Everyday Challenges for Individuals Aging With Vision Impairment: Technology Implications

BACKGROUND AND OBJECTIVES

There are growing numbers of older adults with long-term vision impairment who are likely to experience everyday activity challenges from their impairment in conjunction with age-related changes. Technology has potential to support activity engagement. To develop effective technologies and interventions, we need to understand the context of activity challenges and identify unmet support needs.

RESEARCH DESIGN AND METHODS

The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study is a mixed-method approach to explore everyday challenges of people aging with long-term disabilities. Participants included 60 adults aging with long-term vision impairment (63% female; M age = 67, SD = 4.6) who completed in-depth, structured interviews exploring the nature of everyday challenges and their unmet support needs for activity engagement. We conducted a content analysis using a deductive and inductive approach to build a detailed coding scheme of challenge codes and subcodes.

RESULTS

The analyses provided detailed insights about the nature of challenges people aging with vision impairment experience when performing specific instrumental activities of daily living (IADLs) in the context of home maintenance, transportation, shopping/finance, and managing health. Vision-related challenges and participation restrictions were identified for several activities that require reading, navigation, and identification (e.g., shopping, medication management, public transportation). Emergent challenge themes for performing IADLs included personal limitations (e.g., physical, cognitive, financial) and environmental barriers (e.g., accessibility, technology, transportation).

DISCUSSION AND IMPLICATIONS

Contextual examples of IADL challenges among individuals aging with vision impairment highlight opportunities for technology design and innovation to support participation in everyday activities.

Examining the effects of home modifications on perceptions of exertion and safety among people with mobility disabilities

BACKGROUND

People with mobility disabilities often have reduced stamina and limited energy, making daily activities physically demanding. Home modifications, such as installing grab bars and optimizing the environment, have the potential to reduce exertion and enhance safety in the home, enabling individuals to participate more in other activities.

OBJECTIVE

The purpose of this study was to evaluate the effects of a home modification intervention on perceptions of exertion and safety among people with mobility disabilities.

METHODS

The study utilized the Home Usability Program (HUP), which aims to improve accessibility, safety, and independence in participants' homes. Participants were recruited from four Centers for Independent Living (CILs) across the US and underwent a comprehensive assessment to identify consumer-directed, individualized home modifications. Surveys examining safety and exertion, in addition to qualitative interviews, were conducted to explore the impact of the intervention on participants' energy levels and feelings of safety.

RESULTS

Analysis of pre-post measures and participant interviews revealed that the HUP intervention resulted in decreased exertion. Decreased exertion had positive outcomes, including increased time for other activities, improved socialization, enhanced independence, and the potential for engaging in activities outside the home. Additionally, the HUP intervention led to increased safety, which positively affected mental well-being and independence.

CONCLUSIONS

Findings highlight the need for useable living environments that minimize physical strain and reduce exertion. Policy recommendations include prioritizing accessibility standards for housing, implementing individualized assessments for funding home modifications, providing financial assistance options, and allocating research funding for innovative solutions and technologies.

High-Intensity Functional Training: Perceived Functional and Psychosocial Health-Related Outcomes from Current Participants with Mobility-Related Disabilities

BACKGROUND

People with mobility-related disabilities (MRDs) experience many personal and environmental barriers to engagement in community-based exercise programs. We explored the experiences of adults with MRD who currently participate in high-intensity functional training (HIFT), an inclusive and accessible community-based exercise program.

METHODS

Thirty-eight participants completed online surveys with open-ended questions, with ten individuals also participating in semi-structured interviews via telephone with project PI. Surveys and interviews were designed to examine changes to perceived health, and the elements of HIFT that promote sustained participation.

RESULTS

Thematic analysis revealed themes related to health changes following HIFT participation including improved physical, functional, and psychosocial health outcomes. Other themes emerged within the HIFT environment that promoted adherence for participants such as accessible spaces and equipment, and inclusive HIFT sessions and competitions. Additional themes included participants' advice for the disability and healthcare communities. The resulting themes are informed by the World Health Organization's International Classification of Functioning, Disability, and Health.

CONCLUSION

The findings provide initial data on the potential effects of HIFT on multiple dimensions of health outcomes and contribute to the growing literature on community-based programs that are adaptable and inclusive for people with MRD.

Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities

The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0-6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = -5.99 ± 8.0 kg, -5.4%, FB = -1.68 ± 3.3 kg, -1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas.

Understanding successful transition to independent living: A qualitative study of young adults with disabilities

Background

Independent Living (IL) involves having choice and control over where and with whom one lives. People with disabilities are less likely to live independently than their peers without disabilities.

Objective

The purpose of this study was to understand the perceptions of young adults with mobility disabilities regarding IL, how they define IL, and what advice they would give others considering living a more independent life.

Method

Semi-structured interviews were conducted with six young adults with mobility disabilities who had successfully transitioned to living independently. A content analysis was used to identify emergent themes from the interviews.

Results

Results indicate that participants had individualized perceptions of the definition of IL. Participants identified many barriers and facilitators to IL, including the physical layout of housing, available amenities, and social support. They recommended preparing for IL in advance and taking advantage of outside resources to enable a successful transition.

Conclusion

Young adults with mobility disabilities define IL in various ways, which may have an impact on whether they consider their transition to IL successful. Findings can be used to guide recommendations for young people with disabilities to use to ensure a successful transition to IL.

Understanding the Impact of an Integrated Crisis Team: A Qualitative Study of Emergency Department Staff

Approximately one in eight visits to the Emergency Department (ED) in the United States are due to a behavioral health crisis. A Midwest community created an Integrated Crisis Team (ICT) as part of its county-wide effort to improve quality of care for people with mental health and/or substance use disorders. This ICT, which is embedded in the ED, ensured trained crisis clinicians were available in the ED, among other strategies. Semi-structured interviews were conducted with 15 staff members and a thematic analysis was used to assess ED staff members' perceptions of the impact of the ICT on staff and patient experience, and to identify barriers to implementation. Results indicated that the ICT facilitated a collaborative team effort in the ED and improved patient care in the ED. This evaluation informs key stakeholders about the importance of integrating a crisis team within an ED to better serve behavioral health patients.

Examining the effects of the COVID-19 pandemic on community engagement for people with mobility disabilities

Background

The COVID-19 pandemic and subsequent mandates upended community participation in the United States. People with disabilities were often more vulnerable to the adverse effects of the pandemic. Some areas of community participation affected for this population include employment, access to transportation, and social engagement and connection to others.

Objectives

The purpose of this study was to explore the effects of the COVID-19 pandemic for people with mobility disabilities across a variety of topics related to community engagement including social interactions with family and friends, and access to caregivers, groceries, transportation, and employment.

Methods

A survey was administered to participants with mobility disabilities (N = 39). Participants were asked to elaborate on topic areas that they identified as being affected by the COVID-19 pandemic. Data analysis included descriptive statistics and a content analysis in search of themes from open-ended responses.

Results

Results indicate that access to family and friends was the most negatively affected topic related to participation, followed by access to food and groceries, transportation, employment, living independently, caring for others, and participating in the community in general. In response to these pandemic-related challenges, participants reported utilizing technology to connect with others and to get essential items delivered.

Conclusions

Findings from this rapid research emphasize the need for emergency preparedness strategies, accessible and reliable resources related to technology use (e.g., Internet), and continued access to services for people with disabilities to maintain various aspects of community participation throughout the COVID-19 pandemic and in the future.

Transportation challenges for persons aging with mobility disability: Qualitative insights and policy implications

BACKGROUND

Persons aging with mobility disability (PAwMD) experience transportation barriers, which can hinder their ability to fully participate in society. Despite a vast infrastructure of federal laws and programs designed to ensure access to transportation, PAwMD remain a transportation-disadvantaged population.

OBJECTIVES

This paper presents detailed insights on transportation challenges experienced by PAwMD along with recent Federal programmatic initiatives designed to enhance access and mobility for transportation for older adults and people with disabilities. To identify policy gaps and opportunities to improve transportation services, we compared individual-level challenges from PAwMD to national survey data about barriers associated with delivering transportation services at state and local levels.

METHODS

To assess individual-level transportation challenges, we conducted in-depth, structured interviews with sixty older adult participants with self-identified mobility disabilities for at least 10 years. We also conducted a content analysis of end-user transportation challenges and agency-level transportation coordination barriers to identify correspondences.

RESULTS

Participants reported challenges utilizing public and private modes of transportation, related to availability; accessibility; safety; advanced planning; as well as societal attitudes. Barriers to the availability, delivery, and coordination of access and mobility services are linked directly or indirectly to the PAwMD reports of experiencing a shortage of accessible transportation options.

CONCLUSIONS

Findings highlight the complexity of federal transportation policies and programmatic initiatives designed to support older adults and people with disabilities, which contribute to implementation barriers and transportation challenges. Results highlight the importance of integrating end-user and state and local provider input into transportation policy development and program implementation.

Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) for adults aging with a long-term mobility disability

BACKGROUND

There are growing numbers of adults aging with long-term mobility disabilities. Very little is known about the challenges this population experiences with everyday activities, and such challenges are likely to be greater and more complex than those of older adults who experience mobility declines later in life.

OBJECTIVES

The current manuscript presents in-depth insights on the specific activity challenges experienced by older adults with long-term mobility disabilities, and the response strategies they employ to overcome those challenges.

METHODS

In-depth, structured interviews designed to assess challenges and response strategies for a range of daily activities were conducted with sixty older adult participants (ages 60-79) who self-identified as having a mobility disability for a minimum of 10 years. A coding scheme was developed to classify emerging themes. We identify the most common challenges and responses reported across all 6 broad categories as well as for a single activity category as an exemplar of an in-depth activity analysis.

RESULTS

A needs taxonomy revealed challenges and response themes in relation to the most difficult activities identified by the participants. Frequently reported challenges included physical limitations and accessibility challenges. Common response strategies (e.g., utilizing tools or technologies, obtaining assistance from others, or modifying the approach to the task) were successfully mapped onto the Selection, Optimization, and Compensation model.

CONCLUSIONS

Findings reveal the unique challenges individuals face when engaging in everyday activities, and the potential of affordable and effective supports to promote aging-in-place, functional independence, and community engagement for adults aging with long-term mobility disability.

SMART HOME TECHNOLOGY FOR OLDER ADULTS WITH MOBILITY DISABILITIES: POTENTIAL AND CHALLENGES

Recently, there has been a significant expansion in the number of smart and connected technologies for assisting individuals with a variety of tasks within the home. Examples include digital home assistants (e.g., Amazon Echo), smart lights, smart plugs, robotic vacuums, as well as a multitude of other devices. Such technologies hold the potential to support independence for older adults with long-term mobility disabilities, as they may experience challenges engaging in daily activities. The aim of the current study was to utilize a comprehensive approach with an interdisciplinary team to improve understanding of how to integrate smart technology into older adults’ homes. We focused on identifying functionality that would be useful to them, understanding their perceptions, and developing instructional support. We conducted interviews among older adults with, and without, long-term mobility disabilities to better understand their attitudes towards digital assistants, identify needs for instructional support, and test the usability of our instructional protocol. The overall goal of this research is to improve understanding of older adults’ perceptions of these technologies and identify usability challenges within the home. The instructional protocol offers support by reducing the identified barriers to initial adoption and continued use to promote aging-in-place and improving overall quality of life for older adults with long-term mobility disabilities.

VOICE-ACTIVATED DIGITAL ASSISTANTS: PERCEPTIONS FROM NOVICE USERS WITH LONG-TERM MOBILITY DISABILITY

Voice-activated digital assistants (e.g., Amazon Echo, Google Home) are an emerging technology that have great potential to provide support for adults aging with a long-term mobility disability. Digital assistant technologies allow the user to perform a variety of everyday tasks and activities through voice interactions. Such tasks may include environmental control (e.g., turning on/off lights, voice-activated temperature control); supporting self-health management (e.g., providing medication reminders, encouraging physical activity engagement); and fostering opportunities for social engagement (e.g., messaging/calling others, playing games remotely). This presentation will focus on the perceived facilitators and barriers to digital assistant use in the home among adults aging with mobility disabilities. The findings provide design guidelines and insight for intervention implementation for the use of these technologies for the target population.

IDENTIFYING COMMUNITY PARTICIPATION CHALLENGES FOR ADULTS AGING WITH MOBILITY AND VISION DISABILITIES

There are growing numbers of older adults with mobility and vision disabilities acquired in early to mid-life who are a part of a population described as “aging with disability”. For these individuals, the addition of normative age-related declines (e.g., vision loss, arthritis) on top of a long-term disability can create extensive barriers to community participation. We present findings on activity challenges with community participation among older adults with long-term vision and mobility disabilities (N=120) from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) interview study. Results provide detailed insights on the specific task-based challenges experienced when engaging in one’s community (e.g., going to entertainment events, doing activities with a group or organization, and participating in religious services and activities) as well as the solutions and strategies employed to overcome those challenges. Findings provide guidance for the design of supportive technologies that promote participation and independence for this understudied population.

Perceptions of Digital Assistants From Early Adopters Aged 55+

Voice-activated digital assistants have the potential to assist adults aging-in-place with a variety of everyday tasks and leisure activities. To understand this potential, semi-structured interviews were conducted to explore perceptions and attitudes from current adult users based on the models of the unified theory of acceptance and use of technology model. Several model factors were identified as influential in the initial and continued use of the digital assistants. Results indicate the need for an effective instructional protocol to promote successful interactions during the learning phase and for continued engagement with novel abilities of the digital assistants.