Assistive technology use by disability type and race: exploration of a population-based health survey

Capturing multiple assistive technology use and its impact in later life: lessons learned from distinct measurement approaches

PURPOSE

Assistive technology (AT) use is prevalent in older adulthood and can accommodate activity difficulties to support well-being. However, within the context of multiple activity difficulties and multiple technology use, it is unclear how to best assess their combined effects on older adults' health outcomes. This study proposed four distinct approaches to quantify multiple AT use and examined their respective impact in later life.

MATERIAL AND METHODS

Using data from the 2015 round of the National Health and Aging Trends Study (n = 6,936), we compared four indices to summarize the state of multiple AT use among the U.S. older population: binary, item-specific, cumulative, and accommodative. Separate regression analyses tested the impact of each index on older adults' well-being and restricted participation in meaningful activities.

RESULTS

In 2015, 59.9% of the respondents were identified as AT users. Among these users, 53.8% reported using two or more technologies when performing daily self-care and mobility activities. The implications of multiple AT use for health outcomes varied across the four indices. Approaches that captured elements of person-technology fit provided the most nuanced and actionable insights on the benefits of using AT to support well-being.

CONCLUSIONS

ATs were commonly adopted by older adults in everyday activities. Overall, findings suggest that there are multiple approaches to conceptualize the independent, cumulative, or balanced effects of multiple AT use. Each measurement approach has unique implications for understanding the impacts of using ATs on older adults' health outcomes.

Telemedicine and Dementia Care: A Systematic Review of Barriers and Facilitators

OBJECTIVES

An increasing reliance on telemedicine for older adults with cognitive impairment requires a better understanding of the barriers and facilitators for this unique patient population.

DESIGN

The study team queried PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, Scopus, and ClinicalTrials.gov on May 1, 2020, for studies in English published from January 2010 to May 2020.

SETTING AND PARTICIPANTS

We conducted a systematic review of articles investigating the use of telemedicine among older adults with Alzheimer's disease and related dementia (ADRD) or mild cognitive impairment (MCI) that focused on the patient and care partner perspectives.

METHODS

Telemedicine encounter purpose, technological requirements, and findings regarding sensory needs were extracted. The Cochrane Collaboration's Risk of Bias Tool was applied for quality assessment.

RESULTS

The search yielded 3551 abstracts, from which 90 articles were reviewed and 17 were included. The purpose of telemedicine encounters included routine care, cognitive assessment, and telerehabilitation. All studies reported successful implementation of telemedicine, supported by patient and care partner satisfaction, similar results on cognitive assessment and diagnosis compared to in-person visits, and improvement in outcome measures following rehabilitation. Sixteen studies relied on staff and care partners to navigate technologies. Six studies reported participants reporting difficulty hearing the provider during the telemedicine visits. Five studies excluded participants with visual or hearing impairment because of the potential difficulty of using telemedicine technology. No studies reported technological adaptations to account for sensory impairment.

CONCLUSIONS AND IMPLICATIONS

Telemedicine is well received among patients and care partners, but successful delivery incorporates support staff and the care partners to navigate technologies. The exclusion of older adults with sensory impairment, especially given that it is highly prevalent, in developing telemedicine systems may further exacerbate access to care in this population. Adapting technologies for sensory needs is critical to the advancement of accessible dementia care through telemedicine.

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.

Perspectives on ethnic and racial disparities in Alzheimer's disease and related dementias: Update and areas of immediate need

Alzheimer's disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise "state-of-the-science" report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations.