Understanding adherence to assistive devices among older adults: a conceptual review

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

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Assistive devices among people living at home with advanced cancer: Use, non-use and who have unmet needs for assistive devices?

Objective

To investigate which assistive devices people with advanced cancer have and whether they are in use. In addition, to explore the characteristics of people with advanced cancer who have unmet needs for assistive devices.

Methods

This descriptive cross‐sectional study used data from a randomised controlled trial evaluating efficacy of an occupational therapy‐based intervention. Participants were 237 people with advanced cancer. Data were collected by means of instruments about demography, functioning and assistive devices.

Results

The most frequent assistive devices possessed by the participants were as follows: (1) small aids for dressing (47%), (2) Pillow for positioning (40%) and (3) electrically operated adjustable bed (39%). The prevalence of assistive devices was 92% (95% confidence interval [CI]: 88%–95%) with 14.2% non‐use, largest for trolley tables (50%). In all, 27.4% of the participants were found to have unmet needs for assistive devices. These participants had similar characteristics to the other participants except from lower activity of daily living (ADL) ability (p values = <0.001).

Conclusion

The assistive devices possessed by the participants were primarily for positioning and resting, and most were in use. More than a fourth of the participants had unmet needs for assistive devices and were characterised by lower ADL ability.

Perspectives of older adults with a chronic condition on functioning, social participation and health: a qualitative study

Background

Problems with mobility, functioning and social participation make living independently difficult for frail older adults. To continue living independently, therapy adherence is a prerequisite. The causes for non-adherence among older adults are multiple and complex, which is why insight into older adults’ perspectives regarding their functioning is an essential factor to increase therapy adherence.

This study investigates the perspectives of older adults on their functioning, social participation and health, and the factors influencing these elements.

Methods

We conducted a qualitative study on the older adult’s perceived functioning, social participation and health. Fourteen home-dwelling older adults suffering from chronic health issues were purposively selected.

Semi-structured interviews were conducted with open-ended questions.

Data were analysed following the Basic Logical Model of Abduction and Creswell’s coding method.

Results

Assistive devices, the older adult’s dwelling and living environment, professional and informal support, and medication are perceived as important determinants for retaining functioning and social participation.

Attitude, social influence and personal effectiveness were found to influence whether a person performs or participates in an activity. A person’s attitude is related to the significance the activity has to that person, the activity’s importance, personal wellbeing, the person’s values, and their desire for autonomy. Peers and children have a social influence on the level of activity of the older person. Traditions, in particular religious activities, along with personal effectiveness are motivating factors determining whether a person performs or participates in an activity. Personal effectiveness is linked to the person’s belief in their personal competencies and to the relationship between effort and result.

Finally, it appears that the type of coping strategy the older adult adopts, has an influence on their behavior. The participating older adults often used remarkable problem-focused strategies, which had a positive effect on their level of autonomy.

Conclusions

Older adults have identified barriers and facilitators that influence their level of functioning and social participation. These findings help to create a framework for maintaining and increasing therapy adherence, which may be helpful in facilitating occupational therapists and other healthcare professionals to detect determinants of therapy adherence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02365-w.

Towards improving the quality of assistive technology outcomes research

BACKGROUND

The Assistive Technology Device Outcomes Research (ATDOR) checklist was developed as a reporting guideline for researchers to enhance the quality of research in this field. The checklist contains 13 items that cover outcome domains unique to assistive technology devices (ATDs). The ATDOR was intended to be an adjunct to existing publication guidelines for outcomes research.

PURPOSE

The aim of this investigation was to examine the ability of the ATDOR checklist to identify strengths and weaknesses in ATD outcomes research publications that may not be detected using another publication guideline designed for outcomes research.

METHODS

Twenty original ATD outcome studies were scored using the Template for Intervention Description and Replication (TIDieR) checklist, and the ATDOR in two evaluation rounds. In the first round, articles were scored using the TIDieR alone. In the second round, they were scored using the TIDieR and ATDOR together. The difference in percentage scores between the two evaluation rounds was examined using the Wilcoxon signed rank-sum test for paired data.

RESULTS

There was a statistically significant difference in the percentage scores between the two evaluation rounds (Wilcoxon statistic = 10, Z = -3.547, p<.000).

CONCLUSION

When used alongside the TIDieR, the ATDOR adds significant value to evaluations of reporting quality on assistive technology outcomes research. As this field continues to grow, researchers are invited to join in efforts to standardise reporting to promote healthier outcomes for ATD users.Implications for rehabilitationReporting guidelines that evaluate research studies enhance their reporting quality and promote healthier outcomes for ATD users.The Assistive Technology Device Outcomes Research (ATDOR) checklist was shown to be a useful tool for achieving a minimum standard of reporting in the field of assistive technology.As the field of assistive technology continues to explore different methodologies, ongoing efforts to develop and update reporting guidelines are necessary in order to capture the future needs of this research area.

Toward guidelines for reporting assistive technology device outcomes

PURPOSE

The aim of this study was to develop and pilot-test reporting guidelines for manuscripts describing studies of assistive technology device outcomes, with the hopes of improving the overall quality of research in this field.

METHODS

The research is presented in two stages. In Stage 1, a literature review was completed to identify the essential components of a conceptual framework for reporting guidelines and to create a checklist. In Stage 2, two independent reviewers evaluated twenty articles using the checklist to identify any short-comings of the tool and produce an estimate of interrater reliability. Two items of the original checklist were revised after reconciling disagreements between the two raters.

RESULTS

The Cohen's Kappa value of the checklist was 0.887 (p < .000), reflecting excellent interrater agreement. The overall percent agreement was 94.6%.

CONCLUSIONS

Reporting guidelines for studies of assistive technology device outcomes appear to be reliable. Although the checklist may require periodic updating, it has potential for advancing outcomes research. Researchers are invited to share comments and criticisms to aid in the efforts of enhancing the quality of reporting in this field.Implications for rehabilitationReporting checklists and guidelines are effective tools for achieving a minimum standard of reporting quality in all areas of rehabilitation research.This study presents a preliminary reporting checklist for the field of assistive technology device outcomes that has potential for advancing outcomes research.Authors and journal editors are encouraged to adopt and adhere to reporting guidelines in order to enhance the clarity and completeness of prospective studies.