Assistive Device Use among Community-Dwelling Older Adults: A Profile of Canadians Using Hearing, Vision, and Mobility Devices in the Canadian Longitudinal Study on Aging

Assistive device utilization among disabled elderly in China: A cross-sectional study

OBJECTIVE

This study aimed to examine the characteristics of assistive device users and influencing factors among disabled elderly in China.

METHODS

A total of 13,510 disabled elderly in Sichuan Province were surveyed. Disability was assessed using the Barthel Activities of Daily Living Scale, mental status, sensory perception, and social engagement evaluation. Univariate analysis and logistic regression analysis were employed to identify the impact factors.

RESULTS

The prevalence of assistive device utilization among participants was 79.2% (10,700/13,510, 95% CI 78.5%-79.9%), with the wheelchair being the most commonly used device. Various factors were found to influence the usage of the device, including disability level, somatic disability, age, caregivers, income, caregiver fees, and living situation (p < .05). Additionally, several factors were identified associated with the frequency of device usage, such as somatic disability, education background, income, caregiver fees, living situation, access to acquire assistive devices, duration of assistive device usage, education on assistive devices, and satisfaction level (p < .05).

CONCLUSIONS

The use of assistive devices among elderly individuals in China is prevalent. There are many factors that affect the use of assistive devices, which can provide a reference for the formulation of policies in the field of assistive devices.

Assistive devices non-use, abandonment, or non-adherence? Toward standard terminology for assistive devices outcomes

For individuals with disabilities, failure to use prescribed assistive technology devices (ATDs) according to professional recommendations can have detrimental health consequences. The literature has employed various terms to describe this phenomenon such as nonuse, abandonment, and non-adherence to characterize this behavior, lacking clear and standardized definitions. Consistent use of a standardized language is critical for advancing research in this area. This study aims to identify and describe the concepts related to the failure to use prescribed ATDs, along with the associated contexts, and proposes a framework for standardizing terminology in this domain. A narrative literature review encompassing studies from inception to June 2023 was conducted to elucidate these concepts. Out of 1029 initially identified articles, 27 were retained for in-depth analysis. The review unveiled a significant inconsistency in the use of terms like nonuse, abandonment, noncompliance, and non-adherence. Some articles even employed these terms interchangeably without clear definitions. Only 10 of the 27 reviewed articles provided definitions for the terminology they used. This highlights the crucial need for adopting valid conceptual models to select appropriate terms. Researchers are strongly encouraged to furnish operational definitions aligned with theoretical models and relevant to their research context to advance this field consistently.

Psychosocial predictors of mobility assistive devices non-adherence among older adults

Background: Mobility assistive devices (MADs) provide support to older adults to improve their quality of life; however, research shows that as many as 75% of older adults are non-adherent to prescribed MADs. This study investigated the psychosocial factors that predict non-adherence to MADs among older adults.Methods: A sample of Canadian older adult MADs users who resided in a long-term care facility was included. The data was collected using the Psychosocial Impact of Assistive Devices Scale (PIADS), and the Medical Outcomes Study Social Support Survey (mMOS-SS). Data analysis was performed using SPSS 28. Descriptive statistics were used to describe the sample and the study variables. Pearson correlation coefficients were used to evaluate the association between the study variables. Variables that were associated with non-adherence in a univariate analysis were subsequently entered into a multiple regression analysis.Results: The sample comprised 48 residents (26 females and 22 males), with a mean age of 86.8. In the univariate analysis, scores from the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, and the Social Support scale were significantly correlated with non-adherence (p < 0.05). In the multiple regression analyses, only Self-esteem significantly predicted non-adherence (p < 0.05), and this model explained between 43.5 and 54.3% of the variance in non-adherence.Conclusion: This study revealed that the Self-esteem construct, which includes several concepts related to psychological well-being, was the only significant predictor of non-adherence among the studied sample of older adults. The clinical implications of the findings are subsequently discussed.

Influence of Hearing Loss on Social Participation in Older Adults: Results From a Scoping Review

This study aimed to provide a comprehensive understanding of the influence of hearing loss on social participation in older adults and including its facilitators and barriers. Following the rigorous methodological framework of scoping studies, nine multidisciplinary databases were searched with 44 keywords. Published mainly in the last decade, 41 studies using primarily a quantitative cross-sectional design were selected. Older adults with hearing loss have been found to have difficulty maintaining relationships and social activities. While social support and engaged-coping strategies were major facilitators of social participation, barriers included greater hearing loss, communication difficulties, comorbidities and reduced mental health. To better promote the social participation of older adults, early detection of hearing loss, holistic assessment, and interprofessional collaboration must be considered. Future research is necessary to better address the stigma related to hearing loss in older adults and challenges of early detection, and to propose innovative solutions to develop interprofessional collaboration.

Use and benefit of information, communication, and assistive technology among community-dwelling older adults - a cross-sectional study

BACKGROUND

Technology can support healthy aging and empower older adults to live independently. However, technology adoption by older adults, particularly assistive technology (AT), is limited and little is known about the types of AT used among older adults. This study explored the use of key information and communication technologies (ICT) and AT among community-dwelling adults aged ≥ 65.

METHODS

A cross-sectional study was conducted among community-dwelling adults aged ≥ 65 in southern Germany using a paper-based questionnaire. The questionnaire included questions on the three domains sociodemographic aspects, health status, and technology use. Technology use was considered separately for key ICT (smartphone, computer/laptop, and tablet) and a range of 31 different AT. Data were analyzed using descriptive statistics, univariate analyses, and Bernoulli Naïve Bayes modelling.

RESULTS

The questionnaire was answered by 616 participants (response rate: 24.64%). ICT were used by 497 (80.68%) participants and were associated with lower age, higher level of education, living together with someone, availability of internet connection, higher interest in technology, and better health status (p < .05). No association was found with sex and size of the hometown. The most frequently owned AT were a landline phone, a body scale, and a blood pressure monitor. Several AT related to functionality, (instrumental) activities of daily living- (IADL), and morbidity were used more frequently among non-ICT users compared to ICT-users: senior mobile phone (19.33% vs. 3.22%), in-house emergency call (13.45% vs. 1.01%), hearing aid (26.89% vs. 16.7%), personal lift (7.56% vs. 1.61%), electronic stand-up aid (4.2% vs. 0%). Those with higher interest in technology reported higher levels of benefit from technology use.

CONCLUSIONS

Despite the benefits older adults can gain from technology, its use remains low, especially among those with multimorbidity. Particularly newer, more innovative and (I)ADL-related AT appear underutilized. Considering the potential challenges in providing adequate care in the future, it may be crucial to support the use of these specific AT among older and frailer populations. To focus scientific and societal work, AT with a high impact on autonomy ((I)ADL/disease-related) should be distinguished from devices with a low impact on autonomy (household-/ comfort-related).

A cross-sectional study on the need for and utilization of assistive walking devices by people age 55 and older in Shanghai

We conducted a study to analyze the unmet needs of and risk factors for use of assistive walking devices by the elderly based on sample survey data from Shanghai, China from July to October 2019. Among a total sample size of 11,193 people age 55 and older, 1,947 people (17.39%) needed assistive walking devices, 829 (42.58%) of whom needed but did not use those devices. Multivariate analysis indicated that residence, living alone or cohabitating, indoor handrails, the number of diseases, and IADL were factors influencing the unmet need for assistive walking devices (p < 0.05, respectively). People who lived in community health centers (p = 0.0104, OR = 1.956, 95% CI: 1.171-3.267) and those who lived only with their spouse (p = 0.0002, OR = 2.901, 95% CI: 1.641-5.126) were more likely to have an unmet need for assistive walking devices. People without indoor handrails (p = 0.0481, OR = 0.718, 95% CI: 0.517-0.997), those with 3 or more diseases (p = 0.0008, OR = 0.577, 95% CI: 0.418-0.796), and those with severely impaired IADL (p = 0.0002, OR = 0.139, 95% CI: 0.05-0.386) were less likely to have an unmet need for assistive walking devices. Self-perceived needs of the elderly, the diversity and performance of assistive devices, and the accessibility and affordability of assistive walking devices may lead to unmet needs.

Who uses technical aids in old age? Exploring the implementation of technology-based home modifications in Europe

Introduction

Home modifications and features, e.g., handrails or ramps for people using wheelchairs, should allow residents with functional limitations to maintain social participation, health, and wellbeing for aging in place. However, there is little evidence in relation to the individual characteristics shaping this implementation of technology-based home modifications. Current studies often focus on describing the distribution of certain implementations in households but do not provide information on factors predicting the implementation or detailed and multifaceted data on associations with characteristics of the older user. This article, therefore, examines the use of well-established technological aids and home modifications (e.g., ramps, handrails, automatic doors, bathroom or kitchen modifications, chair lifts, and alerting devices) in the households of older adults in Europe. We refer to Lawton's and Nahemow's concept of personal-environment fit and describe the use of technical aids across 18 countries, analyze associations with individual characteristics and social resources, and compare those associations and variance explanation between older adults in their third age ("young-old", 65-79 years) and older adults in their fourth age ("old-old", 80+).

Methods

Drawing on representative data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), wave 6, a total of N = 38,553 older adults aged 65-105 years (M = 74.4 years, SD = 7.1; 55% women) were analyzed by performing hierarchical logistic regression analyses.

Results

Indicators of functioning explained the highest proportion of variance, followed by social resources, and variance explanation was higher for the fourth age than for the third age. In particular, older adults with physical limitations, a larger social network, and those who received care from a child outside the household were more likely to have home modifications installed.

Discussion

The study provides an overview of associations of diverse variables with assistive devices and modifications in the home and can serve as a starting point for public health activities concerning the heterogeneity of people aged 65 years and older.

Factors Influencing Utilization of Assistive Devices by Tibetan Seniors on the Qinghai-Tibet Plateau: Based on Research Strategy of Triangulation

PURPOSE

To investigate the current situation of assistive device (AD) usage among seniors in Tibet, China, and explore its influencing factors.

METHODS

A mixed-methods design was used. Cognition, attitude, behavior, and preference toward ADs were assessed by a self-designed questionnaire. Additionally, participants responded to the open-ended questions. Anderson's behavior model analyzed the impacts of the prerequisite factors, enabling factors, and demand factors influencing the utilization of ADs by Tibetan seniors.

RESULTS

Of the 211 Tibetan seniors, 149 (70.6%) Tibetan seniors expressed the willingness to utilize ADs. Binary Logistic regression analysis showed that one prerequisite factor: age; one enabling factor: care situation, and one demand factor: dysfunctional condition were factors influencing the utilization of ADs. Qualitative comments described: psychological, physical environment, and social support factors were the main influencing factors.

CONCLUSION

This study presents the current situation to utilize ADs by Tibetan seniors on the Qinghai-Tibet Plateau, incorporates Anderson's behavioral model for quantitative analysis, and combines qualitative research to explore the facilitating and hindering factors, to provide reference and basis for the development of ADs for seniors and policy formulation. The sample size of this study is relatively small and limited to ethnic groups, and we plan to increase the sample size and include more ethnic groups in the future study.

Real-life experience of accepting assistive device services for Tibetans with dysfunction: A qualitative study

Objective

This study aimed to understand the real-life experiences of Tibetans in China with dysfunction in the process of accepting assistive device services and to provide a reference for service quality improvement and policy formulation.

Methods

Semi-structured personal interviews were used to collect data. Ten Tibetans with dysfunction representing three categories of different economic level areas in Lhasa, Tibet were selected to participate in the study by purposive sampling method from September to December 2021. The data were analyzed using Colaizzi's seven-step method.

Results

The results present three themes and seven sub-themes: identification of tangible benefits from assistive devices (enhancing self-care ability for persons with dysfunction, assisting family members with caregiving and promoting harmonious family relationships), problems and burdens (difficulty in accessing professional services and cumbersome processes, not knowing how to use it correctly, psychological burden: fear of falling and stigmatization), and needs and expectations (providing social support to reduce the cost of use, enhancing the accessibility of barrier-free facilities at the grassroots level and improving the environment for the use of assistive devices).

Conclusion

A proper understanding of the problems and challenges faced by Tibetans with dysfunction in the process of accepting assistive device services, focusing on the real-life experiences of people with functional impairment, and proposing targeted suggestions for improving and optimizing the user experience can provide reference and basis for future intervention studies and related policy formulation.

Scoping 'sex' and 'gender' in rehabilitation: (mis)representations and effects

BACKGROUND

Researchers have highlighted a large-scale global unmet need for rehabilitation. While sex and gender have been shown to interact with each other and with other social and structural factors to influence health and wellbeing, less is known about how sex and gender shape rehabilitation participation and outcomes within health systems.

METHODS

Using an intersectional approach, we examine literature that explores the relationship between sex and/or gender and rehabilitation access, use, adherence, outcomes, and caregiving. Following a comprehensive search, 65 documents met the inclusion criteria for this scoping review of published literature. Articles were coded for rehabilitation-related themes and categorized by type of rehabilitation, setting, and age of participants, to explore how existing literature aligned with documented global rehabilitation needs. Responding to a common conflation of sex and gender in the existing literature and a frequent misrepresentation of sex and gender as binary, the researchers also developed a schema to determine whether existing literature accurately represented sex and gender.

RESULTS

The literature generally described worse rehabilitation access, use, adherence, and outcomes and a higher caregiving burden for conditions with rehabilitation needs among women than men. It also highlighted the interacting effects of social and structural factors like socioeconomic status, racial or ethnic identity, lack of referral, and inadequate insurance on rehabilitation participation and outcomes. However, existing literature on gender and rehabilitation has focused disproportionately on a few types of rehabilitation among adults in high-income country contexts and does not correspond with global geographic or condition-based rehabilitation needs. Furthermore, no articles were determined to have provided an apt depiction of sex and gender.

CONCLUSION

This review highlights a gap in global knowledge about the relationship between sex and/or gender and rehabilitation participation and outcomes within health systems. Future research should rely on social science and intersectional approaches to elucidate how gender and other social norms, roles, and structures influence a gender disparity in rehabilitation participation and outcomes. Health systems should prioritize person-centered, gender-responsive care, which involves delivering services that are responsive to the complex social norms, roles, and structures that intersect to shape gender inequitable rehabilitation participation and outcomes in diverse contexts.

Factors influencing utilisation of assistive devices by the elderly in China: a community-based cross-sectional study

OBJECTIVES

The study aimed to gain an insight into the utilisation, self-perceived needs, and attitudes towards and influencing factors of assistive device (AD) usage among community-dwelling older adults in China.

STUDY DESIGN

This is a cross-sectional study.

METHODS

A total of 5790 elderly people from eight communities within three provinces in China were recruited by convenience sampling. Utilisation, needs and attitudes towards ADs were assessed by a questionnaire designed by the authors. Barthel activities of daily living scale was used to determine disability, whereas cognitive function was assessed with the Mini-Mental State Examination. The impact of participant characteristics, enabling factors and demand factors on the utilisation of ADs were assessed by univariate and multifactor analyses.

RESULTS

The prevalence of AD ownership among participants was 10.9% (n = 634), whereas the self-perceived need for ADs was 46.1% (n = 2670). Most participants had negative attitudes towards ADs, with only 37.6% (n = 2175) of participants believing that ADs were of significant help. Factors influencing the usage of ADs included participant characteristics (age, occupation, living area, education), enabling factors (economic situation, number of children) and demand factors (activities of daily living score, attitudes, self-perceived needs).

CONCLUSIONS

Although ADs for the elderly in China have become more affordable and accessible after a series of reforms, there remains a gap in AD services resulting in low AD utilisation, high self-perceived needs and misconceptions of ADs. Certain factors influencing the use of ADs are more significant than others. The findings from this study will be informative for healthcare providers and decision-makers when designing strategies to achieve universal elderly AD usage.

Social participation of community-dwelling older adults in western China: A latent profile analysis

Objective

Social participation has become a policy framework to address population aging. However, little is known about the social participation of older adults in western China, and extensive, multicenter, regional research is lacking. This research investigated the profiles of social participation of older adults in western China and explored the characteristics and factors influencing social participation.

Method

This cross-sectional study was conducted in 3 provinces (Chongqing, Sichuan, and Inner Mongolia) in western China from March 2021 to December 2021 and included 3,456 participants aged 60 years or older. Social participation was assessed using the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA). Latent profile analysis (LPA) was performed to extract latent classes of social participation among older adults in western China. The chi-square test and multinomial regression analyses were used to identify differences between these classes.

Results

Three social participation classes were identified by LPA: high social participation (25.2%), moderate social participation (55.1%), and low social participation (19.7%). Being older, having a primary school education level, having mobility or speaking impairment, using assistive devices, and having a chronic disease were highly associated with the low social participation class (P < 0.05). Furthermore, older adults with no dependence (OR = 0.018, 95% CI = 0.005-0.062) or mild dependence (OR = 0.039, 95% CI = 0.011-0.139) in activities of daily living (ADLs) were less likely to be in the low social participation class. Older adults who were cared for by non-spouse primary caregivers were more likely to be assigned to the moderate social participation group (OR = 2.097, 95% CI = 1.501-2.930) than to the high social participation group.

Conclusions

Most older adults in western China have a moderate level of social participation. Advanced age, reduced ADL ability, reduced speech ability, reduced mobility, and non-spouse care are related to the level of social participation. Healthcare professionals should pay attention to the predictors for different classes, identifying high-risk groups as early as possible.