The Occupational Narratives of Older Adults Participating in Music-Based Occupations

Abstract The purpose of this study was to implement an occupational therapy intervention that could be used for telehealth services with an emphasis on participants learning ways to independently choose and sustain engagement in meaningful music activities, known as occupations. The researchers’ aim was to examine how music occupation interventions lower risks of occupational deprivation (i.e., prolonged restriction from participation in necessary or meaningful activities) that could occur due to the COVID-19 pandemic. Eight adults participated who were 65 years or older, lived in the community, and enjoyed music. The researchers used narrative qualitative methodology to analyze pre- and post-intervention focus group data. The participants completed seven intervention sessions designed to increase and sustain music engagement outside of the sessions. The pre-intervention focus group data resulted in an occupational pattern analysis and a single occupational narrative. Triangulation of data post-intervention included the two focus groups and their pattern analyses and narratives, field notes from each intervention session, and documents produced through group completion. The final analysis produced an occupational change pattern analysis and narrative. The focus of the change narrative was on the participant’s management or prevention of occupational deprivation. The researchers identified several common themes involving change in routines and habits to include regular engagement in meaningful music activities, skills for using occupational participation as an important method of coping with COVID-19, and developing new technological skills to access music to replace in-person participation of attending live concerts and shows when deemed unsafe because of potential for virus transmission.


HEART FAILURE AND HOSPITAL UTILIZATION TRAJECTORIES BEFORE AND AFTER HIP FRACTURE SURGERY
Sijia Wei, 1 Wei Pan, 2 Chiyoung Lee, 3 Hideyo Tsumura, 4 Tingzhong (Michelle) Xue, 4   Washington,Bothell,Bothell,Washington,United States,4. Duke University School of Nursing,Durham,North Carolina,United States Long-term hospital utilization trajectories in the context of surgery are understudied.Heart Failure (HF) is associated with an increased risk for rehospitalization after hip fracture surgery.This study aimed to examine whether older adults (>= 65 years old) have distinct patterns of long-term hospital utilization trajectories and whether HF influences these trajectories before and after hip fracture surgery.An initial cohort of 1,172 older adults hospitalized for hip fracture surgery between October 2015 and December 2018 was extracted from electronic health records.To adjust selection bias in baseline characteristics, we used propensity score 1:1 ratio matching to identify a final cohort of older adults with (n = 288) and without (n = 288) HF.Monthly frequencies of emergency department (ED) and inpatient encounters 1-year before and after the hip fracture surgery were used to identify distinct utilization trajectories from group-based trajectory analysis.Logistic regression models were used to compare the differences in ED and inpatient trajectories among patients with and without HF.High ED users (9.5%) had constant high ED use, and high inpatient users (20.1%) had significantly higher inpatient usage around the index hip fracture surgery hospitalization.Both low ED (90.5%) and inpatient (79.9%) users had low but slightly increased use around the index hospitalization.Compared with older adults without HF, older adults with HF were more likely to be long-term high inpatient user (OR = 1.94, 95% CI 1.25-3.01,p = 0.003), but not significantly different in long-term ED utilization (OR=1.87,95% CI 0.97-3.59,p = 0.62).

PSYCHOMETRIC PROPERTIES OF THE HEALTH LITERACY SURVEY EUROPEAN QUESTIONNAIRE-12
Suyeong Bae, 1 Sung-Ji Park, 2 Hee-Soon Woo, 2 and Ickpyo Hong, 1 1.Yonsei University, Wonju, Kangwon-do, Republic of Korea, 2. Wonkwang university, Wonkwang University/Iksan, Cholla-bukto, Republic of Korea The importance of health literacy has increased as the public awareness of health has increased.Health Literacy Survey European Questionnaire-47 (HLS-EU-Q47) is a representative assessment tool for evaluating health literacy, and its psychometric properties have been examined in various countries.This study analyzed the item-level psychometric properties of a short version of the HLS-EU-Q47 using a Rasch measurement model.We collected 254 Korean adults who completed the 12 items of the HLS-EU-Q47 in hospital settings.We used confirmation factor analysis (CFA) to examine the unidimensionality assumption of the HLS-EU-Q12.We analyzed item fit, precision, and differential item functioning (DIF) across sex, age and education groups.The CFA model confirmed that HLS-EU-Q12 satisfies the unidimensionality assumption (CFI = 0.96, TLI = 0.96, RMSEA = 0.09) and no local independence in the 12 test items (residual correlations ranged from -0.16 to 0.19).The HLS-EU-Q12 demonstrated high reliability (Cronbach's α = 0.90) and no DIF across sex, age and education groups (p > 0.05).The person strata by the instrument were 3.80, which is equivalent to a traditional reliability value of 0.87.In short, the study findings indicate that the HLS-EU-Q12 has good psychometric properties with the 254 Korean adults.Since the HLS-EU-Q12 can accurately and precisely evaluate the health literacy of Korean adults, this instrument could be used in clinical settings.The purpose of this study was to implement an occupational therapy intervention that could be used for telehealth services with an emphasis on participants learning ways to independently choose and sustain engagement in meaningful music activities, known as occupations.The researchers' aim was to examine how music occupation interventions lower risks of occupational deprivation (i.e., prolonged restriction from participation in necessary or meaningful activities) that could occur due to the COVID-19 pandemic.Eight adults participated who were 65 years or older, lived in the community, and enjoyed music.The researchers used narrative qualitative methodology to analyze pre-and post-intervention focus group data.The participants completed seven intervention sessions designed to increase and sustain music engagement outside of the sessions.The pre-intervention focus group data resulted in an occupational pattern analysis and a single occupational narrative.Triangulation of data post-intervention included the two focus groups and their pattern analyses and narratives, field notes from each intervention session, and documents produced through group completion.The final analysis produced an occupational change pattern analysis and narrative.The focus of the change narrative was on the participant's management or prevention of occupational deprivation.The researchers identified several common themes involving change in routines and habits to include regular engagement in meaningful music activities, skills for using occupational participation as an important method of coping with COVID-19, and developing new technological skills to access music to replace in-person participation of attending live concerts and shows when deemed unsafe because of potential for virus transmission.

ACTIVITY SPACE AND FUNCTIONAL OUTCOMES IN FRAIL OLDER PERSONS USING GPS ANALYSIS
Sandra Lau, 1 Frerk Mueller-von Aschwege, 2 Tania Zieschang, 1 Juergen Bauer, 3 Andreas Hein, 1 and Rebecca Diekmann, 1 1.Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany, 2. OFFIS e.V. -Institute for Information Technology,Oldenburg,Niedersachsen,Germany,3. Heidelberg University,Heidelberg,Germany With increasing age, walking becomes a main functional ability to participate in activities of daily living and supports independence and mobility.Frailty in older, multimorbid patients has a negative impact on physical activity and may reduce the personal activity space (AS).In this pilot study, GPS data were used to identify walking tracks to define individual AS and to compare functional performance in frail older persons.GPS data of 20 community-dwelling adults (84.5(±5.2) years, 85% women, mean frailty phenotype 1.9 (70% ≥2) points) were analyzed using a customized software to assess individual AS over a ten-months period.A geriatric home assessment including Short Physical Performance Battery (SPPB), gait speed (GS) and Timed-up-and-Go (TUG) was conducted monthly.GPS analysis revealed three different walking types presenting AS similarities: Type A walkers prefer smaller short walks nearby the home while Type B can be characterized by taking larger regular walks.Type C presents the widest AS using different transportation modes, but only a moderate number of walks.Mean group difference in functional performance of Type A walkers showed significantly reduced GS (0.45(±0.1)m/s),TUG (23.4s(±4.9))and SPPB scores (3.8(±0.8)points; p<0.05) compared to Type C (0.82(±0.1)m/s (GS); 13.2(±1.4)s(TUG); 7.0(±1.3)points (SPPB)).Functional performance of Type B walkers (0.63(±0.2)m/s (GS); 17.1(±4.4)s(TUG); 6.5(±2.4)points(SPPB)) revealed significantly higher SPPB scores compared to Type A (p<0.05).Walks and individual AS can be mapped via GPS under everyday conditions.High heterogeneity within frail older people was observed.Persons with lower functional performance showed a reduced AS and physical activity.

DEVELOPING, TESTING, AND IMPLEMENTING A FALLS PREVENTION AND HEALTHY AGING APP (KEEP-ON-KEEP-UP) FOR OLDER ADULTS
Emma Stanmore, University of Manchester, Manchester, England, United Kingdom Falls are a common and costly concern for older adults.Digital technologies can offer new, inexpensive approaches to increase access and engagement with falls prevention programmes.Keep-On-Keep-Up is a personalised, falls prevention App with strength and balance exercises plus health literacy games.This study reports on the user-centred design, usability testing and implementation of the KOKU App.Older adults aged 55 years and older in the UK were invited to take part in the study.Data collection included focus groups; baseline and 6 week questionnaires and assessments; semi-structured interviews and one focus group with falls prevention therapists to explore App usability.Thirty older adults were invited to use KOKU unsupervised, 3 times a week for 6 weeks.Data were analysed using thematic content analysis.Focus groups (n=11) with 66 older users and 11 therapists informed development.Thirty older adults (mean age = 75) were recruited for the in-depth testing.Mean SUS score was 71 indicating high usability.Qualitative themes included: ease of use (app usability; iPad properties; exercise presentation), usefulness (physical/psychological benefits; falls education), attitude towards the App and intention to use (technological barriers; flexibility of use; exercise class versus App).Therapists (n=6) viewed the KOKU platform positively and suggested extensions for further progression.No adverse events were reported during the study.This research demonstrates that KOKU is an acceptable and easy to use falls prevention intervention that facilitates older adults' ability to access falls prevention training at a time, and in a location, that suits them.

FEASIBILITY AND ACCEPTABILITY OF AN MHEALTH ACP TOOL IN PRIMARY CARE
Desh Mohan, 1 Katelin Cherry, 1 Tatiana Fofanova, 1 Taylor Huffman, 1 Glenn Davis, 2 Anthony Comito, 3 and Elissa Kozlov, 4 1.Koda Health,Houston,Texas,United States,2. Cypress Physicians Association,Spring,Texas,United States,3. FOUNDRY41,Houston,Texas,United States,4. Rutgers University,Piscataway,New Jersey,United States With only 7% of Medicare beneficiaries having completed Advance Care Planning with their physicians, engagement in Advance Care Planning in the clinical setting has been historically low.This study investigated the feasibility of introducing the Koda Health Advance Care Planning software platform in and Eleanor McConnell, 4 1.Duke University School of Nursing, Apex, North Carolina, United States, 2. Duke University, Duke University School of Nursing, North Carolina, United States, 3. University of