Mary Lou Leibold, Margo B. Holm, Ketki D. Raina, Charles F. Reynolds, Joan C. Rogers; Activities and Adaptation in Late-Life Depression: A Qualitative Study. Am J Occup Ther 2014;68(5):570-577. doi: 10.5014/ajot.2014.011130.
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© 2019 American Occupational Therapy Association
OBJECTIVE. We sought to understand activity choices of older adults when they were depressed.
METHOD. Each community-dwelling participant (n = 27) completed one semistructured interview while in recovery for at least 3 mo. but less than 7 mo. Transcripts were coded to identify relevant themes.
RESULTS. Six themes emerged that explained activities participants continued while depressed, and four themes described activities they stopped.
CONCLUSION. Older adults maintained many instrumental activities of daily living while depressed, and some actively adapted activities so they could continue them. Some intentionally stopped activities to direct limited energy to their highest priority activities. To guide effective intervention, it is critical for occupational therapy practitioners to complete a client-centered qualitative assessment to understand what and, most important, why activities are continued or stopped. Each theme for activities continued and activities stopped lends itself to intervention strategies.
Established habits and commitments kept me engaged.
Some activities were still gratifying.
Family and friends nudged me into action.
I gotta keep going.
Distraction and escape took me away from my situation.
I’m hiding my depression from other people.
I’m a newspaper nut. . . . every morning . . . I buy that newspaper, and I read it. And I don’t even think about it. . . . it’s been going on for at least 50 years, more than that. I read it, . . . but I’m not sure I got anything out of it, you know, but I did read it.
If you stop going to church, you’re really disconnecting yourself from the things that are, for me anyway, the most important in my life. And if I stop going to church, . . . it’s all downhill from there, because my social contacts are a big part of church.
I didn’t want to tell them I was depressed because then they would get upset . . . so I forced myself to do it, but I didn’t enjoy it at all. . . . Oh, I wish I wouldn’t have asked them, but if I didn’t ask them for 3 weeks, then somebody would [ask] what happened to those family dinners we used to have.
The activity is not meaningful to me now.
I no longer had the physical or cognitive energy to do it.
It’s too physically painful.
I constricted my social space.
My interest in the computer was not what it used to be. . . . For 26 years, that’s all I did at [work]. I was on bigger and larger machines [with] people counting on me . . . to take care of problems. Now, all of a sudden, I didn’t care; in fact, I was ready to throw it out once.
I have to get them all together. It’s the organizing. I have to get my checks, checkbook, . . . the bills, . . . the envelopes, and the stamps, [and] I have to look at each one. The bills can pile up for weeks and weeks, and then I have to pay all those interest charges.
Had a prearranged commitment or accountability to another person,
Were perceived as pleasurable,
Were viewed as a means of self-preservation,
Supported efforts to hide depression from other people, and
Were within their comfort level in social interaction.
What activities have you continued to do to cope with the depressive episode—and why?
Are you doing things differently than you did before? Can you tell me about the differences?
What have you stopped doing that you used to do before you were depressed—and why?
Why do some people continue and adapt activities independently?
Were activities stopped because it was not possible to adapt them, or would clients have benefited from assistance from an occupational therapy practitioner?
Can a mechanism be identified to anticipate the activity trajectory of older adults to prevent decline and maximize participation during a depressive episode?
Does this qualitative assessment have utility across practice settings and age groups?
Conduct a client-centered assessment to understand why activities are continued and stopped, using a semistructured qualitative interview to ascertain the client’s ability to adapt (see Table 1).
Identify potential clients whose participation is compromised when they are unable to independently adapt and who might benefit from occupational therapy intervention.
Consider implementation of key strategies for practitioners identified in Table 2.
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