Out-of-Home Participation Strategies and Reckoning With Risk for Older Adults With Cognitive Change

Abstract

Aging in place contributes to increased independence and quality of life for community-dwelling older adults, but those with cognitive changes face challenges with necessary mobility and out-of-home engagement. The purpose of this research is to gain insight into the lived experience of navigating and participating in community settings despite cognitive changes. A qualitative exploratory study was conducted with 10 community-dwelling older adults living with cognitive changes using the go-along method (mapping, observation, and interviews). The study revealed three key strategies for maintaining and enhancing community participation (placed-based navigation strategies, relying on routines, and cultivating familiar spaces) despite cognitive change, and revealed ways that this population accepts or avoids risk in daily life. These findings inform interventions for out-of-home participation. Existing functional strategies can be identified and enhanced, and new strategies taught. Increased knowledge about how individuals consider, avoid, or accept risk is useful for therapists working with this population.

Plain Language Summary

Identifying Strategies Used by Older Adults With Cognitive Changes to Maintain the Ability to Go Places and Interact With Others, While Also Looking at the Ways Those Strategies may Involve Taking Certain Risks

Many older adults find it desirable to continue living in familiar homes and communities as they get older. This is also true for older adults who have changes in memory and problem-solving ability, even though such changes may make getting out and about more challenging. The purpose of this research is to understand what day to day life looks like for community-dwelling older adults who are experiencing cognitive changes. Information from interviews, maps, and photographs was used to help understand how getting out and about is experienced in the real places (like neighborhoods, stores, and businesses) of everyday life. This study found that the older adults with memory issues and problem solving difficulties had developed different ways of driving, parking, setting schedules, and having relationships that helped them maintain or even enhance their out-of-home activities, despite experiencing mental changes. These older adults also dealt with making decisions about taking risks, avoiding risks, and staying safe. Understanding these strategies and how safety concerns influence older adults can help providers, care partners, and community programs do a better job supporting this group of older adults to help them stay engaged, have a good quality of life, and reduce isolation.