Unfolding familiarity : re-occupying daily life among older persons with physical disabilities, in Japan.

Older persons increasingly recover from health conditions within their home and community, as opposed to in hospitals and institutions. In this context, a need has arisen to gain a greater understanding of how they resume their daily occupations to aid their transitions of re-establishing satisfactory daily lives. The overall aim of this thesis was to explore and understand how processes of resuming daily occupation unfold for older persons with physical disabilities, in Japan. Study I: In qualitative retrospective interviews, nine persons were asked to narrate their experiences of resuming everyday activities during hospitalization and after returning home. The constant-comparative analysis’ resulted in exposing three themes that expressed, how the participants spend and generated vigor, how they reconciled to requiring assistance, and that they had acted upon moral quests of doing what was the right thing to do (for themselves and for other persons). Study II consisted of participant-observation of daily occupations and complementary interviews with five participants. The aim was to identify meanings given to the actions of participants and other persons involved in observed situations. Through a narrative analysis these meanings were identified as consisting of three complementary strategies. Two of the three strategies aimed to mitigate given problems, one by ‘acting on a plan to achieve one’s goals’, the other by ‘taking a step in a preferred direction by capitalizing on emerging opportunities’. The third strategy focused on avoiding undesirable experiences by ‘modifying problematic situations’. Persons used these approaches flexibly in responding to shifts that mattered in the observed situations and according to their skills, resources and perspectives. Study III was a 9-month longitudinal study of four participants with physical impairments. The aim was to explore and understand how their engaging in daily occupations unfolded over time. Data included qualitative interviews and observations. The findings showed the striving for repertoires of occupations that created familiarity in terms of fulfilling their occupational needs and meanings. Familiarity was also experienced when participants engaged in occupations in line with their expectations. Equally, familiarity was a quality that often assisted participants to deal with ambiguities and challenges in daily life situations. Familiarity unfolded as it was created and adjusted to evolving daily life situations. Study IV was a qualitative study with 15 occupational therapists in two focus groups. Participants narrated and explored experiences of supporting elderly clients to resume daily occupations. The constant-comparative analyses resulted in exposing three themes, showing how resuming occupations were processes of ‘co-creating shared plots’ of pursuing ‘images of client’s future’ by ‘drawing from powers of occupations’. In conclusion, this thesis presents a number of possible understandings of how resuming daily occupation can unfold over time for older persons with physical impairments. The resumption of daily occupation can be understood through a complexity of intertwining dynamics, which are grounded in an occupational context. First, resuming daily occupation is difficult to foretell or to plan. Accordingly, capitalizing on emerging possibilities contributes to the processes of resuming daily occupation. Second, older persons, and others who support them in resuming daily occupations, may resort to the ‘flexible and judicious use of different approaches’. In addition to capitalizing on emerging opportunities, these approaches include pursuing long-term goals. An approach of modifying situations serves to avoid problems that may arise in daily occupations. Third, when other persons, such as occupational therapists, support older persons, then ‘co-creating shared plots’ between them becomes an important contribution to processes of resuming daily occupations. Co-creating shared plots is ongoing as occupational needs, preferences and possibilities for engaging in daily occupation are constantly evolving and changing. Fourth, ‘re-occupying daily life’ allows the older persons to gain experiences that foster improved health and well-being by engaging in daily occupations. Fifth, these transitional processes can be considered as realms of unfolding familiarity which involve re-establishing patterns of daily occupations that fulfill participants’ needs and preferences and which feel familiar to them. In addition, unfolding familiarity pertains to sourcing from familiar ways of dealing with ambiguities and challenges in daily life. Familiarity can also be experienced when events in daily life work because they go according to expectations. In short, resuming daily occupation is facilitated through ‘doing’ and co-creation between the older person with physical impairments and other persons supporting them. It involves experimenting with transforming possibilities into reality, as well as to making meaning from experiences along with re-establishing a sense of familiarity. Resuming daily occupation does not always follow a set course, but rather can proceed in unexpected ways. Consequently, processes involved in resuming occupation are often re-created through the flexible use of different approaches. LIST OF SCIENTIFIC PAPERS I. Bontje P, Asaba E, Tamura Y, Josephsson S. (2012) Japanese Older Adults’ Perspectives on Resuming Daily Life During Hospitalization and After Returning Home. Occupational Therapy International, 19, 98-107. II. Bontje P, Asaba E, Josephsson S. (2015) Balancing struggles with desired results in everyday activities: Strategies for elderly persons with physical disabilities. Scandinavian Journal of Caring Sciences, early online. III. Bontje P, Alsaker S, Asaba E, Kottorp A, Josephsson S. Unfolding familiarity: Resuming daily occupation for four older persons with physical disabilities, in Japan. In manuscript. IV. Bontje P, Josephsson S, Tamura Y, Ishibashi Y, Asaba E. Co-creating possibilities from occupational situations: Supporting older persons with physical disabilities, in Japan. In manuscript.