Percepção de Terapeutas Ocupacionais sobre as ocupações engajadas realizadas por pessoas idosas institucionalizadas, antes e durante a pandemia de COVID-19: facilitadores e barreiras

Abstract

Nursing homes for older adults integrate long-term care, and are devices dedicated to housing and providing comprehensive care to older adults. Maintaining the involvement of older adults in occupations is one of the challenges experienced by occupational therapists in these institutions. Among the various types of occupations, those which are called engaging contribute to the identity and meanings of life. The performance of these occupations, as well as the routine of the older adults in nursing homes was changed during the COVID-19 pandemic due to the higher frequency of outbreaks and the incidence of deaths. Furthermore, there was an impact on the health conditions of the older adults and on the physical and emotional burden of the health teams. The objective of this study was to understand the perceptions of occupational therapists about the engaging occupation performed by older adults in nursing homes, and to unveil the facilitators and barriers to performing these occupations considering the periods before and during the COVID-19 pandemic. A qualitative investigation based on sociological phenomenology was conducted. The 17 participants were occupational therapists who worked in philanthropic and private nursing homes in the city of Belo Horizonte and metropolitan region, Minas Gerais, Brazil. Data collection took place through semi-structured interviews and a questionnaire. The criterion that guided the number of participants was saturation, and the data were analyzed using the thematic content analysis technique. After analysis, the results were grouped into three themes: “Perceptions about engaging occupations”; “Facilitators and difficulties for performing engaging occupations by older adults”; and “The COVID-19 pandemic and the new routine for carrying out engaging occupations”. Occupational therapists perceived the engaging occupations as pleasurable activities and present in the occupational history of the older adults. The therapeutic bond, the professional’s autonomy and teamwork were reported regarding the facilitators. The difficulties perceived were: the broken/poor routine at the nursing home, non-identification of the nursing home as their home by the older adults, and the reduced cognitive capacity of the older adults. Respondents also highlighted the turnover of professionals and work overload. For the COVID-19 pandemic and the new routine for carrying out of engaging occupations, they pointed to changes in the participation of the older adults in occupations, the need to incorporate new habits, the demands for changes in physical contexts and in relationships with older adults in nursing homes. Furthermore, they signaled the need to adapt the practices of occupational therapists. These results may contribute to improving the practice of occupational therapists, enabling the offer of engaging occupations anchored in the experiences of older adults in nursing homes.