The methodological approach was deliberately intimate. The researchers used semi-structured interviews with open-ended questions, allowing participants to describe their days, their meals, their bodies and their frustrations in their own words. Interviews, which lasted between 25 and 47 minutes, mostly took place in residents’ own living rooms and were audio-recorded and transcribed verbatim. The team then applied a phenomenological analysis method developed by Amedeo Giorgi, a framework designed to distil the essential structure of lived experience from first-person accounts. The analysis moved iteratively through four steps, from an initial holistic reading to coding with participants’ own phrases, such as the study’s evocative title phrase about swapping cake for crispbread, and finally to consensus themes agreed between two researchers.

The eleven participants, six men and five women aged 69 to 87, had body mass indices ranging from 31 to 61. Their marital histories varied widely: one was married, three widowed, three divorced and four had never married. From the transcripts, three themes emerged that the researchers say encapsulate the essence of daily life with obesity in an institutional setting: living and coping with an oversized body, wanting to keep going, and navigating the possibilities and barriers of the nursing home’s social and institutional environment.

The first theme reveals how profoundly body and self are intertwined. Every participant described being intensely aware of their body, and that awareness shaped their actions throughout the day. Some used gentle euphemisms such as being well-fed or horizontally challenged, while others were blunter. Crucially, residents tended to describe their bodies not in abstract terms but through function: what they could do and what they could not. One participant, given the fictional name Richard, framed his bodily experience entirely through mobility. How do I see my body? Well, one part of it is that I cannot walk, you know, I’m just sitting in this chair, he told the researchers. In contrast, Adam described himself as overweight but said his body felt good because it did not restrict him from being physically active.

Weight loss emerged as a powerful lens through which residents re-experienced their bodies. Paul, who lost 40 kilograms around the time he moved into the nursing home, described the change in purely physical terms: you can feel it in the legs, you can feel that there is less to drag along. Helen, who cared about dressing neatly, felt her size acutely when her clothes grew tight, saying she did not feel comfortable in clothes she otherwise liked. For several residents, the move into the nursing home itself triggered weight loss and improved function, which in turn became an incentive to continue the positive changes. All eleven participants expressed a desire to lose or maintain weight, and each had developed personal strategies: replacing cake with crispbread or fruit, arranging controlled portions with staff, monitoring what went onto their plates, or, in one case, skipping lunch entirely. Peter, who lost 30 kilograms after moving in, even traded one of his two daily slices of rye bread for a hot dish when meatballs appeared on the lunch trolley, a kind of informal calorie arithmetic conducted meal by meal.

The second theme, wanting to keep going, captures a strikingly energetic stance toward life. Rather than resigning themselves to decline, residents expressed a strong desire for continuity, renewal and doing as much as possible, with or without assistance. Lis, who received help with personal hygiene but insisted on doing as much as she could herself, arranged with the night staff to have breakfast and medication delivered before dawn so she could begin crocheting at five in the morning. That craft, she explained, fills up her entire day. Henry, meanwhile, refused the easier option of using a bottle beside his bed, choosing instead to shuffle to the toilet three, four or five times a night, a decision he framed as refusing to take the easy way out.

Exercise was another expression of this drive. Peter, who uses a walker, took four walks a day around the nursing home, saying it keeps him in shape. Others used wall bars and double-pedal trainers. The desire for change extended beyond fitness: residents longed for more outdoor trips, with one, Mary, willing to leave at nine in the morning to visit a newly opened amusement park. Others wanted changes to the food selection, from traditional Danish dishes to ethnic cuisine, or the removal of ingredients they disliked. The researchers note that this keep-going attitude was not simply a byproduct of weight-loss efforts but seemed to be an inherent characteristic of the group, an eagerness to reshape their immediate circumstances rather than stagnate.

The third theme maps the institutional terrain on which these personal battles are fought, and it cuts both ways. On the positive side, the physical environment offered exercise opportunities residents had lacked in their previous homes, and supportive staff proved invaluable for weight management. Paul praised a staff member as the best at making him low-fat food, and others described staff serving oatmeal without raisins, helping with finances and encouraging outings. For residents who built such relationships, the staff became a lever for influencing the institutional framework itself, shaping when and what food was provided.

But the institutional setting also imposed barriers. Staff busyness and shortages meant some residents could not get the help they needed, one could not go to bed at her preferred time, and several could not go outdoors because the assistance required was unavailable. Social dynamics added another layer of difficulty. Participants described feeling different from residents with cognitive impairments, keeping to themselves, and in some cases using starkly distancing language, referring to other residents as them. Helen avoided communal cake touched by wandering residents with dementia. The researchers observe a painful paradox: being in the nursing home was partly a consequence of their oversized bodies, since they needed daily help, yet placement meant living among people from whom they felt estranged. Volunteers, by contrast, opened doors that routine staffing could not, taking residents rickshaw cycling, shopping and visiting, restoring access to the outdoors and to companionship.

The findings carry practical weight for occupational therapy and nursing care. Because routines, habit change and environmental adaptation are central to successful weight management, the authors argue that occupational therapists are well positioned to design interventions that support residents’ self-reliance, preserve preferred routines and embed physical and social cues that encourage weight loss where it is beneficial. They also caution that nutritional risk and malnutrition, including low protein intake, can be overlooked in older adults with overweight or obesity, underscoring the need for staff education. The study has limitations: participants were recruited by convenience sampling and were relatively well-functioning and articulate, so the findings may not transfer to all residents, and further research is needed on residents unable to verbally express their preferences. Still, as the first study of its kind, it replaces a one-dimensional picture of decline with something more nuanced: older people actively calculating, negotiating and striving, one slice of bread and one early-morning crochet session at a time, to keep going on their own terms.

Subject of Research: Everyday life experiences of nursing home residents living with obesity

Article Title: From cake to crispbread – giving voice to nursing home residents with obesity and their experiences of everyday life

Article References: Holt Bentz, H., Maersk, J. L., Dynesen, A. W., & Lindahl-Jacobsen, L. E. (2025). From cake to crispbread – giving voice to nursing home residents with obesity and their experiences of everyday life. Scandinavian Journal of Occupational Therapy, 32(1), Article 2577287. https://doi.org/10.1080/11038128.2025.2577287

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2577287

Keywords: obesity, nursing homes, older adults, occupational therapy, qualitative research, phenomenology, weight management, everyday life, geriatrics, Denmark, institutional care, staff support

The study, led by Jessica Vollertsen of Linköping University together with Mathilda Björk, Anna-Karin Norlin, and Elin Ekbladh, recruited 48 working-age individuals in Sweden who had experienced a stroke within the previous five years and who reported fatigue. All had been gainfully employed at the time of their stroke. The participants, 37 of whom were women, were interviewed using the Swedish version of the Worker Role Interview, a semi-structured assessment grounded in the Model of Human Occupation that rates sixteen psychosocial and environmental factors on a four-point scale indicating whether each item interferes with or supports return to work. A questionnaire adding demographic data, the Mental Fatigue Scale, and the Hospital Anxiety and Depression Scale completed the picture. Data were analysed with a qualitative abductive content analysis complemented by descriptive statistics, and the study was approved by the Swedish Ethical Review Authority.

The technical profile of the sample underscores why post-stroke fatigue deserves attention as an obstacle to employment. On the Mental Fatigue Scale, 89 percent of participants reported mental fatigue, most at moderate to severe levels, even though the majority did not show clinically significant depression or anxiety. At interview, 96 percent were employed, but only 15 percent were working full-time; 58 percent worked reduced part-time schedules of 25 to 75 percent, and 23 percent remained on full-time sick leave. The Worker Role Interview ratings revealed a telling pattern: the items most often rated as supportive of returning to work were enjoying work, appraising work expectations, and commitment to work, while perceptions of the work environment, expectations of job success, and pursuing interests were most often rated as interfering. In other words, motivation was rarely the problem. Capacity and context were.

The qualitative analysis produced two overarching categories. The first, re-evaluating work ability while experiencing fatigue, captures how participants confronted an altered, fluctuating capacity that often manifested through memory difficulties, impaired concentration and multitasking, and heightened stress sensitivity. This altered capacity maps onto disruptions in what occupational scientists call personal causation, the appraisal of one’s abilities and the confidence to use them effectively. Participants described learning to recognise early warning signs of fatigue, because ignoring them could trigger headaches, migraines, or exhaustion lasting from a single day to a full week. Crucially, because the impairment was largely invisible, participants struggled not to express their needs but to have them understood and regarded as legitimate by supervisors, co-workers, and external contacts such as customers. Concrete needs, like sensitivity to noise or light, were easier for employers to accommodate than task-related needs, which were frequently dismissed.

The social architecture of the workplace emerged as decisive. Supervisors who actively sought to understand the nature of fatigue were described as crucial, yet frequent leadership changes repeatedly forced participants to re-explain their condition, eroding continuity and trust. One participant recounted how a supportive supervisor had arranged adapted work tasks, only for the next supervisor to remove that possibility. Close working relationships with colleagues were especially valuable because familiar co-workers could notice subtle signs of fatigue and informally adjust workloads. Gradual return-to-work programs and work training helped participants understand their changed abilities, but several experienced an abrupt withdrawal of vocational rehabilitation support the moment they reached full-time hours. Some also reported external pressure from employers or the Social Insurance Agency to increase working hours prematurely, leading to relapses and renewed sick leave, an experience one participant described as being forced to crash three or four times to prove the limitations were real.

Outside the workplace, the study documented how everyday life shaped work ability in a continuous feedback loop. Fatigue left no buffer for unexpected events, so a child missing the school bus or misplaced keys could drain enough mental energy to derail an entire workday. Participants engineered elaborate routines, planning clothing the night before, using calendars and reminders, and keeping their homes meticulously organised, because, as one put it, a cluttered mind requires order and tidiness around it. All participants emphasised scheduling rest and recovery into their days, whether through sleeping, lying in a dark room, pausing during walks with a carried yoga mat, or retreating discreetly to restrooms at work. Remote work arrangements, accelerated by the COVID-19 pandemic, were welcomed because eliminating commutes and using home rest areas conserved scarce energy. Yet the researchers highlight a central paradox: structure and routine are the very strategies needed to manage fatigue, but fatigue itself makes those routines difficult to establish and maintain.

The second category, redefining identity in the context of everyday life, is arguably the study’s most striking contribution. Many participants had built careers around helping others and defined themselves through high performance, making it emotionally wrenching to reconcile current limitations with previous expectations. Family members, witnessing the toll of fatigue firsthand, often questioned whether participants should work full-time at all, fearing another stroke. Energy limits strained parental roles, with one mother describing how work overload left her without the energy to cook proper meals for her children, and reshaped spousal dynamics, sometimes producing closeness through emotional support and sometimes provoking worry about how long a partner would tolerate the changes. Deliberate occupational choices, such as moving closer to work or downsizing housing, conferred a sense of control, whereas giving up cherished social and physical activities was experienced as loss and grief. One participant captured the arc from mourning to acceptance with the phrase: this is the new me, Eva 2.0.

From a clinical standpoint, the authors argue that sustainable return to work cannot be achieved through rehabilitation that treats work in isolation. Because challenges at work and at home proved to be integral to the same adaptive process rather than parallel problems, they call for person-centred rehabilitation that integrates work and everyday life, supports the reconstruction of occupational identity, and enables engagement in meaningful activities despite fatigue. The findings align with the Action Plan for Stroke in Europe 2018 to 2030 and Sweden’s integrated care reform, both of which emphasise person-centred, preventive, and long-term support. The researchers also caution that previous studies have focused overwhelmingly on the binary outcome of whether people return to work, while the sustainability of that return over time has been comparatively neglected, leaving clinicians without evidence-based guidance for the long tail of recovery.

The study has limitations worth noting. Recruitment relied solely on Facebook groups for stroke survivors, which may have excluded marginalised populations and limits generalisability, and interviews were conducted by telephone without audio recordings, restricting verbatim analysis, a constraint the authors offset by conducting 48 interviews to ensure sufficient information power. The COVID-19 pandemic also overlapped with early data collection, although recruitment continued post-pandemic. Still, the scale and depth of the qualitative dataset make this one of the richest accounts to date of how fatigue reshapes working life after stroke. The message for employers is concrete: flexible task and schedule adjustments, consistent supervisory relationships, systematic information about post-stroke fatigue, and continued individualised follow-up beyond the return to full-time hours are not accommodations of convenience but prerequisites for keeping skilled people in the workforce. For clinicians, the message is equally clear: supporting someone back to work after stroke means treating the return not as an event to be achieved, but as an ongoing negotiation between a changed self and a demanding everyday life, one in which identity, not just capacity, must be given time to heal.

Subject of Research: How post-stroke fatigue affects sustainable return to work among working-age stroke survivors

Article Title: Return to work with fatigue after stroke: A complex occupational adaptation process

Article References: Vollertsen, J., Björk, M., Norlin, A.-K., & Ekbladh, E. (2025). Return to work with fatigue after stroke: A complex occupational adaptation process. Scandinavian Journal of Occupational Therapy, 32(1), 1-13. https://doi.org/10.1080/11038128.2026.2613621

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2613621

Keywords: post-stroke fatigue, return to work, stroke rehabilitation, occupational therapy, occupational identity, Worker Role Interview, Model of Human Occupation, vocational rehabilitation, mental fatigue, workplace accommodation, everyday life, person-centred care