Dianne Hurren

The Relationship of Functional Independence to Assistive Device Use of Elderly Persons Living at Home

This study explored the relationship between use of assistive devices and functional independence for noninstitutionalized elderly. Predictors of functional independence (including age, sex, education, mental status, physical disability, and visual impairment) were determined through correlation analysis on a sample of 364 subjects. From this sample, 117 pairs of subjects were matched on these predictors and compared for levels of functional independence relative to assistive device use. For 60 pairs, the subject who used more assistive devices was more functionally independent than the subject who used fewer devices. For 36 pairs, the opposite was found. For 21 pairs, the results were mixed: Within most pairs, the subject with more devices was more independent in ADL but less independent in IADL. Results suggest that increased use of assistive devices relates to increased functional independence.

Environmental Problems in Homes of Elders with Disabilities

Reporting on results from the University at Buffalo Consumer Assessments Study, this paper examines environmental problems in the homes of elderly persons with disabilities. For the study, 127 persons over the age of 60 were interviewed; all had received, or were currently receiving, services from a senior services agency or hospital rehabilitation program. An average of almost four problems per home were identified. Problems are grouped into categories by room and by area such as ‘lighting’ and ‘steps’ and described in more detail. Since all subjects had been referred to the project through an agency or hospital providing services, the results suggest that the home environment needs of elders are not adequately addressed by these service providers. An environmental interventions model, developed following an analysis of study results, is presented to guide service providers in setting priorities for recommending home modifications. Occupational therapists are qualified to provide home assessments, and must play a greater role in ensuring that these assessments and interventions are provided for non-institutionalized older persons with disabilities.

Use of Assistive Devices for Bathing by Elderly Who are Not Institutionalized

For elderly persons with disabilities, bathing is a frequent activity that can be both pleasant and dangerous. Bathing involves using water in an environment with hard, smooth surfaces that become slippery when wet, and many falls occur in the bathroom. A variety of assistive devices are available to make bathing safer and more comfortable. Bathing devices rank as one of the most frequently used categories of assistive devices, yet many elders experience problems in the use of bathing devices. Study of bathing devices has been little beyond determination of the frequency of their use. In this article, we developed a hierarchical model for use in prescribing bathing devices related to mobility and support. This model, based on level of disability, is called the Bath Device Prescription Model (BDPM). Subjects were drawn from the University at Buffalo Consumer Assessments Study (n=319), which considers persons older than 60 years with disabilities. Subjects who reported difficulty with bathing (n=294) were divided into two groups based on mental status (Mini Mental Status Exam [MMSE] scores ⩾24 or ⩾23). This model was tested by first determining the level of disability of satisfied users of (1) bath mats, (2) grab bars in the bath area, (3) bath stools, (4) bath chairs, and (5) bath transfer benches. Level of disability was measured with the Sickness Impact Profile-physical dysfunction section (SIP-PDS), the body care and movement subsection of the SIP-PDS, the motor section of the Functional Independence Measure (FIM), and the bathing-washing and drying item of the FIM. Subjects who were having a problem with a bath device, other than installation, maintenance, or access to the bathroom, were considered. Disability scores for these dissatisfied owners of bath devices were compared with the mean score of satisfied users of each bath device. Typically, dissatisfied owners of bath devices were more disabled than satisfied users, suggesting that they would benefit from a higher level device, following the BDPM. This study represents the first reported investigation testing a model for use in the prescription of bath devices.

Assistive devices for home-base older stroke survivors

The University at Buffalo Rehabilitation Engineering Research Center (RERC) on Aging is conducting a longitudinal study of assistive device needs of older persons with disabilities. This article examines the results of interviews with a sub-sample from this study, 30 persons over the age of 60 years who have had a stroke. Results indicate that this population are assistive device users: they own a mean of 16 devices per person and use a mean of 12.6 devices (80% of the devices they own). These older subjects express a need for additional devices, yet lack up-to-date information on devices available in the marketplace. In examining the home environment, the bathroom presents the largest number of problems for older stroke survivors, followed by the kitchen—rooms where many basic activities of daily living (ADLs) and instrumental activities of daily living (lADLs) are carried out. Recommendations for service providers are included in this article.

The Use of Phones by Elders with Disabilities: Problems, Interventions, Costs

Recognizing the important role the telephone plays in the life of frail elders, this study sought to gain a better understanding of the problems these elders encounter in using their phones to meet their needs. Starting with a sample of 354 frail elders, it was determined that 35, or just under 10%, were having some difficulty in the use of their phones. Twenty-two of these 35 subjects were randomly selected for an assessment of their impairments and phone setups in their homes. Interventions were provided to 19 of the 22 subjects, with two subjects refusing an intervention. At a 6-week follow-up call, all subjects were satisfied with the new phone or phone-related equipment. At a 6-month follow-up, 95% of subjects expressed satisfaction with the intervention. Phone usage increased by 50% for subjects provided a phone intervention. Average cost of equipment was

Relationship of severity of physical disability to pain, functional status, and assistive device use of home- based elderly clients

70.45; cost of personnel time was significantly higher. Recommendations are made for addressing the phone-related problems of frail elders.

Changes in Health, Functional and Psychosocial Status and Coping Strategies of Home-Based Older Persons with Arthritis over Three Years:

This study sought to determine the relationship of assistive device use, pain, and functional status to severity of physical disability among elderly persons with disabilities. A total of 194 community-based elderly persons were divided into seven groups based on degree of physical disability derived from their Sickness Impact Profile scores. Dependent measures included the functional independence measure (FIM) for activities of daily living (ADLs), the Jette Func tional Status Index-Modified for pain, and the Assistive Technology Used Survey for use of assistive devices. A Kruskall-Wallis one-way analysis of variance (ANOVA) was computed for each dependent variable. The seven groups showed statistically significant differences (P < .05) in reported pain scores, in functional status as determined by performance on ADL tasks, and in use of assistive devices. The results indicate that the use of assistive devices by elderly persons living in the community is associated with an interaction of several variables that are strongly related to degree of severity of physical disability.

A follow-up study of older stroke survivors living at home

The population of persons over 65 years of age, both in simple headcount and in proportion of the total population of the United States, has been increasing dramatically since 1900. This trend is projected to continue at least until the middle of the next century. Approximately half of persons over 65 years of age experience pain and/or activity limitation as a result of arthritis. There has been little study of the changes over time in health, functional, and psychosocial status of elders with arthritis, nor of the coping strategies they employ. Using participants from the University at Buffalo Consumer Assessments Study, we retrospectively selected 61 cognitively intact Mini Mental Status Exam (MMSE>23) elders with arthritis that impacted on activities, who were living at home at an initial interview and at a three-year follow-up interview. Using paired ṯ-tests we found significant changes at the three-year follow-up in four measures of health status: number of medications, number of chronic illnesses, pain, and vision. Functional status declined significantly as measured by the FIM (using MANOVA for six sections of the FIM), the Sickness Impact Profile, and the IADL section of the OARS (using paired ṯ-tests). No significant changes were found for psychosocial status. Using MANOVA, we found a significant increase in numbers of assistive devices owned (from an initial mean of 14.7 to a three-year follow-up mean of 20.1), and number of devices used. Satisfaction with devices was high. Environmental problems in the home showed a significant increase over the three years. While our selection of study participants did not include individuals who went to nursing homes or hospitals, or who had died, we still found significant decline in health and functional status, and clear evidence of successful coping strategies. Results suggest a strong role for occupational therapy services for elders with arthritis. There is also a need for change in policy toward home modification and occupational therapy services.

Differences between fallers and non-fallers in the frail elderly

Stroke often results in one or more serious long-term effects. Older persons who experience stroke typically experience other chronic conditions as well. This article analyzes coping strategies of home-based older people who experienced a stroke, focusing on use of assistive devices. In a sample of 35 older people with stroke, 20% had either moved into a nursing home or had died within 1 year of an initial interview. The remaining 27 older people were interviewed twice, at 1-year intervals. Comparisons were made to determine changes over 1 year for measures of health, functional status, and psychosocial status, as well as ownership, usage, and satisfaction with assistive devices. Three case studies are presented to illustrate how these older people use assistive technology in coping with the effects of stroke and their other chronic conditions.

Inter-rater agreement and stability of functional assessment in the community-based elderly.

Falls, fall injuries, fear of falling, and difficulty rising from a fall are significant related problems for frail elders. This study used a multivariants analysis to study differences between frail elders reporting one or more falls in the past 5 years, and those reporting no falls. Of 392 subjects, 186 (47%) reported a fall. Subjects reporting falls were more physically disabled, used more devices designed for physical disabilities, had more home environmental problems and used less assistive devices for vision impairment. Copyright