Dimensions of Occupation

• Areas of occupation include ADLs, IADLs, health management, rest and sleep, education, work, play, leisure, and social participation.
• Key concepts in defining occupation: organizer of time and resources, allows economic self-sufficiency.
• Foundations of occupation: rules that dictate engagement, habits as automatic behaviors, and skills reflecting choice and outcomes.
• Four key perspectives of occupation (AOTA): meaningful, variable and dimensional, defines the person, and changes over time.

Dimensions of Occupation

• Biological: mechanism for survival like eating and sleeping.
• Temporal-spatial: length, temporal aspects, space, and context such as skiing in winter.
• Socio-cultural: values, trends, and traditions influencing occupational choices.
• Psychological: emotional and cognitive aspects.
• Spiritual: essence expressed in daily activities.
• Benefits: promotes learning, role identity, uses hands, challenges internal organism, structure/integration, balance/meaning, reduces awareness of symptoms, and aids recovery.

Occupation as a Bridge to Health

• Survival: biological need to engage.
• Diversion: distraction from negative aspects.
• Mastery: gain control through skills.
• Habit: promotes health, increases skills, decreases fatigue, frees attention, and protects from stress.
• Support: value of support and supporting others.
• Identity: grounds us in who we are.
• Spiritual connection: to self, others, higher being.
• Human evolution: humans are occupational beings, defining ourselves by occupations and having capacity to make decisions.
• Occupation is defined as meaningful, everyday activities shaping identity and influencing health.
• Activity is an objective form of action that enhances engagement and skill development.

Concept/Definitions of "Health"

• General concept vs. medical definition depends on culture, spiritual philosophy, economy, and technology.
• Medical model: science should cure illness.
• Social model: examines all factors contributing to health.
• Biopsychosocial model: recognizes all factors, paying attention to “human-ness.”
• Biological factors like age and illness, social factors like communities and relationships.
• Disablement model: describes patients based on pathology/diagnosis and how they limit function.
• WHO definition: complete physical, social, and mental well-being.
• ICF: defines health and related well-being, measuring at individual and population levels.

Concept/Definitions of "Well-Being"

• Wellbeing is a subjective health assessment, less concerned with biological function, yet concerned with self-esteem.
• SAMHSA’s 8 Dimensions: physical, emotional, spiritual, intellectual, environmental, financial, occupational, and social.
• "Needs:" warn of a problem, protect and prevent, and prompt and reward.

Sociocultural Influences on Health

• Occupational norm: execution of activity in a culture, such as dressing up on October 31st in US.
• Occupational circumstance: physical environment and context such as swimming in backyard vs. Olympics.
• Social determinants of health: neighborhood/built environment, healthcare, social/community context, education, economic stability.
• Holism: living systems are more than the sum of their parts.

Occupational Risk Factors

• Imbalance: overabundance/incompatible occupations, limitations, infrequency due to lack of motivation.
• Role overload: exceeds resources.
• Role strain: overlapping and incompatible roles.
• Deprivation: prolonged preclusion from occupation outside personal control.
• Disruption: temporary, transient, resolved with adaptation.
• Alienation: prolonged disconnection, isolation.
• Injustice: participation is barred, confined, or restricted.
• Environmental press: individual needs not matched by environment.

Historical Perspectives on Development

• Preformationist: children are miniature adults.
• Maturationist: education passively supports child, development is dictated by genetics.
• Environmentalist: environment alone impacts development.
• Interactionist: interaction between environment and heredity.
• Continuity vs. multiple patternicity vs. multiple determinicity Continuity: lifelong process.
• Multiple patternicity: periods of growth/decline.
• Multiple determinicity: no single factor determines development.

Determinants of Development

• Heredity, environment, age-normative events, history-normative events, and non-normative events
• Effect of inactivity/disuse in early development: lack of play results in negative consequences such as failure to thrive.
• Frailty: reduced physiological reserve associated with increased susceptibility to physical disability

Context of Older Adult's Occupations

• Living at home has most freedom.
• Increase in level of care leads to decreased opportunities for engagement in occupation.

Changes Associated with Immobility/Disuse

• Cardiovascular: deconditioning, tachycardia, orthostatic hypertension, venous stasis.
• Respiratory: decreased movement, pulmonary stasis, disturbed CO2-O2 balance, pulmonary embolism.
• Gastrointestinal: acid reflux, ulcers, constipation.
• Motor dysfunction: reduced ROM, swelling, muscle atrophy.
• Skeletal system: osteoporosis, fractures.
• Integumentary system: pressure injury.
• Metabolic effects: tissue wasting, fluid imbalance.
• Urinary retention: UTI, renal stones.

Effect of Disease and Disability on Occupation

• Signs and symptoms impact engagement.
• Important to consider whole person in interventions.
• Prognosis and outcome can be dependent on patient’s willingness to engage in treatment.
• Spinal cord injury: quadriplegia vs. paraplegia (lower limbs).

Culture

• Real, shared, malleable, dynamic, learned, invisible.
• Values: ideas or beliefs that are important to self or others.

Perspectives of Time

• Linear: unidirectional such as a specific date.
• Cyclical: rotational such as a date that occurs annually.
• Biological: traditional sense of time and cycles, such as sleep/wake cycle.
• Psychological: reflects sense of timing in regard to human interaction.

Types of Time

• Necessary: basic physiological and self-maintenance needs.
• Contracted: paid productivity or formal education.
• Committed: work or productive character without pay or specific time frame.
• Free time

Spirituality and Occupation

• Spirituality is more than religion.
• Understanding place in universe, making meaning through personal activity.