Use of assistive devices – a reality full of contradictions in elderly persons' everyday life

Purpose. The aim was to explore very old persons' use and experience of assistive devices in daily occupations and changes over a ten-year period. Method. This study focuses on 86-year olds (n = 201) and following a retrospective longitudinal design, reviews their situation at the age of 76 (n = 199). Data were collected by structured and open-ended interviews during home visits and subjected to statistical and content analysis. Results. A significantly higher proportion (69%) used assistive devices at the age of 86 than at age 76 (43%). During the interval about one third became new users, 35% were permanent users and 23% did not use assistive devices at all. Among those being dependent on personal help in ADL a higher proportion were users of assistive devices (81%) than among those being independent (55%) (p = 0.00013). The result regarding the usefulness, reason for use and experience of using assistive devices showed that very old persons' perspectives on personal, practical and social aspects varied greatly and were often contradictory. Conclusions. An assistive device is generally regarded as an enabler in daily occupation, but it can also become a ‘disabler’. There is a need for a deeper and broader understanding of these ambivalent perspectives and an ethical discussion of subtle factors that might influence the use and experience of assistive devices.

[1]  L. Gitlin,et al.  Emerging concerns of older stroke patients about assistive device use. , 1998, The Gerontologist.

[2]  G Grimby,et al.  Assistive devices in an elderly population studied at 70 and 76 years of age. , 1994, Disability and rehabilitation.

[3]  T. Sumsion Book Review: Enabling Occupation: An Occupational Therapy Perspective , 1997 .

[4]  B. Lundman,et al.  Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. , 2004, Nurse education today.

[5]  D. Lupton,et al.  Technology, selfhood and physical disability. , 2000, Social science & medicine.

[6]  U. Sonn,et al.  Activities of daily living studied longitudinally between 70 and 76 years of age. , 1996, Disability and rehabilitation.

[7]  Å. Brandt,et al.  Satisfaction with rollators among community-living users: a follow-up study , 2003, Disability and rehabilitation.

[8]  D. Mellström,et al.  Medical-social intervention in a 70-year-old Swedish population. A general presentation of methodological experience. , 1987, Comprehensive gerontology. Section C, Interdisciplinary topics.

[9]  A. Silman,et al.  Locomotor disability in very elderly people: value of a programme for screening and provision of aids for daily living. , 1990, BMJ.

[10]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[11]  Machiko Tomita,et al.  Dissatisfaction and Nonuse of Assistive Devices Among Frail Elders , 2002, Assistive technology : the official journal of RESNA.

[12]  A. Buysse,et al.  Awareness among community-dwelling elderly of assistive devices for mobility and self-care and attitudes towards their use. , 2002, Social science & medicine.

[13]  Lifeworld perspectives on assistive devices: Lived experiences of spouses of persons with stroke , 2005, Scandinavian journal of occupational therapy.

[14]  B. Steen,et al.  The gerontological and geriatric population studies in Gothenburg, Sweden. , 1993, Zeitschrift fur Gerontologie.

[15]  A. Svanborg A medical-social intervention in a 70-year-old Swedish population: is it possible to postpone functional decline in aging? , 1993, Journal of gerontology.

[16]  U. Sonn,et al.  Assessment of activities of daily living in the elderly. A study of a population of 76-year-olds in Gothenburg, Sweden. , 1991, Scandinavian journal of rehabilitation medicine.

[17]  N. I. Edwards,et al.  Ownership and use of assistive devices amongst older people in the community. , 1998, Age and ageing.

[18]  H Nazirah,et al.  THE APPLICATIONS OF INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) BY WORLD HEALTH ORGANIZATION(WHO) IN REHABILITATION MEDICINE PRACTICE , 2007 .

[19]  恵子 紀国谷 国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題 , 2007 .

[20]  Susanne Iwarsson,et al.  Occupational Therapy Research on Assistive Technology and Physical Environmental Issues: A Literature Review , 2006, Canadian journal of occupational therapy. Revue canadienne d'ergotherapie.

[21]  M P Lawton,et al.  Future society and technology. , 1998, Studies in health technology and informatics.

[22]  Helen Hoenig,et al.  Does assistive technology substitute for personal assistance among the disabled elderly? , 2003, American journal of public health.

[23]  Al Copolillo Use of Mobility Devices: The Decision-Making Process of Nine African-American Older Adults , 2001 .

[24]  Susanne Iwarsson,et al.  Assistive devices among very old people in five European countries , 2005, Scandinavian journal of occupational therapy.

[25]  Susanne Iwarsson,et al.  Accessibility and usability in housing: construct validity and implications for research and practice , 2003, Disability and rehabilitation.

[26]  T. Hadjistavropoulos John W. Rowe and Robert L. Kahn. Successful Aging . New York: Pantheon Books, 1998. , 1999, Canadian Journal on Aging / La Revue canadienne du vieillissement.

[27]  C. Hocking Function or feelings: factors in abandonment of assistive devices ∗ , 1999 .

[28]  William C. Mann,et al.  Frail Older Adults' Self-Report of Their Most Important Assistive Device , 2004 .

[29]  I. Hallberg,et al.  The experience of older people of entering into the phase of asking for public home help – a qualitative study , 2005 .

[30]  A. Conneeley Methodological Issues in Qualitative Research for the Researcher/Practitioner , 2002 .

[31]  Lawton Mp Future society and technology. , 1998 .

[32]  Claudine McCreadie,et al.  Can adapting the homes of older people and providing assistive technology pay its way? , 2004, Age and ageing.

[33]  Patricia Rigby,et al.  The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance , 1996 .

[34]  A. Skogstad,et al.  The oldest old and personal activities of daily living. , 1995, Scandinavian journal of caring sciences.

[35]  M. Powell Lawton,et al.  Ecology and the aging process. , 1973 .

[36]  Albert M. Cook,et al.  Assistive Technologies: Principles and Practice , 1995 .

[37]  D. Peterson,et al.  Ethics and assistive technology service provision , 2006, Disability and rehabilitation. Assistive technology.

[38]  B. E. Maki,et al.  Assistive devices for balance and mobility: benefits, demands, and adverse consequences. , 2005, Archives of physical medicine and rehabilitation.

[39]  B. Weiner,et al.  The shaping of individual meanings assigned to assistive technology: a review of personal factors , 2002, Disability and rehabilitation.

[40]  E. Agree,et al.  The influence of personal care and assistive devices on the measurement of disability. , 1999, Social science & medicine.

[41]  Gunilla Carlsson,et al.  Very old people's experience of occupational performance outside the home: Possibilities and limitations , 2007, Scandinavian journal of occupational therapy.

[42]  Jacobijn Gussekloo,et al.  Assistive devices and community-based services among 85-year-old community-dwelling elderly in The Netherlands: Ownership, use,and need for intervention , 2006, Disability and rehabilitation. Assistive technology.

[43]  A. Hunter,et al.  Multimethod Research: A Synthesis of Styles , 1989 .

[44]  Synneve Dahlin Ivanoff,et al.  Changes in the use of assistive devices among 90-year-old persons , 2005, Aging clinical and experimental research.

[45]  C. Granger,et al.  Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly. A randomized controlled trial. , 1999, Archives of family medicine.

[46]  B. Spillman Changes in elderly disability rates and the implications for health care utilization and cost. , 2004, The Milbank quarterly.

[47]  S. Furner,et al.  Older Adults and Assistive Devices , 1998, Journal of aging and health.

[48]  S. Söderberg,et al.  Disabled Persons' Experience of Dependence on Assistive Devices , 2002 .

[49]  U. Sonn,et al.  Longitudinal studies of dependence in daily life activities among elderly persons. , 1996, Scandinavian journal of rehabilitation medicine. Supplement.

[50]  U. Sonn,et al.  Elderly women's way of relating to assistive devices , 1999 .

[51]  B. Steen,et al.  The use and effectiveness of assistive devices in an elderly urban population , 1996, Aging.

[52]  Susanne Iwarsson,et al.  Preferences and frequencies of visits to public facilities in old age--a pilot study in a Swedish town center. , 2005, Archives of gerontology and geriatrics.

[53]  V. Freedman,et al.  Incorporating Assistive Devices into Community-Based Long-Term Care , 2000, Journal of aging and health.

[54]  L H Kraskowsky,et al.  Factors affecting older adults' use of adaptive equipment: review of the literature. , 2001, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[55]  Incorporating or Resisting Assistive Devices: Different Approaches to Achieving a Desired Occupational Self-Image , 2003 .