Being mobile: electric mobility-scooters and their use by older people

The impact of mobility scooter on occupational participation among older adults in Singapore: an exploratory study

PURPOSE

With an ageing population, the use of mobility scooters by community-dwelling older adults with mobility limitations has been increasingly prevalent in Singapore. Their experiences in using mobility scooters remain unclear. This study aimed to explore the impact of mobility scooters on occupational performance and engagement among elderly Singaporeans.

MATERIALS AND METHODS

Mobility scooter users were recruited via purposive and snowballing sampling. Semi-structured interviews were conducted in English or Mandarin via phone call or face-to-face and audio-recorded with permission. Interviews were transcribed verbatim in their original language and translated to English (when applicable) for thematic analysis.

RESULTS

Twelve eligible participants (mean age: 75 years) completed the interviews. They were predominantly female Chinese with 7 receiving training from occupational therapists (OT). Four main themes emerged from the interviews describing their experiences of using mobility scooters: factors of decision-making in getting a mobility scooter, enhanced occupational participation with the use of the mobility scooter, enablers for community participation and barriers to community participation. Despite having barriers, older adults with mobility limitations generally still had positive experiences to continue using mobility scooters to perform occupations in the community.

CONCLUSIONS

This study highlights the benefits of mobility scooters in supporting users' occupational performance and engagement in the community. Continual efforts are required from all stakeholders to provide an accessible environment and improve societal attitudes to further support the mobility scooter users.IMPLICATIONS FOR REHABILITATIONMobility scooter users can be deterred from performing their preferred occupations if they had a prior negative encounter and they mainly rely on self-developed coping strategies to overcome possible barriers in the community.Occupational therapists should identify and address the potential barriers when prescribing mobility scooters to older adult users.Occupational therapists should work collaboratively with other key stakeholders, such as external vendors and government agencies, to co-create a universal guideline to support and safeguard mobility scooter users.

Developing a taxonomy of hazards and hazard mitigation strategies for Motorised mobility scooter users

The increased use of motorised mobility scooters (MMSs) presents a road safety challenge as using a MMS has risks for the user, pedestrians, and other road users. In relation to enhancing MMS driving safety, much of the training and available literature focuses on training vehicular control. Equally important is the need to investigate higher-order cognitive skills involved in driving MMSs, particularly hazard perception. Through a large questionnaire study with MMS users, we develop a taxonomy of the types of hazard MMS users encounter when crossing roads and strategies that are used to negotiate these hazards. Whilst MMS experience modulated hazard perception and strategy use, a core set of hazards and strategies were identified that have policy and practice implications for training interventions and the built environment. Exploration of the advantages and disadvantages of MMS use indicated its impact on various wellbeing outcomes as well as some potential barriers to use.

Public Health-Led Insights on Electric Micro-mobility Adoption and Use: a Scoping Review

The advent of electric micro-mobility (EMM) has transformed the urban mobility landscape, with projections indicating a 5-10% increase in its modal share in European cities by 2030. In this scoping review, we aimed to comprehensively examine the key determinants of EMM adoption and usage from a public health perspective. Sixty-seven articles were included in the analysis, primarily covering e-bikes and e-scooters. The determinants were categorised into two broad categories: (1) contextual determinants that encompass enabling and hindering factors related to legal frameworks, transportation systems and infrastructure, and technology, and (2) individual-level determinants that pertain to intrinsic motivations and deterrents of individuals. Our findings reveal that EMM vehicles are widely perceived as a cost-effective, flexible, ad hoc, and fast mode of transportation within urban areas, augmenting accessibility and connectivity. Additionally, the lightweight, foldable, and transportable nature of these vehicles is highly appreciated by users. However, several barriers have also been identified, including inadequate infrastructure and end-of-trip facilities, limited capability to traverse diverse terrains and trip scenarios, acquisition and maintenance costs, limited carrying capacities, technical failures, and accident risks. Our results suggest that the interplay of contextual enablers and barriers and personal motivations and deterrents drive the emergence, adoption, and usage of EMM. Hence, a comprehensive understanding of both contextual and individual-level determinants is crucial for ensuring a sustainable and healthy uptake of EMM.

Older adults' adaptations to life events: a mobility perspective

Mobility research tends to focus on physical movement and experiences in later life; however, changes in older adult mobility over time remains underexplored. Furthermore, older adults typically experience many life events, some of which result from cognitive and physical decline, and many of which impact mobility. This article aims to explore how life events affect the mobility of older adults over time. We conducted in-depth interviews with 22 older adults aged 55 years and over from Lancashire, United Kingdom. Of these participants, eight lived with memory problems. The findings show that both anticipated and unexpected life events play a profound role in the participants' mobility over time. Retirement, long-term illness and age-related illness were examples of anticipated life events, while the death of a loved one and developing memory problems were examples of unexpected life events. In both cases, participants' made external adaptations, such as moving home, or internal adaptations, such as self-awareness. The findings also emphasise the layered nature of life events and adaptations playing a role in the participants' mobility. Additionally, life events such as developing memory problems showed a domino effect, triggering further life events and adaptations which impacted the participants' mobility. This article emphasises how transition periods can occur before or after a life event, showing that adaptations can be pre-emptive to a life event. Our article contributes to calls for internal adaptations to be fully incorporated into age-related policy and also for age-related policy to be more inclusive for older adults who experience memory problems and dementia.

Perception of autonomy among people who use wheeled mobility assistive devices: Dependence on the type of wheeled assistive technology

We evaluated perceived autonomy among users of different types of wheeled mobility assistive devices (WMADs) across five environments and identified the effect on user autonomy due to specific device characteristics. A study-specific questionnaire was used to assess satisfaction with autonomy of WMAD users in the Home, Buildings Outside of the Home, Outdoor Built, Outdoor Natural Environment, and Transportation. For each environment, 15 contextual factors were rated for their impact on participants' autonomy. Our results revealed that manual wheelchair with add-on (MWC+AO) users had higher overall satisfaction with their autonomy compared to other WMAD users. MWC+AO users reported higher satisfaction with autonomy due to their health conditions compared to other WMAD users across all environments. In Outdoor Natural Environments, MWC+AO users had the highest satisfaction with autonomy across all factors except for negotiating hills. When performing activities in Buildings, MWC users with and without add-ons reported higher satisfaction for all factors compared to power wheelchair users, except for maneuverability on different surfaces. Satisfaction with autonomy regarding contextual factors varied among WMAD users, however, MWC+AO(s) appeared to provide a more balanced sense of autonomy across most factors and environments. More in-depth investigations are required to evaluate impacts of add-on use on autonomy.

The impact of a power mobility device on occupational participation and quality of life for people with chronic diseases: A scoping review

Introduction

The aim was to explore occupational participation and quality of life (QoL) for power mobility device users with chronic disease.

Methods

Arksey and O’Malley’s framework for scoping reviews was used. Six data bases were searched using keywords: wheelchair, scooter, QoL and participation. Data were extracted with coding and thematic analysis performed.

Results

Forty-one articles met the inclusion criteria. An overarching theme of enhanced QoL was identified with subthemes of (i) independence, (ii) enabling participation in instrumental activities of daily living, (iii) enhanced social participation and leisure, (iv) environmental barriers to occupational participation, (vi) power mobility device (PMD) performance concerns impacting occupational participation and (vii) overcoming risk of harm through PMD training.

Conclusion

The scoping review identified a heterogeneity of study designs and outcome measures, which makes comparison between studies difficult. For people with chronic diseases, PMDs improve independence in occupational participation, particularly in IADL, social participation and leisure. Unfortunately, improved QoL was often inferred, without the use of an outcome measure. Areas which impacted occupational participation for PMD users were environmental barriers and a lack of PMD training. Further research is needed to understand the impact of a PMD on QoL and occupational participation for those with chronic disease.

Mobility scooters in urban environments: A research agenda

INTRODUCTION

As our society ages, mobility scooters are a fast-growing mode of transportation. The growing prevalence of mobility scooters as a mode of transportation has the potential to not only affect the lives of older adults who use them but to impact urban environments at large as well as have implications for the safety of pedestrians and of other vehicle users.

GOAL

The goal of this paper is to explore the gaps in the existing literature regarding mobility scooters, laying out key areas for future research.

RESULTS

We propose three areas of research that focus on mobility scooter use by older people: (1) research involving users - impacts on older people employing mobility scooters; (2) studying the impact on urban space - public spaces and passageways used as travel routes, the barriers impeding travel and lack of appropriate parking solutions in the urban environment; and (3) issues of safety - mobility scooter driving and travel regulations and infrastructure design regulations.

DISCUSSION

Addressing these gaps in knowledge has the potential to contribute to the social and physical sustainability of future urban environments as well as to the wellbeing of older adults.

Mobility, Citizens, Innovation and Technology in Digital and Smart Cities

Cities are constantly transforming and, consequently, attracting efforts from researchers and opportunities to the industry. New transportation systems are being built in order to meet sustainability and efficiency criteria, as well as being adapted to the current possibilities. Moreover, citizens are becoming aware about the power and possibilities provided by the current generation of autonomous devices. In this sense, this paper presents and discusses state-of-the-art transportation technologies and systems, highlighting the advances that the concepts of Internet of Things and Value are providing. Decentralized technologies, such as blockchain, are been extensively investigated by the industry, however, its widespread adoption in cities is still desirable. Aligned with operations research opportunities, this paper identifies different points in which cities’ services could move to. This also study comments about different combinatorial optimization problems that might be useful and important for an efficient evolution of our cities. By considering different perspectives, didactic examples are presented with a main focus on motivating decision makers to balance citizens, investors and industry goals and wishes.

A systematic review of public transport accessibility for people using mobility devices

PURPOSE

Being able to access public transport is vital for mobility device users as this is an affordable way of maintaining community connections and participating in activities that promote quality of life. This systematic review investigated literature on public transport access for people using mobility devices, excluding transit restraint and securement literature.

MATERIALS AND METHODS

A systematic review of the peer-reviewed literature in English from 1995 to 2019, with critical appraisal and narrative synthesis.

RESULTS

Twenty-six articles were identified, including 14 studies investigating user experiences, seven examining bus formats and floor layouts, and five focusing on bus ramp incidents and optimal design. Studies were generally observational and descriptive, with 12 including analysis of video data.

CONCLUSION

This is the first systematic review of literature related to the accessibility of public transport for people using mobility devices. Topics such as ramp access have been relatively well-researched, as have the experiences of users. However, many gaps remain and there is a need for research to; address the barriers identified through user experiences, discern the best access to stations and stops, as well as floor formats for people to ingress, manoeuvre and egress from a variety of transport modes, and promote universal design principles in the transport sector. Rehabilitation professionals can use the findings of this review to advocate for, and support people using mobility devices to successfully negotiate public transport.Implications for RehabilitationAccessible public transport is vital to enable people using mobility devices to remain connected in their communities.Despite increased international awareness and adoption of accessibility features by the public transport sector to improve getting to a stop, ingress, manoeuvrability within and egress from conveyances, access for people using wheeled mobility devices cannot be assumed.When prescribing new wheeled mobility devices with clients, rehabilitation professionals and users need to consider public transport access and the suitability of different devices for this purpose.Rehabilitation professionals can undertake skills training with people using wheeled mobility devices to test out access prior to independent travel on public transport and develop strategies to overcome any barriers.

Sunnerhagen K. "The car is my extra legs" - Experiences of outdoor mobility amongst immigrants in Sweden with late effects of polio

BACKGROUND

The aim of the study was to describe the experience of outdoor mobility among immigrants with late effects of polio living in Sweden. There is a need to understand more about this young group of persons since they often have problems with mobility and gait, but they may also face participation restrictions due to issues associated with integration into a new community and culture.

METHOD

A total of 14 young immigrants with late effects of polio participated and were interviewed individually. The study used a qualitative method to explore personal experiences and the interviews were analyzed through an inductive approach, using qualitative content analysis.

RESULTS

The analysis led to a major theme; self-image and acceptance, that comprised a changeable process and experiences of cultural, social, and gender-specific barriers, but also of environmental and personal factors that impacted their outdoor mobility. By using a car, the participants felt they could come across as normal which also increased their self-esteem.

CONCLUSIONS

Independent mobility is a major enabler for ongoing employment and being able to use a car increases the chances for integration into society for young immigrants with late effects of polio. Public transport is not considered to be adequate or efficient enough due to the participants' mobility impairments, but driving can prevent involuntary isolation and facilitate participation. A car can increase quality of life but may also be a facilitator for work and reduce the demand for societal support.

Acute injuries resulting from accidents involving powered mobility devices (PMDs)-Development and outcomes of PMD-related accidents in Sweden

Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular. The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term. Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data (N = 301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single (N = 427) or collision (N = 315). Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007-2016. With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions (N = 427 and N = 316, respectively) and the level of injury sustained in each type of accident is on par. The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb). Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%). Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events. Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.

Does the purchase of a mobility scooter alter physical activity levels in older adults?

Purpose: This cohort study investigated changes in physical activity, community mobility and social participation following the first-time purchase of a mobility scooter.Methods: A national sample of persons aged 65+ years was surveyed using customized semi-structured interviews that explored changes in physical activity via the International Physical Activity Questionnaire modified for the elderly, and community involvement. Participants were recruited at the point of purchase of their first mobility scooter, and interviewed at this time and again at 2 and 6 months post-purchase.Results: Eighteen participants (F = 10, M = 8) aged between 65 and 95 years were recruited. Physical activity levels remained unchanged in 12 participants, and declined by at least one category in five participants. All participants reported improvement to their self-perceived quality of life following acquisition of a mobility scooter. Participants did not access additional forms of physical activity, though nine reported increased social participation. At baseline, five participants stated that the scooter was used for journeys they formerly made by other motorized transport, and by the 6-month interview, this number had risen to 15 participants.Conclusions: It is unlikely that changes in physical activity were related to the ageing process given the relatively short time span of the study. Thus it can be inferred that participants viewed their mobility scooter as a vehicle for maintaining their lifestyle rather than as a means to seek out additional activities. Improvements to perceived quality of life may be attributed to continuing or furthering community and social engagement, and a sense of retained independence.Implications for rehabilitationAn awareness of possible changes in physical activity associated with the purchase of a mobility scooter is needed.The purchase of a mobility scooter provides a viable means of transport to facilitate access to physical activity situations.Over-reliance on a mobility scooter has the potential to decrease health-related physical activity.The development and dissemination of a targeted health message about maintaining (or improving) physical activity levels is warranted to increase the awareness in this growing group of new, and current, mobility scooter riders in an increasingly ageing population.

Services, systems, and policies affecting mobility device users' community mobility: A scoping review: Services, systèmes et politiques influençant la mobilité dans la communauté des utilisateurs d'aides à la mobilité : examen de la portée

BACKGROUND

Opportunities to travel from one place to another in the community, or community mobility, are especially important for mobility device users' ability to participate fully in society. However, contextual challenges to such mobility exist.

PURPOSE

This study summarizes the literature on existing community mobility barriers and facilitators of mobility device users created by services, systems, and policies as defined by the International Classification of Functioning, Disability, and Health (ICF).

METHOD

Arksey and O'Malley's approach for scoping studies was used for the review. The extraction chart was organized following the ICF, and frequency counts were used to report the data.

FINDINGS

The findings suggest that certain factors, such as transportation, open-space planning, and architecture and construction, influence community mobility opportunities. However, little attention has been paid to services, systems, and policies in the research literature, limiting the knowledge on the subject.

IMPLICATIONS

Further research is needed to examine the relationship between specific services, systems, and policies and mobility device users' mobility within their communities.

Perception of needing and using a mobility scooter: a preclinically disabled non-scooter user perspective

Purpose: Older people experiencing a decline in their mobility often choose to use a mobility scooter. They are used by those with mobility impairments to enable them to travel independently and engage in activities outside the home. This project explored the perceptions of mobility scooters by older adults who experience mobility difficulties but do not use mobility scooters. It aimed to understand how scooters were perceived by this group to uncover any barriers to scooter use and to help in predicting future uptake. Materials & Methods: Semi-structured interviews were carried out to enable the elicitation of attitudes and perceptions about mobility decline and mobility scooters. All the interviewees were classified as preclinically disabled so that they had some mobility limitations that would indicate that a mobility scooter could be beneficial to increase their mobility. Results: Non-mobility scooter user are wary of scooter users due to negative experiences interacting with them. Potential personal scooter uptake is viewed with great reluctance and as an indication that they themselves have given up. Conclusions: Older adults with mobility impairments could benefit from using a mobility scooter by gaining an improved quality of life, engagement and social relationships. However the wish to disassociate oneself with ageing or physically decline means that large proportions of this population are unwilling to. Implications for rehabilitation Mobility scooter use can aid those with restricted mobility to increase their independence and quality of life. Stigmatization of and previous negative interaction with mobility scooter users discourage potential users from utilizing them.

Low vision and mobility scooters: the experiences of individuals with low vision who use mobility scooters

Purpose: Older adults with low vision are a growing population with rehabilitation needs including support with community mobility to enable community participation. Some older adults with low vision choose to use mobility scooters to mobilize within their community, but there is limited research about the use by people with low vision. This paper describes a pilot study and asks the question: what are the experiences of persons with low vision who use mobility scooters? Methods: This study gathered the experiences of four participants with low vision, aged 51 and over, who regularly use mobility scooters. Diverse methods were used including a go-along, a semi-structured interview and a new measure of functional vision for mobility called the vision-related outcomes in orientation and mobility (VROOM). Findings: Four themes were found to describe experiences: autonomy and well-being, accessibility, community interactions and self-regulation. Discussion and implications: This study was a pilot for a larger study examining self-regulation in scooter users. However, as roles emerge for health professionals and scooters, the findings also provide evidence to inform practice, because it demonstrates the complex meaning and influences on performance involved in low vision mobility scooter use. Implications for rehabilitation Scooter use supports autonomy and well-being and community connections for individuals with both mobility and visual impairments. Low vision scooter users demonstrate self-regulation of their scooter use to manage both their visual and environmental limitations. Issues of accessibility experienced by this sample affect a wider community of footpath users, emphasizing the need for councils to address inadequate infrastructure. Rehabilitators can support their low vision clients' scooter use by acknowledging issues of accessibility and promoting self-regulation strategies to manage risks and barriers.

Older adults' perspectives on the process of becoming users of assistive technology: a qualitative systematic review and meta-synthesis

PURPOSE

To identify, synthesize, and evaluate existing literature concerning the process of becoming a user of assistive technology (AT).

METHOD

A systematic review and meta-synthesis were carried out. Five bibliographic databases (MEDLINE via PubMed, CINAHL, Web of Science, PsycINFO and SocINDEX) were systematically searched up to 13^th of March 2017, using two sets of search terms: (i) elderly and synonyms and (ii) assistive technology and similar words, and combined with a qualitative research filter. Articles were screened, read and critically assessed. The meta-synthesis was guided by Ricoeur's theory of interpretation.

RESULTS

Seventeen out of 4645 articles were included. Five phases emerged relating to the process of becoming a user of AT: phase A: Evaluating need, phase B: Acknowledging need, phase C: Incorporating the AT into daily life, phase D: Using the AT, and phase E: Future use. Three transitions, describing factors essential to moving from one phase to the next, were identified; from phase A-B: Valued activities are threatened, from phase B-C: Obtaining the AT and from phase C-D: Trust in the AT. No transition was identified from phase D-E.

CONCLUSION

The meta-synthesis led to a deeper understanding of the process of older adults becoming users of AT, by exploring findings across the included articles. The identified phases and transitions in the systematic review serve as an analytical framework for understanding the process from the older adult's perspective. This review advocates for using a client-centred approach throughout the entire delivery process. Implications for rehabilitation The process of the older adult becoming a user of AT involves an individualized time factor, and this supports the practice of individualized follow-up. The process of becoming a user of AT is closely related to self-image; healthcare professionals should support not only the use of AT but also the older adult's emotional adjustment to a new self-image. The process is highly influenced by the older adult's social context; healthcare professionals should consider involving the client's social network in the AT delivery process.

"I'm very visible but seldom seen": consumer choice and use of mobility aids on public transport

PURPOSE

The number of mobility aid users continues to rise as the population ages. While mobility aid users rely on public transport due to its affordability, evidence suggests access can be difficult. This study aims to describe people who use mobility aids to access public transport and the role of public transport access in influencing mobility aid choice.

METHODS

Sixty-seven mobility aid users participated in telephone surveys which predominantly used a structured quantitative format. Data were analysed descriptively and any additional comments were simply categorized.

RESULTS

Thirty-six participants were female (54%), with a total sample mean age of 58.15 years (SD = 14.46). Seventy-two percent lived in metropolitan areas, 48% lived alone, and the sample experienced a variety of conditions including spinal cord injury (37%) and arthritis (18%). Sixty-four percent of all respondents used two or more mobility aids including powered wheelchairs, scooters and walking frames. The most important features when choosing a mobility aid were reliability, turning ability and size. Fifty-two percent of all respondents strongly agreed that public transport is generally accessible.

CONCLUSIONS

While work continues to ensure that public transport vehicles and stations are fully accessible, mobility aid users must manage current infrastructure and access a system which has been shown through this research to have many limitations. Mobility aid users, vendors and health professionals need to work together to identify mobility aids that fulfil needs, and are reliable and safe, so that mobility aid users are both "visible and seen" when accessing the public transport network. Implications for rehabilitation Some mobility aid users experience difficulties accessing and using public transport and further research is required to ensure the whole public transport network is fully accessible to people using mobility aids. Many people have more than one seated mobility aid, suggesting people can choose different aids for different purposes and environments. Health professionals may need to increase their involvement in assisting individuals to select and use mobility aids.

Data Logger Technologies for Powered Wheelchairs: A Scoping Review

In recent years, studies increasingly employed data loggers to record the objective behaviors of powered wheelchair users. Of the data logging work reported in the literature, the technologies used offer marked differences in characteristics. In order to identify and describe the extent of published research activity that relies on data logger technologies for powered wheelchairs, we performed a scoping review of the scientific and grey literature. This scoping review, complementary to a previous one related to manual wheelchairs, is part of a process aiming to help further the development and increase the functionality of data loggers with wheelchairs. Five databases were searched: Medline, Compendex, CINAHL, EMBASE, Google Scholar. Sixty papers were retained for analysis. The most frequently used technologies were all installed on the wheelchair: 19.0% were accelerometers, 14.6% were pressure sensors or switches, 13.9% were odometers, 10.9% were global positioning systems, 9.5% were tilt sensors, and 7.3% were force-sensing technologies. The most reported outcomes were pressure-relief activities (17.3%), distance traveled (9.3%), mobility events (8.9%), acceleration (8.5%), and sitting time (6.9%). Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to optimize the practicality of wheelchair data loggers.

The meaning ascribed to wheeled mobility devices by individuals who use wheelchairs and scooters: a metasynthesis

PURPOSE

To synthesize qualitative study findings on the meaning ascribed to wheelchairs and wheeled mobility devices (WMD) by WMD users.

METHOD

Bibliographic databases were systematically searched up to January 2015 to identify relevant papers. Reviewers selected studies, assessed methodological quality and thematically synthesized findings using a metasynthesis process described by Thomas and Harden (2008).

RESULTS

Twenty articles were included. Four descriptive themes emerged: physical environment interaction; sociocultural experiences; participation in activities and occupations; and WMD-self relationship. WMD use was found to be a complex experience that can fluctuate through interaction with aspects of the environment and opportunities for participation. The analytic theme, dynamic duality of WMD experience, addressed the simultaneous enabling and disabling aspects of WMD use.

CONCLUSIONS

Metasyntheses enable researchers to gain a deeper understanding of issues by examining findings across studies. Findings of this study provide a framework for understanding the complexity of WMD use. The framework has practical applications for clinicians and users of WMD in understanding the experience of WMD to be neither singular nor static. Implications for Rehabilitation The meaning of wheeled mobility device (WMD) use is dynamically influenced by the environment and opportunities afforded for occupational and social participation. A duality of experiences can emerge for WMD users, where wheeled mobility use can be at the same time positive and negative, based on the interaction with the environment. Clinicians need to determine the meaning that each individual user ascribes to the WMD, and to consider how that meaning may change over time. By understanding the meaning ascribed to WMD use by individuals, clinicians can be better prepared to work with the WMD users to address negative reinforcers of the experience in physical and sociocultural environments as well as highlighting the positive experiences.

Adult Scandinavians' use of powered scooters: user satisfaction, frequency of use, and prediction of daily use

PURPOSE

To investigate user satisfaction with characteristics of powered scooters (scooters), frequency of use, and factors predicting daily scooter use.

DESIGN

Cross-sectional.

SAMPLE

Adult scooter users (n = 59) in Denmark and Norway, mean age 74.5 (standard deviation 12.3) years.

METHODS

Structured face-to-face interviews. The NOMO 1.0, the Quebec User Evaluation of Satisfaction with assistive devices (QUEST 2.0), and a study specific instrument were used to collect data. Descriptive statistics were applied, and regression analyzes were used to investigate predictors for daily scooter use. The International Classification of Functioning, Disability and Health (ICF) served as a framework for classifying variables and guiding the investigation.

RESULTS

Satisfaction with the scooter characteristics was high with most participants being very satisfied or quite satisfied (66.1-91.5%). Most scooters were used daily (36.2%) or several times a week (50.0%). User satisfaction with safety of the scooter [odds ratio (OR) = 11.76, confidence interval (CI) = 1.70-81.28] and reduced balance (OR = 5.63, CI = 0.90-35.39) increased the likelihood of daily use, while reduced function in back and/or legs (OR = .04, CI = 0.00-0.75), tiredness (OR = .06, CI = 0.01-0.51), and increased age (OR = .93, CI = 0.87-1.00) reduced the likelihood of daily use. 52.8% of the variance was explained by these variables.

CONCLUSIONS

User satisfaction was high, and most scooters were used frequently. User satisfaction with safety, specific functional limitations and age were predictors for daily scooter use. Implications for Rehabilitation Scooters seem to be a beneficial intervention for people with mobility impairment: user satisfaction and frequency of use are high. Users' subjective feeling of safety should be secured in the service delivery process in order to support safe and frequent scooter use. Training of scooter skills should be considered in the service delivery process.

Is it love or loneliness? Exploring the impact of everyday digital technology use on the wellbeing of older adults

Loneliness is a prevalent phenomenon within the older adult population. Previous literature suggests that technology use, specifically internet use, can alleviate loneliness and improve wellbeing. This research study follows 32 people over the age of 65 using a digital technology for six months. A mixed-method approach was used to collect quantitative and qualitative data throughout the time period. The repeated questionnaire measured changes in frequency of use, emotional attachment towards a device, a sense of belonging and perceptions of self-worth, whilst an event-based diary was used to note usages and influences of technology on lifestyle. Results revealed positive relationships between frequency of use and emotional attachment and frequency of use and perceptions of self-worth. There was no significant relationship between frequency of use and a sense of belonging for the aggregate data. There was, however, a negative relationship between emotional attachment towards a device and a sense of belonging, suggesting a fine balance between technology use to improve self-esteem through connections with social networks and an over-dependence on technology that can actually reduce feelings of belonging.

Meanings and experiences of assistive technologies in everyday lives of older citizens: a meta-interpretive review

PURPOSE

The purpose of this study was to synthesize the available qualitative studies on the meaning of assistive technologies (AT) in elderly people's everyday lives in order to identify central concepts, themes, and findings from existing research.

METHOD

A systematic search of the literature was conducted, using predetermined search strategies. Exclusion criteria were, in accordance with the meta-interpretive approach, developed iteratively during the reading of abstracts and articles. Interpretations from the studies were used as data for thematic analysis and synthesis of findings.

RESULTS

Review of these studies show that older people not only have positive attitude towards AT, but also that acceptance of technologies is a potentially stressful process where trust towards technologies and other people are of importance. Older people have ambivalent experiences with technology, as it gives rise to possibilities as well as constraints, and safety as well as worries. AT enact sometimes conflicting values related to self and society.

CONCLUSIONS

Although AT seem to support societal discourses on active aging, the empirical studies in this field show that the technologies enter older people's lives in complex ways, enacting social values and ambivalences and interact with caretakers, relatives and other actors, within specific institutional settings. Implications for rehabilitation In implementing AT, attention should be paid to ambivalences and conflicting values enacted by AT in older people's lives In implementing AT, attention should be paid not only to independency but also to the eventually dependencies, created by the use of AT.

Transport, driving and ageing

Transport is the invisible glue that holds our lives together, an under-recognized contributor to economic, social and personal well-being. In public health terms, the medical profession had previously allowed itself to focus almost exclusively on the downsides of transport. However, the research basis for transport, driving and ageing is steadily evolving and has important academic and practical considerations for gerontologists and geriatricians. For gerontologists, teasing out the critical role of transport in the health and well-being of older people is an imperative, as well as the key challenges inherent in transitioning from driving to not driving. The safe crash record of a group with significant multi-morbidity allows us to focus on the remarkable strategic and adaptive skills of older people. From a policy perspective, strictures on older drivers are an exemplar of institutionalized ageism. For geriatricians, a key challenge is to develop strategies for including transportation in our clinical assessments, formulating effective strategies for assessment of medical fitness to drive, incorporating enabling techniques, giving due consideration to ethical and legal aspects, and developing and promoting multi-modality and alternative transportation options.

The impact of mobility scooters on their users. Does their usage help or hinder?: A state of the art review

As older people start to have difficulty in walking many choose to use a mobility scooter to help them move around. Benefitting from improved design, mobility scooters are becoming an increasingly popular mobility device and are a common sight on many streets. However, very little is known about their usage or their impact in terms of either quality of life or functional health. Whilst mobility scooters may help to improve the quality of life of their users, it is also possible that the sedentary nature of their usage results in a decline of physical functionality and therefore reduced capabilities. Before any substantial research can be carried out it is crucial to understand the importance of a mobility scooter on the lives of the people that use them and to review the initial research published on the effect of scooter use on physical health. This paper is a state-of-the-art review. It describes the current research knowledge on mobility scooters, shows where gaps in knowledge exist and where future research needs to focus.

Prescribing mobility scooters in Australia: Occupational therapists' narratives

BACKGROUND/AIM

In order for older people to remain active and engaged as they age they need to be mobile in the community. One way of maintaining community mobility is through the use of a mobility scooter. Occupational therapists are key health professionals involved with assessing for mobility scooters yet minimal research exists into the experience. This study sought to explore occupational therapists' experiences of assessing for mobility scooters to older people in Australia.

METHODS

A qualitative study was undertaken in which narratives were solicited from 18 occupational therapists involved in scooter assessment to people aged 65 or over. Interview data were analysed following narrative analysis guidelines.

RESULTS

Analysis revealed six predominant narratives ranging from two success stories to the narrative of disempowerment and stories of negotiating risk. Experienced therapists had more resources and skills to draw on to manage the complexity of prescription and negotiation of risk.

CONCLUSIONS

Findings from this study suggest that novices or those new to mobility scooter prescription need to access supervision and support to improve the chances of having a successful outcome. Further exploration of how therapists manage situations of vulnerability and risk is warranted to prevent burnout for therapists and reduce the likelihood of restricting clients' occupational potential. Continuing professional development activities are also recommended.

Motorized mobility scooters: the use of training/intervention and technology for improving driving skills in aging adults - a mini-review

BACKGROUND

Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths.

OBJECTIVE

The aim of the current review was to summarize results from clinical studies regarding the enhancement of MMS driver safety with a primary focus on improving driving skills/performance using clinical approaches. We addressed three main objectives: (1) to identify and summarize any available evidence (strong, moderate, or weak evidence based on the quality of studies) regarding improved driving skills/performance following training/intervention; (2) to identify types of driving skills/performance that might be improved by training/intervention, and (3) to identify the use of technology in improving MMS performance or training procedure.

METHODS

Articles were searched for in the following medical and engineering electronic databases: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, CINAHL, ERIC, EI Compendix, IEEE Explore, and REHABDATA. Inclusion criteria included: aging adults or those with ambulatory problems, intervention or targeted training, and clinical trial. Outcomes included: MMS skills/performance.

RESULTS

Six articles met the inclusion criteria and are analyzed in this review. Four of the six articles contained training approaches for MMS drivers including skill trainings using real MMS inside and outside (i.e. in the community) and in a 3D virtual environment. The other two studies contain infrastructural assessments (i.e. the minimum space required for safe maneuverability of MMS users) and additional mobility assistance tools to improve maneuverability and to enhance driving performance.

CONCLUSIONS

RESULTS from the current review showed improved driving skills/performance by training, infrastructural assessments, and incorporating mobility assistance tools. MMS driving skills that can be improved through driver training include: weaving, negotiating with and avoiding pedestrian interference, simultaneous reading of signs and obstacle avoidance in path, level driving, forward and reverse driving, figure 8s, turning in place, crossing left slope, maneuvering down a 2-inch curb, and driving up and down inclines. However, several limitations exist in the available literature regarding evidence of improved driving skills/performance following training/intervention, such as small sample sizes, lack of control groups and statistical analysis.