Special issue: The ageing population – challenges and opportunities (II)

This issue of the British Journal of Occupational Therapy is the second part of a two-part special issue addressing the ageing population and the opportunities and challenges for occupational therapy research and practice for which I have been guest editor. Since there were more accepted contributions than it was possible to include in the special issue itself (others will be published in regular issues of the journal), I decided to focus in this second part of the special issue on research relating to people ageing with different types and severities of cognitive decline. Five papers explicitly relate to older people with some form of cognitive decline, ranging from memory problems or mild cognitive impairment to dementia; interestingly, several of them include digital technology use, making this somewhat of a subsidiary theme for this collection.

This second part of our special issue opens with a scoping review of the literature on technology use to improve everyday occupations in older persons with mild dementia and mild cognitive impairment. Patomella et al. (2018) identified 14 mostly quantitative small-scale studies, where six focused on the use of technology for improving performance and eight on the effects of training strategies in technology use. They concluded that there are indications of positive effects but, as is often the case, they found that the evidence is limited and more research is warranted. The second article is a practice analysis reflecting on and discussing ‘dementia positivity’, as well as reporting on the outcomes of a Delphi consensus round in Japan involving experts in rehabilitation and community care for dementia. Although no older adults with or without dementia participated in this endeavour, Maki and Endo (2018) concluded that occupational therapists can contribute to building a dementia-positive community. Another contribution from Japan is quite different; in their research paper, Ono et al. (2018) concentrated on the development and validation of an instrument supporting co-occupation for family caregivers with people with dementia. This is an early study of the psychometric properties of a new instrument, and concluded that the instrument must be revised and further tested before it can be recommended for use. It is very important to report such results, and I do hope that the authors will continue their efforts to produce a sound instrument in this area.

Turning to intervention research, Rotenberg and Maeir (2018) report the results of a pilot study of a creative occupation-based metacognitive book club intervention for older adults experiencing memory problems. The results are promising and indicate that their intervention has the potential to promote attainment of occupational goals and reduce memory-related mistakes. Next, Nalder et al. (2018) report from their exploratory qualitative study assessing the feasibility of transitioning three cognitive behavioural interventions to online delivery. Including clinicians as well as older adults as study participants, they concluded that online delivery is acceptable but should be evaluated using randomized controlled study designs.

Technology use is also a theme for the final paper, but here the target group is the general ageing population, with participants representing different levels of cognitive functioning. Interestingly, and still rare in occupational therapy, while Ryd et al.’s (2018) study is a qualitative study involving few participants, they adopt a public health and societal level perspective. The authors’ critical reasoning regarding the individualized view of occupational therapy models as a potential systematic disadvantage is interesting, challenging and promising.

I have now had the privilege of reviewing and reflecting upon an impressive array of publications for this two-part special issue. My impression is that occupational therapy researchers have much to offer when it comes to new knowledge serving the ageing population and society. An overall observation, from the articles I read, is that occupational therapy research does not often explicitly address ageing as a phenomenon. For example, ‘ageing’ was used as a keyword in only three out of the 11 papers included in the two parts of this special issue. References to theories of ageing (for an overview, see Bengtson and Settersten, 2016) are rarely used and thus not discussed in relation to occupational therapy theory. In my view, several of the studies reported in this special issue could have benefitted from reflections grounded in relevant theories of ageing. In my experience, researchers on ageing coming from different disciplinary backgrounds are keen to learn about theories and research approaches from other disciplines (Wahl and Iwarsson, 2007). Similarly, theories emphasizing the importance of meaningful human occupation for health over the life span (see, for example, Kielhofner, 2002; Wilcock and Hocking, 2015) have much to offer ageing research more generally (Iwarsson, 2018). Accordingly, the reciprocal exchange potential between occupational therapy and ageing research is underutilized.

Research on ageing – or gerontology – is an explicitly multi- and inter-disciplinary area of inquiry. As a member of the core team of the coordination action project FUTURAGE financed by the European Commission under Framework 5, I had the privilege of working with researchers and knowledge users of ageing research in the most extensive consultation ever undertaken in Europe in this field. The project had the following basic assumptions: multi-disciplinarity, user engagement, a life course perspective, a person–environment perspective, the importance of diversity and intergenerational relationships, knowledge exchange, and technological innovation. The outcome of FUTURAGE was a roadmap (Walker, 2011) outlining the major priority themes for future ageing research. While population ageing to a major extent is positive, and many people will enjoy active and healthy ageing, there are vulnerable sub-groups that deserve more research efforts. Examples put forward were people with dementia and other cognitive disorders, frail older people and their carers – that is, groups featured in this special issue of the British Journal of Occupational Therapy. Moreover, a crosscutting dimension identified in FUTURAGE was the rapidity of technological development.

With these observations, I encourage and challenge colleagues to consider new avenues for strengthening occupational therapy research to contribute even more convincingly to this broad area of research. It is very important to develop the discipline and profession as such, but there are mutual benefits of more inter-disciplinary anchorage and collaboration. Positioning studies such as those displayed in this special issue of the British Journal of Occupational Therapy in the international inter-disciplinary landscape of ageing research, preferably adding perspectives beyond the specific clinical contexts where the studies were implemented, would considerably increase attention to occupational therapy research. Importantly, the phenomenon of ageing deserves more attention in its own right. Finally, the basic premises of occupational therapy have much to offer in contributing to the knowledge development in ageing research overall. As demonstrated by this special issue, occupational therapy research has a high relevance for ageing research, in Europe and beyond.

The Editor-in-Chief thanks Professor Susanne Iwarsson for her valuable contribution as guest editor for this special issue of the British Journal of Occupational Therapy. The first part of the Special Issue: The ageing population – challenges and opportunities was published in the August issue of the journal.