Journal article review: Dying of Boredom
Dying of Boredom: An exploratory case study of time use,
apparent affect, and routine activity situations on two Alzheimer’s
special care units. American Journal of Occupational
Therapy reviewed by Stephen Wey, Senior Lecturer at York
St John University.
Stephen is currently engaged in doctoral
studies related to ‘the dynamic assessment of zones of proximal
development in the context of dementia rehabilitation and
enablement’
This powerful and challenging new paper by
Wendy Wood, Jenifer Womack and Barbara Hooper, discusses selected
findings from a larger study conducted by Wendy Wood into
opportunities for meaningful occupation and use of time by people
with dementia resident in two “Special care units” in the United
States. From this standpoint it can be read as an empathic and
insightful study of the occupational needs, and striving for
occupation, of people with dementia in care settings. As such it
will be of particular interest to those of us who work with people
who have dementia. However, it would be a mistake to see it as
limited to any one field of practice. Anyone who is familiar with
Wendy Wood’s work will know that she has carried out many studies
that explore the origins, supports for, and limits of occupation
and occupational behaviour; in particular, the relationship between
ecological setting, occupational behaviour and quality of life. So
this study is also of importance to anyone interested in exploring
some of the central and foundational questions of occupational
science.
“I’m dying of boredom”: Wood describes in her
field notes from the study how she was greeting with this statement
by Joseph, one of the residents, and that it haunted her throughout
the study. The two Special Care Units (SCUs), where the study was
conducted, were each purpose built with the needs of people with
dementia in mind. For methodological reasons Wood chose two units
that had good reputations for quality of care but that represented
divergent social and physical environments. One was described as
more “homelike” with seven residents, the other as a more
“traditional” nursing home environment with 27 residents.
The methodology involved a process of
structured observations using observers trained to use a tool
developed by Wood. The tool used was the Activity in Context and
Time (ACT) tool, which enabled recording of residents’ use of time,
the immediate socio-physical environmental context, and the
resident’s affective state at the time. Affect was used to inform
hypotheses regarding the person’s well-being, in a manner that
appears broadly similar to the approach used in the Bradford
Dementia Group’s Well-Being Profiling and Dementia Care Mapping
tools. The study discusses the findings of these observations in
relation to several case examples, which not only helps place the
findings in a human context but also brings home some of the
emotional depth of the residents’ experience.
The study focused on meaningful use of time
and emotional well-being – both issues that previous research has
shown strongly correlates with the socio-cultural and physical
environment for people with dementia. In particular it discusses
the concept of excess disability (i.e. disability beyond what is
attributable to disease process alone); such as that which results
from care practices that do not support or sustain existing skills
or provide activity opportunities that tap into the person’s full
range of skills and capacities. In each unit it was found that
individuals were spending inordinately large periods of time dozing
or unengaged and that only a small percentage (5-6%) of time was
spent engaging in meaningful direct interactions with staff
members. The study did not identify significant differences between
the two settings, despite the lower numbers of residents and more
“homelike” environment in one setting.
One important finding was that many everyday
occupations that people with dementia themselves were attempting
(not always successfully) to engage in were often seen but not
noticed. Additionally, in some instances attempts at meaningful
occupations were pathologised; for example a person seeking to walk
outside at night and expressing anger at a locked door was
construed merely as symptomatic of “sundowning” rather than any
attempt being made to explore the unmet occupational and emotional
needs being expressed. On the other hand, people spending many
hours disengaged, withdrawn or asleep was seen as normal.
The authors draw attention to the fact that,
like many care settings here in the UK, there is a notable absence
of any support for occupations of people with dementia by
occupational therapists and end with a plea for greater involvement
and suggestions for future research.
This study is highly recommended reading. It
demonstrates with great power how actively observing, noticing and
building on the striving for meaningful and relevant occupation,
and contact of people with dementia themselves, is an essential
requirement for creating opportunities for enhancing quality of
life and overcoming excess disability for this client group.
If you would like to read this research
article the reference is:
Wood W, Womack J, Hooper B (2009) Dying of
Boredom: An exploratory case study of time use, apparent affect,
and routine activity situations on two Alzheimer’s special care
units. American Journal of Occupational Therapy, 63(3)
337-350