Annicka Hedman

Patterns of functioning in older adults with mild cognitive impairment: a two-year study focusing on everyday technology use

Objectives: Early detection is vital for persons with mild cognitive impairment (MCI) who are at risk of activity and participation limitations, and crosssectional studies suggest the ability to use everyday technology (ET) to be a sensible tool. However, group level analyses fail to inform us about how functioning can vary over time for individuals. This study aimed at exploring and describing patterns of functioning over two years in a sample newly classified with MCI, with a special focus on perceived difficulty in ET use and involvement in everyday activities. In addition, cognitive functioning and conversion to dementia were studied. Method: 37 older adults (aged ≥ 55) with MCI were assessed at inclusion, and at 6, 12, and 24 months. Longitudinal case plots for the variables under study were analyzed based on strict criteria using a person-oriented approach. Paired t-tests from baseline and 24 months were also conducted to analyze change. Results: The 32 participants who remained in the study after two years showed three distinct patterns of functioning over time: stable/ascending (n = 10), fluctuating (n = 10), and descending (n = 12), with the highest conversion to dementia in the descending pattern (58%). The perceived ability to use ET decreased or fluctuated in 50% of the sample. However, on a group level, a significant difference between baseline and 24 months was found only regarding cognitive function. Conclusion: As the need for support is individual and likely to alter over time, repeated evaluations of activity involvement and difficulty in ET use are suggested to target timely interventions for persons with MCI.

Amount and type of everyday technology use over time in older adults with cognitive impairment.

Abstract Objectives: This two-year study examined everyday technology (ET) use in older adults with mild cognitive impairment (MCI) testing five predefined theoretical assumptions regarding factors potentially influencing the amount of ET used in everyday life. Methods: Data from 37 participants with MCI were collected at inclusion, six, 12, and 24 months, on the type and amount of ET used and how difficult this was, activity involvement, and cognitive and diagnostic status. These variables were, together with age group (55–64, 65–74, or 75–84 years) and educational level, analysed in a mixed-linear-effect model. Results: A significant decrease in the overall amount of ET used was found over time, but the number of users of specific ETs both decreased and increased. Increasing perceived difficulty in ET use, less activity involvement, decreasing cognitive status, and belonging to the oldest age group significantly decreased ET use. Two years after inclusion 42% of the participants had converted to dementia, but neither change in diagnostic status nor length of education contributed significantly to the predictive model. Conclusion: Over time, a decreasing use of ET was shown in this sample with MCI. This process was influenced by several aspects important to consider in occupational therapy intervention planning.

Access to and use of everyday technology among older people : an occupational justice issue – but for whom?

ABSTRACT Research into older peoples use of remote controls, mobile phones, digital home appliances, and computerized communication systems reveals that many have difficulty accessing and using these everyday technologies. By using occupational justice theory as a lens onto this technological development, we argue in this commentary that critical analysis of the findings from an occupational perspective reveals systematic injustices that disadvantage certain sectors of the older population. In particular we propose that, contrary to what might be expected, diagnosis or disability is not the sole marker for a vulnerable population at high risk of occupational injustices. Rather, the empirical findings support that other aspects (e.g., economic, educational) may also be influencing both everyday technology access and use among the older population. In light of these concerns, we argue that (a) occupation-centred outcome measures are needed to target everyday technology populations at risk of occupational injustices, and (b) future studies evaluating the access and use of everyday technology among older people must also monitor and target socio-demographic diversities.

Changing everyday activities and technology use in mild cognitive impairment

Introduction Knowledge of the conditions under which older adults facing cognitive decline engage in everyday activities is of major importance for occupational therapists in designing supportive interventions. This study aimed to investigate perceived activity involvement over time and its longitudinal relationship to perceived ability to use everyday technology in older adults with mild cognitive impairment. Method Thirty-seven older adults with mild cognitive impairment at inclusion were assessed over 4 years. Overall and item-specific activity involvement were analyzed using mixed-linear-effect modeling and differential item functioning. Furthermore, overall activity involvement and ability in everyday technology use were correlated. Results Overall activity involvement decreased significantly over time. When adjusting for declining ability in the sample, actual differential item functioning indicated descending involvement in seven of 15 activities, while eight activities were stable. All leisure activities descended. The positive correlations between activity involvement and ability in everyday technology use became stronger over time. Conclusion Variations across activities and time-points suggest that occupational therapists should repeatedly monitor the increasingly associated aspects of activity involvement and ability to use everyday technology in persons with cognitive decline.

How older adults with mild cognitive impairment relate to technology as part of present and future everyday life: a qualitative study

BackgroundExisting everyday technology as well as potential future technology may offer both challenges and possibilities in the everyday occupations of persons with cognitive decline. To meet their wishes and needs, the perspective of the persons themselves is an important starting point in intervention planning involving technology. The aim of this study was to explore how persons with mild cognitive impairment relate to technology as a part of and as potential support in everyday life – both present and future.MethodsQualitative in-depth interviews with six participants aged 61–86 were conducted and analyzed, using a grounded theory approach.ResultsThe findings describe the participants’ different ways of relating to existing and potential future technology in everyday occupations as a continuum of downsizing, retaining, and updating. Multiple conditions in different combinations affected both their actions taken and assumptions made towards technology in this continuum. Both when downsizing doing and technology use to achieve simplicity in everyday life and when striving for or struggling with updating, trade-offs between desired and adverse outcomes were made, challenging take-off runs were endured, and negotiations of the price worth paying took place.ConclusionsOur findings suggest that persons with mild cognitive impairment may relate to technology in various ways to meet needs of downsized doing, but are reluctant to adopt video-based monitoring technology intended to support valued occupations. Feasibility testing of using already-incorporated everyday technologies such as smartphones and tablets as platforms for future technology support in everyday occupations is suggested.

Everyday Technology Use Related to Activity Involvement Among People in Cognitive Decline

OBJECTIVE. We investigated how everyday technology use related to activity involvement over 5 yr in people with mild cognitive impairment. METHOD. Thirty-seven older adults with mild cognitive impairment were evaluated regarding everyday technology use and involvement in activities over time. Information on diagnostic changes was collected from medical files. Linear mixed-effects models were used in data analysis. RESULTS. Ability to use everyday technology showed a significant effect on activity involvement (p = .007) beyond the effects of time, diagnostic change, and age. Decreases in number of everyday technologies used (p < .001) and share of accessible and relevant everyday technologies used (p = .04) were associated with decreasing activity involvement. However, these two aspects did not reinforce each other. CONCLUSION. When monitoring activity involvement in clients with cognitive decline, health care professionals should take into account clients’ ability to use everyday technologies and the amount of everyday technologies they use.

Network-based approaches for evaluating ambient assisted living (AAL) technologies

Ambient assisted living technologies could support people experiencing physical or cognitive challenges, to maintain social identities and complex activities of daily living. Although there has been substantial investment in developing ambient assisted living innovation, less effort has been devoted to understanding how to evaluate the impact of ambient assisted living on physical and mental health. Taking a theory-based evaluation approach, we suggest firstly that ambient assisted living technologies rely on networks of people and organizations to function, and secondly, analysing the changing structure of networks can bridge the gap between socio-technological change and individual-level capabilities. We present conceptual arguments for taking a network perspective in ambient assisted living evaluations, illustrated with examples from our own group’s work on technology use among older people with cognitive impairments. We then discuss the different types of network-based evaluation approaches available, their theoretical assumptions, and the sort of research questions they could address.