Factors Influencing the Use of Mobility Technology in Community-Based Long-Term Care

Evaluation of a new assistive technology: the StandBar

PURPOSE

Evaluate the potential of a wheelchair assistive technology (StandBar) to promote power wheelchair users' ability to safely stand independently from their power wheelchair and determine the impact of the device use on psychological well-being for both power wheelchair users and their caregivers.

MATERIALS AND METHODS

A convenience sample of 11 power wheelchair users and caregiver dyads provided study data. Participants included power wheelchair users who were existing StandBar users or currently in training with the StandBar as part of their rehabilitation. Assessments were conducted at baseline and at six-month follow-up and included physiological assessments and functional testing with and without the StandBar. Monthly follow-up phone calls were completed to collect information on adverse events (e.g., falls, hospitalizations, and skin breakdown). A qualitative interview assessed StandBar users' and caregivers' perception at six-month follow-up.

RESULTS AND CONCLUSIONS

StandBar use provided power wheelchair users a higher level of independence, confidence, and safety. All participants highly recommended StandBar use to others with similar levels of functional impairment. StandBar use allowed many participants the ability to complete functional tasks that were otherwise not possible without assistance. Qualitative interviews reported improved independence and psychological well-being for StandBar users as well as reduced levels of anxiety and burden of care by caregivers. The StandBar is a cost-effective assistive technology that promotes independence and functionality for power wheelchair users and improves the psychological well-being of users and their caregivers. Implications for RehabilitationStandBar allows power wheelchair users to:Minimize negative effects of immobilization.Increase independence for activities of daily living (grooming, hygiene, toileting, transfers) and instrumental activities of daily living (social experiences).Improve their quality of life through increasing independence and confidence.Reduce need for assistance and corresponding caregiver burden.

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.

Impact of assistive devices use on levels of depression in older adults: Evidence from China

The purpose of this study is to evaluate the effect of assistive devices on the level of depression among older adults. Using data from the 2015 and 2018 waves of China Health and Retirement Longitudinal Studies (CHARLS), we analysed this effect through the PSM-DID model and verified the mechanism of the effect through Hayes' mediating effect model. The results showed that assistive devices increased depression levels in older adults. Moreover, there were significant differences among different groups of older adults. The use of assistive devices in developed areas, women, people under 75 years old, and socially active older people had a deeper impact on the level of depression. Differences in the type and number of assistive devices used also affect the level of depression in older people. Furthermore, assistive devices use in older adults increases depression levels by decreasing health satisfaction. This study provides new evidence to explore the relationship between the use of assistive devices and depression levels in older adults. Meanwhile, our research illustrates the importance of developing products and services with age-friendly technology.

What are the perceptions of staff who work in, and professionals who advise on the design of, Australian aged care facilities on the value and use of handrails in corridors?

OBJECTIVE

To investigate the perceived value of handrails and how they are used in Australian aged care facilities (ACFs). Such information aims to contribute to the body of knowledge available about handrails, their design features and application.

METHODS

This study adopted a descriptive cross-sectional research design. Online surveys were distributed to members of Australian professional networks, collecting information about handrail use, mobility supports and handrail design in ACFs.

RESULTS

There were 112 participants (80% female), aged 18-55 years or older. Many identified that handrails in ACF corridors are used by a residents, staff and visitors, and that circular-shaped handrails should be installed in ACF corridors to assist with mobility and safety.

CONCLUSION

Handrails in ACF corridors offer an alternate support to those who experience an unexpected loss of balance and those without or unable to use a mobility aid, ultimately enabling users' mobility and assisting staff to carry out work duties.

Racial and Ethnic Differences in Disability Transitions Among Older Adults in the United States

BACKGROUND

Racial and ethnic differences in disability persist and are possibly widening in recent years, but evidence is limited for racial and ethnic differences in disability progression through the entire disablement process and potential influential factors. The objective of this study is to examine racial and ethnic differences in patterns of late-life disability transitions, using a new disability spectrum that incorporates successful accommodation with assistive devices in response to capacity limitations to prolong independence.

METHODS

The study cohort consisted of a nationally representative sample of Medicare beneficiaries aged 65 and older in the United States who were enrolled in the 2011 National Health and Aging Trends Study and followed up annually until 2015 (n = 6,198). First-order Markov transition models were used to determine racial/ethnic differences in transitions among three stages of self-care and mobility limitations (fully able, successful accommodation, difficulty/assistance) and death.

RESULTS

After adjustment for age and sex, non-Hispanic Black and Hispanic respondents had higher probabilities of unfavorable transitions and lower probabilities of remaining in the successful accommodation stage than non-Hispanic White respondents. The racial and ethnic differences in probabilities of maintaining successful accommodation remained statistically significant after adjustment for socioeconomic and health factors (Black: 0.56, 95% CI = 0.52-0.60; Hispanic: 0.53, 95% CI = 0.44-0.61; White: 0.63, 95% CI = 0.61-0.65).

CONCLUSIONS

Successful accommodation with assistive devices may provide possibilities for implementing interventions to enhance older adults' capacities and reducing racial/ethnic differences in late-life disability.

The promise of assistive technology in institutionalized old age care: economic efficiency, improved working conditions, and better quality of care?

PURPOSE

Assistive technologies in care work are expected to alleviate the challenges related to population aging, namely the pressure on public budgets and a shortage of care professionals. This study examines how various stakeholders view the potentials of assistive technology in an institutionalized care setting in Denmark.

METHOD

Using ethnographic field observations, interviews, and document analysis, we explore the residents', the staff's, and the municipality's perspectives on the technologies and analyze whether they live up to the stated expectations.

RESULTS

We identify three parallel narratives representing each of the stakeholder's perspectives. The municipality's triple-win narrative emphasizes expected gains in terms of efficiency, improved working conditions, and better quality of care. The staff's ambiguity narrative contains both negative views regarding the motive for using technologies to save resources and positive accounts of how technologies have reduced work-related pain. The residents' limited agency narrative reflects an internalization of the staff's perspectives.

CONCLUSIONS

We conclude that, despite both the staff and the municipality highlighting the residents' well-being and comfort as important outcomes of assistive technologies, the residents' wishes have limited influence on whether and, if so, how assistive technologies are used.IMPLICATIONS FOR REHABILITATIONDifferent stakeholders' views on assistive technology vary and are closely connected to their respective institutional interests and roles. These perspectives are important for a successful implementation of assistive technologies.Understanding the positions of staff and older care recipients, and differentiating between their respective perspectives can help both scholars and product developers understand the potentials and risks of AT in a more nuanced way.

Personal and Interpersonal Drivers that Contribute to the Intention to Use Gerontechnologies

BACKGROUND

Over the past few years, various new types of technologies have been introduced, which have been tailored to meet the specific needs of older adults by incorporating gerontological design principles (i.e., "gerontechnologies"). However, it has been difficult to motivate older adults to adopt and use these new technologies. Therefore, it is crucial to better understand not only the role of personal drivers but also the family influences on older adults.

OBJECTIVE

This research goes beyond traditional technology acceptance theories by investigating the role of personal (e.g., inherent novelty seeking) and interpersonal drivers (e.g., influence of family) in stimulating older adults to use gerontechnologies. Nine hypotheses, building on traditional and new technology acceptance theories, were developed and tested.

METHODS

This research applies a cross-sectional study design. Therefore, a face-to-face survey instrument was developed building on a qualitative pilot study and validated scales. Three hundred and four older adults (minimum age = 70 years) were willing to participate as well as one of their family members. Structural equation modeling was applied to analyze the hypothesized conceptual model.

RESULTS

Our results extend the seminal technology acceptance theories by adding personal (i.e., inherent novelty seeking p = 0.017) and interpersonal drivers. More specifically, it was found that the attitude toward gerontechnologies was influenced by family tech savviness (i.e., people who often use technology), as this relationship is fully mediated through the social norms of older adults (p = 0.014). The same was found for older adults' trust in the family member's technology knowledge (p ≤ 0.001). Here, the relationship with older adults' attitude toward gerontechnologies was partially mediated by the older adults' trust in technology.

CONCLUSION

This study identified important personal and interpersonal drivers that influence attitudes toward and intentions to use gerontechnologies. To foster technology acceptance among older adults, it was found that it is important to strengthen the trust in and the attitude toward gerontechnologies. Furthermore, family members' knowledge and beliefs in technology were the keys to promoting the actual use of gerontechnologies among older adults. Furthermore, the families' trust in gerontechnologies and the provision of access to technology can improve their attitudes toward technology and usage intentions for the older relative.

Effects of a caregiver-inclusive assistive technology intervention: a randomized controlled trial

Background

The principal aim of this study was to investigate whether a caregiver-inclusive assistive technology intervention improved older care recipients’ functional autonomy and decreased the perceived burden of their family caregivers compared to customary care.

Methods

The study was a single-blind, mixed-methods, randomized controlled trial with baseline data collection and follow-ups at 6-, 22-, and 58-weeks after baseline evaluation, which was prospectively registered (ClinicalTrials.gov Identifier: NCT01640470. Registered 11/21/2011). Dyads comprising a care recipient and family caregiver were randomly assigned to either a caregiver-inclusive experimental group (N = 44) or a customary-care comparison group (N = 46). Eligible care recipients were aged ≥55 years and had one or more limitations with mobility or daily activities, and family caregivers provided at least four hours per week of assistance. Outcome measures were administered to both groups at baseline and at the three follow-up time points. The data collectors were blinded regarding participants’ intervention group. The primary outcome measures were the Functional Autonomy Measurement System to assess care recipients’ functional performance, and the Caregiver Assistive Technology Outcome Measure to assess caregivers’ burden. Qualitative interviews examined participants’ perceptions of the caregiver-inclusive and customary care interventions.

Results

The experimental intervention addressed significantly more dyad-identified problematic activities, but caregiver involvement was evident in both groups and outcomes were not significantly different over time. In both groups, care recipients’ functional autonomy declined significantly (P < .01), and caregivers’ activity-specific and overall burden decreased significantly (P < .01).

Conclusions

Given the unintended congruence between the caregiver-inclusive and customary care interventions, the overall findings lend support for the provision of assistive technology to reduce caregiver burden.

Gender Differences in Mobility Device Use Among U.S. Older Adults

Objectives

Research has shown greater mobility limitations among women than men. We aimed to examine (a) gender differences in the use of canes for mobility and (b) what factors contribute to these differences under the frameworks of the disablement model and the Theory of Planned Behavior.

Method

Using National Health and Aging Trends Study data, we estimated hierarchical logistic regression models to predict the likelihood of cane use among older adults who completed performance-based measures (n = 5,503). We tested the interactions between gender and selected variables to further understand gender difference.

Results

In unadjusted analysis, 22% of women and 16% of men used canes. In models adjusted in steps for sociodemographics, health, physical impairments, capacity, psychosocial, and social environment factors, women were progressively less likely to use canes, significantly so at the last step. Suppression effect analyses showed the influence of living alone and receiving mobility help variables. Interaction analyses showed that women reporting poor health or balance were less likely to use canes; obese women were more likely.

Discussion

Significant gender differences exist in cane use among older community-living adults. Findings suggest that health and function partly account for these differences. Future research is needed to understand social/cultural factors involved.

Psychometric properties of a Power Mobility Caregiver Assistive Technology Outcome Measure

Caregiver burnout is a serious concern among informal caregivers, especially for those who provide care to individuals with more severe limitations such as power mobility users. The Power Wheelchair Caregiver Assistive Technology Outcome Measure tool measures device specific and overall burden experienced by informal caregivers of power mobility users. A one-month, test-retest study was conducted to examine the reliability, internal consistency, and construct validity of the Power Wheelchair Caregiver Assistive Technology Outcome Measure. Two construct validity measures were administered: the Hospital Anxiety and Depression Scale and the Late Life Disability Index. The test-retest-reliabilities of part 1 (power wheelchair specific burden) and part 2 (general caregiving burden) were 0.769 and 0.843 respectively. Scores on part 1 were moderately and positively correlated with part 2 and with frequency of participation. Scores on part 2 were moderately and negatively correlated with anxiety, depression, and positively with perceived limitation of participation. The strength and direction of these correlations provide support for the construct validity of the measure and suggest part 1 and part 2 provide complementary information. Further testing is needed to assess the clinical utility and responsiveness of the measure.

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR = 1.09 [1.05–1.14]; both NSEI: HR = 1.36 [1.29–1.44]. Lower SEI: HR = 1.67 [1.57–1.79]; upper SEI: HR = 1.27 [1.19–1.37]; both SEI: HR = 1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR = 4.23 [4.11–4.35]).

Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

An observational comparison of the older and younger bus passenger experience in a developing world city

This study was an unobtrusive observational analysis of 333 older and younger bus passengers in Guadalajara, Mexico. A set of data were collected for each observed passenger, as well as more general observations related to driver behaviour, bus design and bus service characteristics. There were significant differences between older and younger passengers in terms of boarding and alighting times, use of handrails, seat location preferences, passenger stability and coping strategies in order to maintain postural stability. The conditions of travel are conducive to a poor passenger experience for the older passengers in particular. Although the problems may be attributed to bus design and driver behaviour typical of that in developing countries, they are also influenced by the wider transport infrastructure, and a lack of a regulatory regime which places drivers under time pressure and in direct competition with each other. Practitioner Summary: Bus services must cater for all ages of passengers, including the elderly. This unobtrusive observational study investigated the passenger experience in a developing world city. Bus and wider service design were found to compromise the journey experience, with the older users being particularly negatively impacted. Design recommendations are provided.

Effect of a tailored assistive technology intervention on older adults and their family caregiver: a pragmatic study protocol

BACKGROUND

Many older adults with mobility limitations use assistive technology to help them perform daily activities. However, little attention has been paid to the impact on their family caregivers. This neglect produces an incomplete portrayal of the outcomes of assistive technology provision. This paper describes the protocol for a study that examines the impact of a tailored assistive technology intervention that is inclusive of assistance users and their family caregivers.

METHODS/DESIGN

This research will use a combination of quantitative and qualitative methods. The quantitative portion will be an experimental, single-blinded study in which participants are randomly assigned to either an experimental assistive technology intervention or a standard care group. We will enroll 240 participants (120 dyads) into the study from three Canadian sites. Participants will include older adults (>55) and family caregivers who provide ≥4 h per week of assistance with daily activities and social participation. The primary outcome measure for the older adults will be the Functional Autonomy Measurement System, and the primary outcome measure for the caregivers will be the Caregiver Assistive Technology Outcomes Measure. Qualitative data will be collected through detailed records of the therapists' interventions, as well as through interviews with dyads and therapists following the interventions. Data collection will occur at baseline (T0) with follow-ups at 6 weeks (T1), 22 weeks (T2), and 58 weeks (T3) after baseline evaluation.

DISCUSSION

The findings from this study will help service providers and clinicians to move forward with assistive technology recommendations that are more attuned to the needs of both older adults with mobility limitations and their family caregivers. Additionally, the study's findings will enhance our conceptual understanding of the spectrum of assistive technology outcomes and set the stage for econometric studies assessing cost-effectiveness.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01640470 . Registered 11/21/2011.

Compensatory Strategies: Prevalence of Use and Relationship to Physical Function and Well-Being

We examine prevalence of four compensatory strategies (assistive devices, receiving help, changing frequency, or method of performance) and their immediate and long-term relationship to well-being. A total of 319 older adults (>70 years) with functional difficulties at home provided baseline data; 285 (89%) provided 12-month data. For 17 everyday activities, the most frequently used strategy was changing method of performance ( M = 10.27 activities), followed by changing frequency ( M = 6.17), assistive devices ( M = 5.38), and receiving help ( M = 3.37; p = .001). Using each strategy type was associated with functional difficulties at baseline ( ps < .0001), whereas each strategy type except changing method predicted functional decline 12 months later ( ps < .0001). Changing frequency of performing activities was associated with depressed mood ( p < .0001) and poor mastery ( p < .0001) at both baseline and 12 months ( ps < .02). Findings suggest that strategy type may be differentially associated with functional decline and well-being although reciprocal causality and the role of other factors in these outcomes cannot be determined from this study.

The role of accommodations in poststroke disability management

OBJECTIVE

To explore use of assistive devices and personal assistance and unmet need for assistance among older stroke survivors and identify potentially modifiable factors to optimize self-care and mobility activities in this population.

METHOD

Using the 2011 National Health and Aging Trends Study, we compared demographic characteristics, accommodation-enabling factors and need-related factors for self-reported stroke survivors (N = 892) and stroke-free controls (N = 6,709). For individual self-care and mobility activities, we examined type of accommodation (no devices/no help, devices/no help, devices/help, help/no devices) and unmet need by stroke status. For the sample of stroke survivors, we then estimated (a) multinomial logistic regression models predicting type of accommodation and (b) logistic regression models predicting unmet need.

RESULTS

Stroke survivors used more assistive devices and received more personal assistance and had greater unmet need than stroke-free controls. In adjusted models, physical and cognitive capacity measures were most important in predicting accommodations and accommodations most important in predicting unmet need.

DISCUSSION

Although accommodations are commonly used by older adult stroke survivors, unmet need is also substantial. Future research should focus on finding ways to improve poststroke functional capacity and cognitive capacity and enhance adoption of assistive devices with the aim of reducing unmet need.

Activity limitations, use of assistive devices or personal help, and well-being: variation by education

OBJECTIVES

This study examined the associations among self-care or mobility limitations, use of assistive devices or personal help, and well-being while giving special attention to 3 dimensions of well-being and older adults' educational attainment.

METHOD

The analysis was based on 4,456 community-dwelling older adults with self-care or mobility limitations who completed interviews in the first round of the National Health and Aging Trends Study. Path models were estimated to examine the associations among limitations, use of assistive devices or personal help, and 3 dimensions of well-being (positive affect, self-realization, and self-efficacy) for different educational groups of older adults.

RESULTS

Self-care or mobility limitations had a negative association with 3 dimensions of well-being. The use of assistive devices was positively related, but the use of personal help was negatively related to well-being. Older adults with more education demonstrated weaker associations between assistive devices and well-being and stronger inverse associations between personal help and well-being than those with less education.

DISCUSSION

The use of coping strategies to address self-care or mobility limitations is not necessarily associated with better well-being, and education does not seem to play a protective role once limitations develop. More research is needed to unpack population heterogeneity in the association between coping strategies and well-being.

What factors are associated with the provision of assistive technologies: the Bogotá D.C. case

AIM

To examine what demographics and clinical factors are associated with the provision of assistive technology (AT) devices in a low-income country.

METHOD

Retrospective cross-sectional exploratory study design including 15 of the 20 localities across Bogotá D.C., Colombia, a city with 6,776,009 inhabitants.

RESULTS

The type of AT device provided was significantly dependent (p < 0.001) on the client's diagnosis, impairment, age, and socio-economic strata, whether the client has a care giver, the geographical zone in which the client lives, the year of the AT provision, and the total number of AT delivered. In contrast, the client's gender (p > 0.05) and the client's affiliated type of healthcare service had no effect. In addition to that, the client's age, the client's socio-economic strata, the number of AT devices provided to the client, and the diagnostic type were the factors with the strongest level of association with the type of AT device provided.

CONCLUSIONS

Our research showed that the provision of AT in Bogotá D.C. prioritizes both people who are at the highest levels of vulnerability, and as many people as possible with the budget. That is, the low socio-economic strata, younger and older people, and the provision of at least one AT device.

IMPLICATIONS FOR REHABILITATION

Provision of AT is intended for equal opportunities for the social participation of people with a disability. Also, people with disabilities have the right to access AT regardless of the type of limitation, gender, race, age or region where they live. Research regarding AT in developing countries is scarce; thus, there is a need to conduct studies in such contexts. This study provides scientific evidence to support the development of models, approaches and strategies of AT provision in low-income countries where resources for rehabilitation are scarce.

Users' satisfaction with assistive devices in South Korea

[Purpose] The objective of this study was to determine users’ satisfaction with assistive devices, and their serviceability and effectiveness. [Methods] A random sample of 138 users participated in this study. The Korean-Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 and an additional questionnaire were used for data collection. Data were analyzed by using descriptive statistics. [Results] Overall client satisfaction was high. Respondents most commonly reported use of their device for “personal activities of daily living” and “mobility”, and considered engagement in “activities of daily living”, and “social participation” to be most desirable, respectively. [Conclusion] This study will provide rehabilitation professionals with valuable information about client satisfaction with assistive devices.

Fifteen-year disability trends among older persons in the Beijing municipality of China

OBJECTIVE

The aim of this study was to examine disability trends among men and women aged 70+ in Beijing, China; determine whether trends are impacted upon by changes in population composition; and investigate whether trends are experienced similarly across socio-demographic subgroups.

METHOD

Fifteen-year panel data were used to model probability of reporting activities of daily living (ADLs) disability adjusting for age, sex, marital status, residence, and education. Predicted probabilities and average annual percent change in probabilities are reported.

RESULTS

The results showed increasing disability trends experienced by men, and stable or decreasing trends by women. Trends would be less favorable had education of older population not increased over time. Trends are much worse when bathing is excluded as an ADLs item. This is because trends in bathing were favorable whereas trends in other activities were not.

DISCUSSION

On balance, results are not overly encouraging for reductions in population-level disability given population aging and increasing life expectancy in China. But, future increasing education could mitigate some increases in disability rates.

The psychosocial impact of home use medical devices on the lives of older people: a qualitative study

Background

Increased life expectancy and the accompanying prevalence of chronic conditions have led to the focus and delivery of health care migrating from the hospital and into people’s homes. While previous studies have investigated the integration of particular types of medical devices into the home, it was our intention to describe how medical devices are integrated into the lives of older people.

Methods

Adopting a qualitative study design, 12 older people, who used medical devices in the home, took part in in-depth, semi structured interviews. In 7 of the interviews participants and their partners were interviewed together. These interviews were recorded, transcribed and analysed thematically.

Results

Two themes were constructed that describe how medical devices that are used in the home present certain challenges to older people and their partners in how the device is adopted and the personal adaptations that they are required to make. The first theme of 'self-esteem’ highlighted the psychological impact on users. The second theme of 'the social device' illustrated the social impact of these devices on the user and the people around them.

Conclusions

We found that these devices had both a positive and negative psychosocial impact on users’ lives. An improved understanding of these psychological and social issues may assist both designers of medical devices and the professionals who issue them to better facilitate the integration of medical devices into the homes and lives of older people.

Effects of an assistive technology intervention on older adults with disabilities and their informal caregivers: an exploratory randomized controlled trial

OBJECTIVE

The aim of this study was to demonstrate experimentally that an assistive technology (AT) intervention improves older AT users' activity performance and satisfaction with activity performance and decreases their caregivers' sense of burden.

DESIGN

This study was a delayed intervention, randomized control trial. Baseline data were collected on 44 community-dwelling AT user-caregiver dyads in Vancouver, British Columbia, and Montreal, Quebec. The primary outcome measures for AT users were the satisfaction and accomplishment scales from the Assessment of Life Habits. The primary outcome measure for caregivers was the Caregiver Assistive Technology Outcome Measure, which assessed burden associated with dyad-identified problematic activities.

RESULTS

After the intervention, assistance users in the immediate intervention group reported significantly increased satisfaction with activity performance (P < 0.001) and improved accomplishment scores (P = 0.014). Informal caregivers in the immediate intervention group experienced significantly decreased burden with the dyad-identified problematic activity (P = 0.013). Participants in the delayed intervention group experienced similar benefits after the intervention. Improvements for both groups were mostly maintained 4 mos after the conclusion of the intervention.

CONCLUSIONS

This is the first experimental study to demonstrate that the provision of AT decreases caregiver burden. If confirmed and extended by subsequent research, the findings have significant policy and practice implications and may enable health care providers to advocate for improved access to AT provision and the related follow-up services.

Assistive devices in context: cross-sectional association between challenges in the home environment and use of assistive devices for mobility

PURPOSE

A primary goal for aging policy is to optimize independence in later life. We estimate the cross-sectional association between physical and social challenge in the home environment and use of assistive devices (AD) for mobility in the home, controlling for lower extremity physical performance (short physical performance battery [SPPB]) and other factors.

DESIGN AND METHODS

Data are from the Women's Health and Aging Study I, a prospective study of the factors related to physical disability in a sample of moderately to severely disabled older women. We describe these associations in the baseline sample overall and also within subsets who do and do not have both a baseline and a 3-year follow-up observation.

RESULTS

On average, physical challenge in the home environment is inversely associated with level of AD use (p < .05) in the overall sample, independent of SPPB, living alone, and other factors. We do not find a significant (p < .05) association between social challenge and the level of AD use in the overall sample. Findings by follow-up responder status were similar (with minor variability).

IMPLICATIONS

Future cohorts who are better educated and more receptive to technology may confront challenges in the home environment that limit their ability to age in place. Our findings suggest that the physical challenges of the home are significantly related to AD use. Future analyses that explore the mechanisms of the home environment as a source of challenges to independent functioning could help in the design of future interventions for these cohorts as they age.

How assistive technology use by individuals with disabilities impacts their caregivers: a systematic review of the research evidence

Informal caregivers are a critical yet frequently unacknowledged part of the healthcare system. It is commonly presumed that providing assistive technology will decrease the burden of their care provision; however, no review has evaluated the evidence behind this assumption. Therefore, a systematic review was undertaken to evaluate evidence of the impact of assistive technology use by care recipients on their informal caregivers. Data sources included EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area. Twenty-two studies met the specified inclusion criteria. Collectively, the findings suggest that assistive technology use helps caregivers by diminishing some of the physical and emotional effort entailed in supporting individuals with disability. However, confidence in this causal connection is limited because of the study designs that were used. This undermines the understanding of the impacts of assistive technology use on the users' informal caregivers.

How older adults make decisions regarding smart technology: an ethnographic approach

Comparatively little research has been conducted regarding the smart technology needs of the older adult population despite the proliferation of smart technology prototypes. The purpose of this study was to explore the perceived smart technology needs of older adults with mobility impairments while using an ethnographic research approach to construct a preliminary decision tree model of how these smart technology decisions are made. In-depth individual interviews with 11 older adults aged 65 and older with mobility impairments provided insight into how older adults perceived smart technology. Audio-taped interviews were transcribed verbatim, then analyzed for key phrases that represented participant decision criteria. Decision criteria concepts were combined to construct an older adult smart technology decision tree model. The model consisted of a preliminary decision stage that participants engaged in to make the decision of whether a change was needed in their current pattern of behavior; followed by an evaluation stage that included five potential barriers (i.e., not easy to use/learn) and seven potential facilitators (i.e., decreasing imposition on family/friends) to the smart technology need decision process. Future designers could use this decision model to create appropriately matched technological devices to promote independence of aging baby boomers with mobility impairments.

The contribution of home-based technology to older people's quality of life in extra care housing

Background

British government policy for older people focuses on a vision of active ageing and independent living. In the face of diminishing personal capacities, the use of appropriate home-based technology (HBT) devices could potentially meet a wide range of needs and consequently improve many aspects of older people's quality of life such as physical health, psychosocial well-being, social relationships, and their physical or living environment. This study aimed to examine the use of HBT devices and the correlation between use of such devices and quality of life among older people living in extra-care housing (ECH).

Methods

A structured questionnaire was administered for this study. Using purposive sampling 160 older people living in extra-care housing schemes were selected from 23 schemes in England. A face-to-face interview was conducted in each participant's living unit. In order to measure quality of life, the SEIQoL-Adapted and CASP-19 were used.

Results

Although most basic appliances and emergency call systems were used in the living units, communally provided facilities such as personal computers, washing machines, and assisted bathing equipment in the schemes were not well utilised. Multiple regression analysis adjusted for confounders including age, sex, marital status, living arrangement and mobility use indicated a coefficient of 1.17 with 95% CI (0.05, 2.29) and p = 0.04 [SEIQoL-Adapted] and 2.83 with 95% CI (1.17, 4.50) and p = 0.001 [CASP-19].

Conclusions

The findings of the present study will be value to those who are developing new form of specialised housing for older people with functional limitations and, in particular, guiding investments in technological aids. The results of the present study also indicate that the home is an essential site for developing residential technologies.

Assistive technology use of older American Indians in a southeastern tribe: the native elder care study

The objectives of this study were to examine the prevalence of assistive technology (AT) use, type of assistance used for each activity of daily living (ADL) limitation, and correlates of AT use among Native Indian aged 55 and older. Data were collected as part of a cross-sectional study of disability with 505 members of a federally recognized tribe using in-person interviewer administered surveys. Participants who reported difficulty with ADLs, including bathing, dressing, eating, transferring, walking, toileting, grooming, and getting outside, were asked about AT use. Other measures were demographics, living arrangements, receipt of personal care, Medicare and Medicaid beneficiary status, number of chronic conditions, lower body function, and personal mastery. Results indicated that 22.3% of participants aged 55 and older and 26.0% aged 65 and older reported AT use. Toileting had the largest percentage of participants who relied on AT only and getting outside had the largest percentage of participants relying on a combination of AT and personal care. Multiple variable logistic regression analysis identified receipt of personal care, having more chronic conditions, and poorer lower body function as significantly associated with higher odds of AT use. The results suggest that there is greater AT use in this sample than in same-aged adults in national samples. This greater use may be reflective of a combination of higher disability rates, cultural factors, and greater access to AT. Clinicians can use this information to identify the activities with which their patients are experiencing the most difficulty and which ones can be addressed with AT versus personal care.

Intentions of Older Homebound Women About Maintaining Proximity to a Cane or Walker and Using It at Home

Older persons are typically classified as “users” or “nonusers” of walking devices. Little is known about their experience of maintaining proximity to the walking device or the consistency with which they use it. The authors addressed those gaps in this longitudinal, phenomenological study with 40 women (aged 85-98). With regard to maintaining proximity to the device, the experience was structured by “keeping track of my cane,” “keeping the cane handy,” “transitioning between keeping track of the cane and keeping it handy,” and “keeping the walker handy so I can use it.” Despite stated intentions to the contrary, few women consistently walked with a device. The experience was characterized by “walking with it unless . . . ” and “judging whether I need it to walk in this situation.” Rather than assuming that clients use a cane or walker consistently, practitioners should explore intentions to maintain proximity to it and individualize interventions accordingly.

A conceptual framework of outcomes for caregivers of assistive technology users

OBJECTIVE

To develop and validate the content of a conceptual framework concerning outcomes for caregivers whose recipients are assistive technology users.

DESIGN

The study was designed in four stages. First, a list of potential key variables relevant to the caregivers of assistive technology users was generated from a review of the existing literature and semistructured interviews with caregivers. Second, the variables were analyzed, regrouped, and partitioned, using a conceptual mapping approach. Third, the key areas were anchored in a general stress model of caregiving. Finally, the judgments of rehabilitation experts were used to evaluate the conceptual framework.

RESULTS

An important result of this study is the identification of a complex set of variables that need to be considered when examining the experience of caregivers of assistive technology users. Stressors, such as types of assistance, number of tasks, and physical effort, are predominant contributors to caregiver outcomes along with caregivers' personal resources acting as mediating factors (intervening variables) and assistive technology acting as a key moderating factor (effect modifier variable).

CONCLUSIONS

Recipients' use of assistive technology can enhance caregivers' well being because of its potential for alleviating a number of stressors associated with caregiving. Viewed as a whole, this work demonstrates that the assistive technology experience of caregivers has many facets that merit the attention of outcomes researchers.

Ethical perspectives on emerging assistive technologies: insights from focus groups with stakeholders in long-term care facilities

ASSISTIVE TECHNOLOGIES ARE RELATIVELY novel tools for research and daily care in long-term care (LTC) facilities that are faced with the burgeoning of the older adult population and dwindling staffing resources. The degree to which stakeholders in LTC facilities are receptive to the use of these technologies is poorly understood. Eighteen semi-structured focus groups and one interview were conducted with relevant groups of stakeholders at seven LTC facilities in southwestern Pennsylvania. Common themes identified across all focus groups centered on concerns for privacy, autonomy, cost, and safety associated with implementation of novel technologies. The relative importance of each theme varied by stakeholder group as well as the perceived severity of cognitive and/or physical disability. Our findings suggest that ethical issues are critical to acceptance of novel technologies by their end users, and that stakeholder groups are interdependent and require shared communication about the acceptance of these emerging technologies.

The Use of Mobility Devices Among Institutionalized Older Adults

Objectives: The purpose of this article is to examine the demographic, health, and social characteristics of mobility device users in long-term care settings. Methods: Data were used from a recently institutionalized sample of older adults from the Canadian Study of Health and Aging. Multinomial logistic regression was used to examine the factors associated with the use of different mobility devices (cane, walker, or wheelchair). Results: Over 70% used mobility aids (over 50% used a wheelchair). Mobility limitations were strongly associated with the use of mobility devices. However, among those with mobility limitations, educational resources reduced the odds of wheelchair use. Conclusions: Consistent with findings from the community setting, need factors are strongly associated with the use of mobility aids in institutions. However, socioeconomic resources may provide older adults with alternate ways to manage mobility limitations in institutional settings.

Disparities in usage of assistive technology among people with disabilities

Assistive technology is essential to the lives of many people with disabilities, but disparities in usage put certain segments of the disability population at a particular disadvantage. This article uses survey data and statistical modeling to explore differences in technology usage across disability subpopulations. Responses to a 2005 survey of nearly 2,000 adult consumers of California Independent Living Centers reveal large differences in technology usage by age, race, ethnicity, education, income, and type and severity of disability. Statistical modeling of overall device usage, number of devices used, and usage of high-, medium-, and low-tech devices reveals several factors that appear to put people with disabilities at a disadvantage in accessing and using assistive devices. These factors include lower educational attainment, racial or ethnic minority status, lower household income, later disability onset, and disability related to mental as opposed to physical or sensory functioning. Findings highlight approaches needed to expand usage of and to promote equal access to technologies that enable greater social and economic participation for people with disabilities.

Health disparities among Latinas aging with disabilities

Latinas with disabilities report greater levels of disablement than non-Hispanic, White women with disabilities. Over the life course, Latinas experience increased numbers of functional limitations, more difficulties with activities of daily living, and more unemployment due to impairments. The reasons for this health disparity are unclear. The purpose of this article is to explore the empirical evidence surrounding health disparities in disablement among Mexican American women. From this exploration, recommendations are made, including moving beyond the correlational documentation of disparities, to building a knowledge base that provides theoretical reasons for disparities amenable to intervention.

Assistive technology in medicaid home- and community-based waiver programs

PURPOSE

As consensus emerges concerning the need to extend publicly funded home- and community-based services that support the independence of seniors, studies have reported the efficacy and cost effectiveness of assistive technology (AT). This article presents the latest available national AT expenditure and participation trends (1999-2002) for Medicaid 1915(c) waivers, the largest Medicaid home- and community-based service program.

DESIGN AND METHODS

We collected annually reported Centers for Medicare and Medicaid Form 372 data from state officials for each waiver providing AT for the period from 1999 to 2002. Descriptive statistics examined trends in national participation and expenditures, interstate variations in participation and expenditures, and differences in provision between elderly persons and persons with developmental disabilities.

RESULTS

Although we report a rise in the number of waivers providing AT, there has been much slower participant growth compared with the broader waiver program, and there is wide interstate variation in waiver AT provision. Not only do most waivers with AT serve persons with developmental disabilities, AT spending for that target group is almost twice that for aged or disabled waiver participants.

IMPLICATIONS

This study highlights three policy concerns: first, the large interstate variations in AT provision in Medicaid waivers may signal access problems in some states; second, policy choices in some states may favor Medicaid spending on AT for the developmental disability population over that for the elderly population; and third, data limitations prevent a comparable state-by-state analysis of Medicare AT provision.

Racial and ethnic disparities in mobility device use in late life

OBJECTIVE

Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference.

METHODS

The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care.

RESULT

Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites.

DISCUSSION

Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it.

Low use of durable medical equipment by chronically disabled elderly

Assistive devices are a common effective approach to mitigating the effects of chronic disability. The Medicare Durable Medical Equipment (DME) benefit is intended to provide patients with equipment to meet the challenges of health-related disability; the penetrance of benefit among the disabled is unclear. A nationally representative cohort of 4,687 community-dwelling elderly enrolled in fee-for-service Medicare (part of the Medicare Current Beneficiary Survey in 1999 and 2000) assessed self-reported disability, and receipt of Medicare DME was assessed through linked claims. Fewer than half the chronically disabled, and less than one-quarter of the newly disabled, received any DME from Medicare. These data suggest underuse of the benefit by the disabled elderly.

Racial and ethnic differences in use of assistive devices for mobility: effect modification by age

PURPOSE

The authors investigated the extent to which differences in mobility device use existed by race/ethnicity and whether the effects were modified by age.

METHOD

Using Phase II of the National Health Interview Survey on Disability, the authors identified 7,148 mobility-impaired adults. Logistic regression models provided estimates of race/ethnicity, adjusting for predictors of device use.

RESULTS

Blacks were 1.2 times as likely as non-Hispanic Whites (95% CI: 1.0-1.4) to use devices. Hispanics were 0.78 times less likely to use devices as were non-Hispanic Whites (95% CI 0.65-0.96). Differences were attenuated by age, with a 40% increased likelihood of use attributable to being Black and aged 45 to 75, a 30% increased likelihood attributable to being Hispanic and aged 65 to 75, and a 130% increased likelihood attributable to being Hispanic and older than 75.

CONCLUSION

Disentangling the observed patterns in mobility device use will provide direction for development of interventions to promote assistive device use.

Socioeconomic disparities in the use of home health services in a medicare managed care population

OBJECTIVE

To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans.

DATA SOURCES

A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period.

STUDY DESIGN

We estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees.

PRINCIPAL FINDINGS

Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment.

CONCLUSIONS

Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages.