Home and Community Occupations for Very Old People

1. Home and Community Occupations
for Very Old People

2. The home setting is a very important arena for many of the
interventions performed by occupational therapists, especially among
frail older persons.
These professionals are expected to focus not only on the disabling
effects of the home environment, which means taking the physical
aspects of the environment into account, but also on the meaning
that older people attach to home.
The home is an important and meaningful place to older people
The home environment supports the sense of self and a sense of
identity as people age, and many people emphasize attachment to a
place, memories, and a sense of belonging , thus indicating the
importance of emotional dimensions of the home.

3. When older people experience the onset of functional limitations, they
can lose their home as private territory*it turns into a working
place where many persons come and go
The home is the center of self , explaining the relationship between
self and home in terms of memories and mastery; the home is the
center of caring ; a place where they cared for themselves and
others; and the home is the center of reach ; a base, a place to come
back to.
The main theme emphasizes that very old people feel that home has a
central place in their lives because it is where they live and spend so
much time. The significance of the home is based on the fact that it
means so many different things to the old people.

4. In home means security, these are: living in a familiar neighborhood,
everything functions, and having memories.
Home means freedom comprises a place for reflection, a social
meeting-point, and leaving your own mark.
Home means the feeling of being within one’s own four walls. It
generates an atmosphere of security characterized by warmth and
comfort.

5. Home means having someone close by in case one needs help.
This creates feelings of safety and security.
Having the home in a familiar part of town near known neighbors
usually means having someone near to turn to when needed.
It is important to live in a place where one knows one’s way about, e.g.
where one has grown up, and which one associates with positive
memories. To be acquainted with the area and know what is available
as far as shops and healthcare and social services, etc. are concerned,
is considered important. This makes one feel secure.

6. Home stands for functionality and is adapted to and planned
according to one’s own needs, again providing a sense of security.
It functions with the help of household machines and adjustments to
furniture/fittings, such as a raised toilet. That home functions
signifies independence, and living in a functional home is described
as a necessary condition for managing independently.
A functional home in combination with having sufficient skills and
not being too frail or too cognitively dysfunctional enables one to
remain at home.
This functionality will be jeopardized if the elderly person is obliged to
move to another kind of living accommodation..

7. Home means being surrounded by the people who have been there,
and having memories to live on. This, too, gives a sense of security.
Memories of a past life, things that one has inherited, or that one has
saved up over the years all give home a value.
The memories are linked to events of different kinds that have
occurred throughout life, both joyful and sad. Every memory has its
own history/story.
The photos on display recall events in life, such as, for example,
bringing up children. They also remind one of when one’s husband or
wife was alive and how, for example, they drank coffee together.
Thanks to these memories, it is as if these significant persons were
still there at home. If one does not have any memories associated with
home, it does not feel like home. The feeling of being at home grows
as events occur and creates meaning and security

8. Home means having the freedom to come and go as one wishes and
being able to do things in one’s own way, and decide when and how to
do things. For example, to have the freedom to decide how clean
and tidy the home has to be, and how to keep things in order, all this
creates feelings of home.
One can close the door and be alone, or open it to friends when one
wants to. Being able to decide when to lie down, if one wants a rest
during the daytime, or to go to bed late, without interference from
anyone else, is important.
On the other hand, not being able to look after the home affects one’s
freedom to decide how one wants things. In such a situation, one can
no longer have things the way one wants them to be. If, for instance,
one wants to lie in ironed sheets, and cannot iron them, a feeling of
pleasure is lost by not doing something one would have chosen to do
earlier. Having to move to sheltered accommodation could
mean that one’s sense of freedom will be jeopardized.

9. Home is a place to have the freedom to withdraw and be ‘‘sufficient
unto oneself’’ and to do what one wants to; a place to be on one’s own
in peace and quiet.
It is a place to sit and recall situations, people and memories, and
think things over if one has had a bad day. One come home
and sit down and enjoy the day.
It feels good to be able to go out on the balcony and see greenery, the
trees and the sky. Contact with nature is important; one feels alive.

10. The home is experienced as the hub of existence where everything
happens on one’s own terms.
Home is always there; there is nothing temporary about it.
It is a place one can always come back to.
It is always open to receive family, and it is always there for them
whenever the opportunity arises.
This feeling of being in one’s own home, of being surrounded by
family and friends, reinforces the meaning of home.
A home is your own, and you can close your door and be by yourself
when you want, and then it’s great fun to open up and be able to
receive your friends and enjoy being at home

11. Home is a place that looks the way one wants it to look, with personal
things around.
It signifies a place where one has the freedom to leave one’s own
mark, and which one can furnish according to one’s own taste,
mixing colors and shapes in such a way that one is comfortable
with oneself.
People in general think it is important to be able to keep order, have
flowers for decoration, be free to have the furniture they like, and to
make things as cozy as possible

12. Very old persons are a vulnerable group suffering from frailty,
comorbidity, and disability.
It is a group whose inner reserve of strength is failing, and just a
small change can increase disability.
A functional home is therefore very important, a point raised by the
target group.
When occupational therapist offers measures such as prescribing
assistive devices or recommending housing adaptations, it is
important that such solutions are based on the very old person’s own
experienced meaning of home, and linked as closely as possible to
current daily routines and habits

13. Home is seen as a place of security where habits, routines, and
customs were maintained.
Such daily activity patterns seem to be socially learned norms and
values for creating a sense of home, which implies that it could be
very difficult to change the very old person’s habits, routines, and
customs
It is very important to discuss and highlight these aspects so that very
old people as well as professionals become aware of the impact any
intervention can have on elderly people’s lives and sense of security

14. Being frail forces older people always to take into consideration the
state of their own health and their functional status.
Having someone close by and having one’s home in a familiar part of
town where one knows one’s neighbors means that one usually has
someone near to turn to if needed.
This is probably important among very old persons and a strong
reason for staying put at home when disability, frailty, and
comorbidity increase.

15. Being surrounded by objects that are filled with past
memories makes it possible for old people to combine the past and the
present in their day-today experience and to find life still meaningful.
It is important for a occupational therapists to enter the old people’s
world of meaning and support them in uniting past themes of
meaning and present activities.

16. As very old persons become increasingly frail, they have to face
fundamental changes in their homes.
Their homes become not only places for assistive devices and
adaptations but also workplaces for social services and healthcare
staff.
Having to reorganize one’s home and the frequent coming and going
of professionals and other persons can affect the sense of freedom.

17. Frail elderly persons are no longer independent in the same way as
before, and even if they consider themselves to be in control of their
daily activities, the elderly frail persons are in the hands of others in
terms of not being allowed to decide for themselves.
The freedom can be limited simply because they cannot decide when
and how to do things in a different way.
Occupational therapy places strong emphasis on the environmental
context of activity.
- People are studied in meaningful interaction with their
environment, and activities are seen as an action on the
environment .
- From an occupational therapy perspective it would be difficult to
describe the meaning of home without linking it to activities.
- The meaning emerges from the significance of performing
activities, which always takes place in some context.

18. Occupational therapists have to consider the meaning people attach to
their home.
The experience of an activity is as important as the performance of
the occupation itself.
It is important to consider both objective and perceived aspects of
housing for better health and well-being for very old persons
Those who lived in more accessible housing experienced their home
as more useful and meaningful in relation to their routines and
everyday activities, were less dependent on external control, more
independent in daily activities, and had a better sense of well-being

19. Occupational therapy practice, the home needs to be approached as a
place of meaning.
Home is part of the environment and influences the meaning and
selection of activities that the very old decide to engage in.
The meaning of home and performance of activities are different
aspects and it is important to consider both aspects in occupational
therapy.
The occupational therapist working with very old persons has to
consider the importance of security and freedom

20. When prescribing devices or recommending housing
adaptations, she/he must make sure that such measures are as closely
associated with normality as possible so as not to disrupt the feeling of
security.
It is also essential to help very old people to continue to be in charge
of their everyday life and to experience freedom even though they
suffer from frailty and disability and, as far as possible, to encourage
them to take risks in order to carry out daily occupations