants gave their consent or legal guardians of the person gave consent. Since some of the activities were already part of their life in the institution, the elderly adults were already used to some of the activities. UPJV and AFEJII were to some extent in disagreement. UPJV wanted modification of the activities in the light of results of explore phase while AFEJI proposed to keep the initial activities defined in project prior to the explore phase. 

Demand

No particular demand identified at this stage

Implementation/Practicality/Organisational/Financial Feasibility

The project appears to be financially feasible and practical since some of the activities were already implemented in the home prior to the SAIL project and the new activities rely mostly on the existing staff. The number of participants per activity is adapted (small groups). The activities also rely on local collaborations. 

Additional assets and resources

Do you need any additional assets or resources including expertise to help you deliver your project?

No particular demand identified at this stage

Adaptation

Have you made any changes to your original plans, why did you make the change and what information did you base your new plans on? For instance any changes you made to the context, format, timing, setting or population at this stage?

We used the world café methodology as promoted by most of the SAIL project partners. However, this was difficult to perform with elderly adults suffering from severe neurocognitive deficits. In order to complete this methodology, psychologists conducted face-to-face interviews. Each interview and inquiry were conducted on weeks considering the profile of the elderly adults. The data collection is complexed because persons with neurocognitive deficits frequently have Poor self-esteem or lack of (or at least not always full) awareness with regard to their capacities. In the first case, due to low self-esteem or lack of self-confidence, some ageing adults may feel that they are no more able to perform on their own certain activities that they actually can. Inversely in the second case, not knowing that a deficit exists may make problematic for people to accept assistance for certain activities. Consequently, the collection of data with this population is a time consuming activity. The data collected are still under analysis and meeting with stakeholders have been postponed. We have requested an additional delay with the SAIL partners, all data will be accessible for the 27^th of February.Actually all data have been processed.

Integration

Do you think this project will work within the current local setting/structures? What changes need to be made to integrate your new project into existing infrastructure or programs?

Implementation of the selected activities could be difficult considering that many residents have severe dementia . We (upjv) proposed to new activities based on the capacities and desires of the residents (as revealed by the QUETAL questionnaire). The staff institution should be more informed about the SAIL project for good engagement in the activities.

Selected ideas for next phase

Based on the areas stated above, which ideas from your meetings have been selected for the phase of design and develop on SAIL?

No big change with regard to the initial project prior to the explore phase. Most activities are kept although UPJV wanted modification of the activities in the light of results of explore phase.