Participation Challenges and Their Determinants in Older Adults with Subjective Cognitive Decline: Occupational Therapists’ Perspectives

Older adults with subjective cognitive decline (SCD) experience emotional distress and report challenges or withdrawal from activities that support health and well-being. This qualitative descriptive study explored participation challenges of older adults with SCD, and their determinants. Data were collected through focus groups with 15 occupational therapists (OTs) working with older adults with SCD in community-based clinical settings, and analysed using deductive content analysis. OTs identified two key participation challenges: limited participation in healthy lifestyle activities, and negative occupational experiences (e.g., reduced enjoyment and diminished sense of competence). Personal determinants were subtle (yet normal) cognitive changes, ineffective strategy use, and limited knowledge about cognition and factors influencing it. Motivational determinants were adverse emotions and negative self-perceptions. Environmental determinants were insufficient social support and internalized age-related stigma. Future intervention for older adults with SCD should focus on supporting occupational experience and participation by addressing knowledge, skills, beliefs, and emotional regulation.