Demographic Differences in the Relationship between Assistive Device Use and Cognition among Home Based Elderly

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Demographic Differences in the Relationship
between Assistive Device Use and Cognition among
Home Based Elderly

• University at Buffalo
• The International Conference on Aging, Disability
  and Independence
• 4-7 Dec 03, Washington D.C.

• Vidyalakshmi Sundar
• Graduate Student
• Machiko R. Tomita, Ph.D.
• William C. Mann, Ph.D.
• Kathy Stanton, MS, MNS.

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Introduction

• Most older adults have at least one type of
  disability or chronic condition
• The proportion of older adults experiencing
  activity limitations increases with age (Hartke,
  Prohaska and Furher, 1998)
• Assistive devices can help to compensate for
  limitations physical and cognitive

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Assistive Technology

• Assistive device (AD) use varies with age,
  gender, race, etc. (Edwards and Jones, 1998)
• Persons with cognitive impairments use fewer
  devices than persons with physical impairments
  (Mann, Karuza, Hurren and Tomita, 1992)

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Purpose

• To understand the differences in demographic
  factors in the use of assistive devices by older
  adults with and without cognitive impairment.
  Specifically, to examine differences in
• Gender
• Age (less than or greater than 75)
• Race (white/minority)
• Education (less than or more than high school)
• Housing status (own/renting)
• Living arrangement (living alone/with someone)
• Income (less than or greater than 10,000)
• Marital status (married/not married) and
• Geographic region (Buffalo vs. Florida)

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Purpose

1. To identify the pattern of device use among older
   adults with and without cognitive impairments
2. To determine demographic factors predicting
   assistive device use among elders with and
   without cognitive impairment

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Method

• Retrospective cross-sectional study
• Sample
• Home based adults aged 60 or above (N1027)
• With some limitation in ADL
• Living in 2 geographical locations Buffalo
  Florida

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Method Data Collection

• Interviews - conducted by trained occupational
  therapists and nurses
• Instruments used
• Cognition MMSE
• Physical disability Sickness Impact Profile
• Demographic factors Dukes Older Americans
  Resources and Services Procedure.
• Assistive devices Identified by trained OT/nurse

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Methods Statistical Analysis

• ANCOVA
• To determine the adjusted value for AD use (after
  controlling for physical disability, hearing and
  vision)
• Scatter plot
• To identify the relationship between cognition
  and assistive devices (AD) used
• Hierarchical Multiple regression
• To identify the demographic predictors for AD use
  for older adults with and without cognitive
  impairment

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Results - Descriptives

• Mean MMSE 26.28 (SD5.76)
• Mean Physical disability 27.32 (SD 15.41)
• 27.7 males, 72.3 females
• 49.7 were 75 years or less
• 19.7 belonged to minority ethnic groups
• 52 were living alone
• 62.3 had completed high school or less
• 70.4 lived in Buffalo
• 54.2 owned a house
• 35.4 earn less than 10,000 annually
• 33.1 were married

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Results

• Predicted number of assistive devices used for
  Physical Impairments
• Group 1 12.45 (1.62)
• Group 2 12.03 (1.54)
• Group 3 11.42 (1.44)
• Predicted number of assistive devices used for
  Cognitive Impairments
• Group 1 0.27 (.04)
• Group 2 0.27 (.04)
• Group 3 0.28 (.04)

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Physical Device Use and Cognition
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Relationship between AD and Cognition

• A curvilinear relationship was found between
  cognition and AD use
• (Tomita, Mann, Stanton and Fraas, 2001)
• Cut-off points for MMSE were established
• Group 1 0-15 (severe cognitive impairment)
• Group 2 16-23 (mild cognitive impairment)
• Group 3 24-30 (no cognitive impairment)
• (Tombaugh and Mclntyre, 1992)

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Demographic Differences - Race
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Demographic Differences - Geographical Region
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Demographic Predictors

• Group 1 (MMSE 0-15)
• Assistive devices for physical impairments
• MMSE (ß -.283, p lt.05)
• Assistive devices for cognitive impairments
• None

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Demographic Predictors

• Group 2 (MMSE 16-23)
• Assistive devices for physical impairments
• Geographic region (ß .228, p lt.05)
• Education (ß .215, p lt.05)
• Assistive devices for cognitive impairments
• Race (ß -.263, p lt.01)
• Housing status (ß .183, p lt.05)

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Demographic Predictors

• Group 3 (MMSE 24-30)
• Assistive devices for physical impairments
• Race (ß -.235, p lt.01)
• Education (ß .071, p lt.05)
• Assistive devices for cognitive impairments
• Geographic region (ß .182, p lt.01)
• MMSE (ß -.094, p lt.01)
• Living Arrangement (ß -.080, p lt.05)

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Conclusion

• This study hypothesized that based on the
  demographic factors there are differences in the
  pattern of AD use among elders with and without
  cognitive impairment
• However, no differences were observed for adults
  with low levels of cognition
• Caregiver involvement
• For elders with mild cognitive impairment
• Living alone, higher education, owning a house
  and living in the south were factors associated
  with increased use of AD
• For elders with no cognitive impairment
• In addition to the above factors, minority elders
  were less likely to use ADs

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Discussion

• Assistive devices can help promote independence
  and autonomy in older adults
• Knowledge of who uses assistive devices and under
  what circumstances is essential
• Occupational therapists should work towards
  increasing the awareness of ADs and focus their
  intervention on the predisposed groups