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

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.     

Everyday technology use among older adults in Sweden and Portugal

Abstract

Background: Technology use is relevant for engaging in everyday occupations and aging in place and difficulties might limit participation.

Aim: The aim of the present study was two-fold: to investigate the internal scale validity of the Everyday Technology Use Questionnaire (ETUQ) in a matched Portuguese and a Swedish sample of older adults without known cognitive impairments and to compare everyday technology use (i.e., the relevance of Everyday Technology (ET) and perceived difficulty of using ET).

Methods: The Rasch rating scale model was used to investigate the psychometric properties of the data from the two countries. Analyses were then used to compare the samples.

Results: There is evidence of internal scale and person response validity in the Swedish and Portuguese ETUQ datasets. The Swedish sample demonstrated almost 25% more ETs to be relevant, as compared to the Portuguese sample (p?<?.05). The samples’ means of perceived difficulty in using ETs were similar.

Conclusions: The results support that the ETUQ is a valid assessment for measuring the relevance of and perceived difficulty of ET use and is able to detect differences and similarities between older adults in these European countries in relation to ET use in the home and society.     

Perceived difficulties using everyday technology after acquired brain injury: Influence on activity and participation

Abstract

Using everyday technology (ET) is a prerequisite for activities and participation at home and in the community. It is well known that persons with an acquired brain injury (ABI) can have limitations in activities of daily living but our knowledge of their difficulties using ET is not known. Thirty-six persons (27 men and 9 women, mean age 44 years, age range 26–60) with an ABI (2–10 years post injury) were interviewed, using the Everyday Technology Use Questionnaire (ETUQ), about their perceived difficulties using ET and how these difficulties influenced their everyday activities and their possibilities to participate at home and in the community. A majority (78%) of the persons reported difficulties using ET. The most common difficulties were related to the use of telecommunication and computers. Despite these difficulties, a majority still used most objects and services independently. Twenty-six participants (72%) perceived that their difficulties using ET influenced their everyday activities and their possibility to participate at home and in the community. The results indicate that rehabilitation following an ABI should consider whether clients' use of ET influences their activity and participation and adopt interventions accordingly. The results also indicate that difficulties using ET need to be considered in the design of community services to prevent societal barriers.     

不同类型日常生活活动能力与老年人抑郁的关联

目的  了解中国老年人抑郁及日常生活能力现状,并分析两者的联系。方法  选取2018年7月10日—9月13日中国健康与养老追踪调查中60岁及以上老年人,运用χ²检验和logistic回归分析模型探索日常生活能力对老年人抑郁的影响。结果  中国老年人抑郁检出率为43.82%;基本日常生活自理能力(basic activity of daily living, BADL)受损率为8.78%;工具性日常生活自理能力(instrumental activity of daily living, IADL)受损率为25.82%。BADL(OR=1.621, 95% CI: 1.304~2.016, P < 0.001)、IADL(OR=1.520, 95% CI: 1.321~1.748, P < 0.001)受损老年人抑郁可能性较高。IADL受损对不同地域老年人抑郁皆有影响,而BADL受损对中部地域老年人抑郁作用不明显。结论  日常生活能力受损老年人抑郁的可能性较高。建议将心理健康服务融入失能老年人的照护体系,配置相应的养老资源时注重地域差异。     

中国社区老年居民日常生活活动能力失能状况调查

目的 调查我国城乡社区老年人失能现状及其流行特征。方法 调查对象来自2015年老年期重点疾病预防和干预项目。采用多阶段分层整群随机抽样,抽取6省市共23 803名≥ 60岁城乡社区老年人,对其进行问卷调查和身体测量,采用日常生活活动能力量表（ADL）评估老年人失能情况。采用χ²检验分析基础性日常生活活动能力量表（BADL）和工具性日常生活活动能力量表（IADL）各项功能受损率及BADL/IADL失能率在不同特征老年人群间的差异,采用多因素logistic回归模型分析失能的影响因素。结果 BADL功能中洗澡受损率最高（1.7%）,吃饭受损率最低（0.6%）;IADL功能中打电话受损率最高（16.6%）,其次是乘公共汽车（5.5%）,吃药受损率最低（1.8%）。社区老年人BADL失能率2.1%,IADL失能率19.1%。BADL失能率在女性、无配偶、文盲、低体重和肥胖老年人中较高（P<0.05）。IADL失能率在女性、农村、无配偶、低文化程度和低体重老年人中较高（P<0.05）。多因素分析显示,BADL失能的危险性随年龄增加而升高,非正常体重也增加其危险性,而文化程度较高的老年人群BADL失能的危险性相对较低。增加IADL失能的危险因素有女性、增龄、农村、无配偶和低体重;而文化程度高和肥胖的老年人群IADL失能的危险性相对比较低。结论 本研究结果显示,受年龄老化和人口学诸多因素影响,我国老年人群失能率仍维持在一个高水平,加强老年人群躯体性的和工具性的日常生活活动能力下降预防和干预工作是非常必要的。     

Awareness through interaction in everyday occupations: Experiences of people with Alzheimer's disease

The aim of this study was to explore and describe the characteristics of awareness of the consequences of having Alzheimer's disease on everyday life occupations. Six community-dwelling participants with Alzheimer's disease were interviewed on repeated occasions about their lived experiences of everyday occupations. A phenomenological method was adopted for the analysis. The findings show that the participants discovered and explored the changes in how they performed everyday occupations in the context of their social relations and through immediate reflections on their forgetfulness. They attempted to handle the changes by adapting their behaviour. Awareness of the changes in their lives was evident in their reflections, as they tried to make sense of what was happening to them. This seemed to be related to an elusive perception of change in situations that they found impossible to influence. The participants reflected on the impact their condition had on other people near them. Their reflections also involved emotional reactions to the shortcomings they experienced. In conclusion, the findings show how these people with Alzheimer's disease were able to express awareness of the consequences of their illness through their reflections on their experiences of interaction with the occupations and the social environment.     

中国城乡老年人群两年内日常生活活动能力受损发生情况及影响因素

目的 了解中国城乡社区老年人群2年内日常生活活动能力（ADL）下降情况及其影响因素。方法 调查对象来自老年期重点疾病预防和干预项目。该调查采用多阶段分层整群随机抽样的方法,于2015年从我国6个省份抽取23 803名研究对象进行基线调查,2017年进行随访,剔除死亡、失访、数据不完整和2015年基线调查ADL受损的研究对象后,共计18 785名≥ 60岁的老年人符合纳入标准。以第6次全国人口普查数据为标准人口对样本数据进行加权后,分析不同特征老年人群2年内ADL、基础性日常生活活动能力（BADL）和工具性日常生活活动能力（IADL）受损发生率,并采用多因素logistic回归模型分析相关影响因素。结果 经过2年的随访,队列人群中共有1 959例发生ADL受损,ADL受损的2年累计发生率为12.0%,其中,BADL受损的2年累计发生率为1.6%,仅IADL受损的2年累计发生率为10.4%。多因素logistic回归模型分析结果显示,增加仅BADL受损发生风险的因素是年龄增加、肥胖、≥ 2种共病以及认知功能异常;增加仅IADL受损发生风险的因素为年龄增加、女性、低体重和认知功能异常。降低仅IADL受损发生风险的因素包括小学或初中及以上文化程度、超重或肥胖。结论 年龄增加、认知功能异常均增加BADL和IADL受损发生的风险。患有≥ 2种疾病的老年人BADL受损风险较高;肥胖增加老年人BADL受损发生风险,但降低IADL受损发生风险;女性比男性发生IADL受损风险高;高文化程度的老年人IADL受损风险低。     

The association between perceived and observed ability to use everyday technology in people of working age with ABI

Abstract

Objective: Everyday technology (ET), including computers and automated telephone services, is increasingly required for everyday functioning. However, people with acquired brain injury (ABI) may have difficulty with ET use. To design interventions to support ET use, further knowledge of how to assess dimensions of such use is needed. Methods: This study investigated the relationship between the perceived difficulty of ET use (self-reported using the short version of the Everyday Technology Use Questionnaire, S-ETUQ) and observed ability to use ET (observed using the Management of Everyday Technology Assessment, META) in a sample of people with ABI (n = 81). Data were analysed using a Rasch measurement model, and person measures of perceived difficulty and observed ability to use ET were identified and correlated. Results and conclusions. The person measures had a correlation of 0.49 (p < 0.001). In groups of different severity levels after ABI, significant associations were found in the moderate (0.36) and severe (0.47) disability groups. In the good recovery group, only a non-significant correlation was found (0.21). This indicates that the S-ETUQ and the META measure different but complementary dimensions of ET use. Hence, the assessments are proposed to be used together in clinical practice to more fully understand the ability of people with ABI to use ET.     

Performance-Based Assessment of Instrumental Activities of Daily Living: Validation of the Sydney Test of Activities of Daily Living in Memory Disorders (STAM)

Objectives

The distinction between dementia and mild cognitive impairment (MCI) relies upon the evaluation of independence in instrumental activities of daily living (IADL). Self- and informant reports are prone to bias. Clinician-based performance tests are limited by long administration times, restricted access, or inadequate validation. To close this gap, we developed and validated a performance-based measure of IADL, the Sydney Test of Activities of Daily Living in Memory Disorders (STAM).

Performance-Based vs Informant-Reported Instrumental Activities of Daily Living in Predicting Dementia

ObjectivesIdentifying individuals at risk of developing dementia may be aided by early detection of functional impairments. The aims of the present study were to examine differences in informant-reported and performance-based measures of instrumental activities of daily living (IADL) and to assess whether a performance-based IADL measure contributes additional unique variance over informant reports in predicting incident dementia over 4 years.DesignProspective cohort study (Sydney Memory and Ageing Study).SettingEastern Suburbs, Sydney, Australia.Participants307 community-dwelling individuals (60.6% female) aged between 76 and 96 years with normal cognition (NC; n = 190) or mild cognitive impairment (MCI; n = 117).MethodsIADL ability was assessed with the performance-based Sydney Test of Activities of Daily Living in Memory Disorders (STAM) and the Bayer-Activities of Daily Living (B-ADL) informant report, at baseline and 4-year follow-up. Covariates included age, sex, education, Mini-Mental State Examination and Geriatric Depression Scale scores, arthritis, vision impairment, cardiovascular risk, and number of medications. Logistic regressions were conducted to examine the longitudinal association between the 2 types of IADL measures and incident dementia.ResultsLogistic regressions showed that performance-based IADL impairment at baseline [odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.77, 0.90; P < .001] and decline in performance-based IADL function (OR = 0.82, 95% CI 0.73, 0.91; P < .001) were associated with incident dementia over 4 years, with the association provided by the STAM being statistically significant over and above the B-ADL.Conclusions and ImplicationsPerformance-based measures of IADL can predict progression to dementia over 4 years beyond that provided by an informant report of IADL. Performance-based IADL measures are promising tools for clinical practice to identify individuals at greater risk of developing dementia.     

Evaluating domains of everyday functioning in people with developmental disabilities

Objective: To examine the relationship among (a) quality of activities of daily living (ADL) task performance, (b) quality of social interaction, and (c) the extent of discrepancy between the person’s and the occupational therapist’s perspectives; and explore patterns of strengths and challenges among people with developmental disabilities (DD). Methods: Fifty-eight adults with different types of DD, living in northern Sweden, were evaluated using the Assessment of Motor and Process Skills (AMPS), the Evaluation of Social Interaction (ESI) and the Assessment of Compared Qualities – Occupational Performance (ACQ-OP) and Assessment of Compared Qualities – Social Interaction (ACQ-SI). The relationships among assessments were analysed using Pearson correlation analyses. Cluster analysis was used to group participants based on their evaluation results. Results The quality of ADL task performance and the quality of social interaction demonstrated weak to moderate positive relationships while the ACQ-OP and ACQ-SI demonstrated a strong positive relationship. The cluster analysis resulted in identifying three distinct groups that differed significantly from one another. Conclusion: The findings support the clinical use of multiple assessment tools, including observation and self-report, to evaluate different aspects of occupational performance. Comprehensive and relevant evaluation supports collaborative goal setting and intervention planning.     

Everyday technology use among older adults in Sweden and Japan: A comparative study

Abstract

Background: As context may impact everyday technology (ET) use it is relevant to study this within different contexts.

Aims: To examine the usefulness of the Everyday Technology Use Questionnaire (ETUQ) in different contexts by investigating and comparing (1) the level of challenge of ETs in the ETUQ and (2) the relevance of and perceived ability to use ET in samples of Swedish and Japanese older adults.

Materials and methods: The Swedish and the Japanese samples (n?=?86/86) were interviewed using the ETUQ about relevance of and perceived ability to use ET. Data were analyzed using Rasch analysis, chi square and a general linear model. Moreover, Differential Item Functioning (DIF) was investigated.

Results: The hierarchy of ETs’ level of challenge was generally stable in the two contexts. On group-level, the relevance was somewhat higher and the perceived ability to use ET significantly higher in the Swedish sample than in the Japanese.

Conclusions and significance: The similarities and differences between the technological landscapes of Sweden and Japan could be detected by ETUQ, demonstrating its usefulness in both countries. The potential causes to the differences in relevance of and perceived ability to use ET between older adults in Sweden and Japan need further exploration.     

Difficulties in using everyday technology after acquired brain injury: a qualitative analysis

Abstract

The aim of this study was to identify and describe the characteristics of the difficulties using everyday technology in persons with an aquired brain injury (ABI), and their experiences of how these difficulties influenced their life. Thirteen persons with an ABI were interviewed about their difficulties in using everyday technology and were observed in their use of technology. Data were analysed qualitatively with a constant comparative method. The results showed that the persons' experiences formed two categories: “A variety of combinations of difficulties in the use of everyday technology” and “Restrictions in life”. The difficulties identified were related not only to everyday technology itself but also to the interaction between the technology, the task, the person, and the environment. These difficulties influenced their experiences of restrictions in occupational performance, personal identification, and participation in society. The results emphasize that occupational therapists who design interventions for people with an ABI need to accommodate both the technology and other interacting aspects in order to overcome difficulties in using everyday technology.     

老年人日常活动能力与睡眠质量及其交互作用对认知功能的影响

目的 探究我国老年人日常活动能力、睡眠质量及其交互作用对认知功能的影响。方法 基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据,运用logistic回归模型进行危险因素分析。结果 控制相关变量后,多因素logistic回归结果显示,日常活动能力受损（OR = 3.941,95%CI:3.464～4.484）、睡眠障碍（OR = 1.370,95%CI:1.167～1.608）是老年人发生认知功能障碍的影响因素。交互作用结果显示,日常活动受损与睡眠障碍对认知功能障碍的发生具有相加交互作用（OR = 5.492,95%CI:4.380～6.888）,RERI（95%CI） = 1.261（0.092～2.430）,AP（95%CI） = 0.230（0.057～0.402）,S（95%CI） = 1.390（1.052～1.837）。结论 同时存在日常活动能力受损和睡眠障碍会增加老年人认知障碍的发生风险,通过有效措施提高老年人的睡眠质量和日常活动能力可有助于降低认知障碍的发生风险。     

Patient-Related Factors Associated With Depressive State in Caregivers of Patients With Dementia at Home

ObjectvesTo identify patient-related factors associated with depressive state in caregivers of patients with dementia, we investigated the caregivers' and patients' characteristics in relation to the depressive state in their caregivers.DesignProspective hospital-based cohort study.SettingTwo memory clinics in Japan.ParticipantsOutpatients with dementia (n = 135) and their caregivers at home.MeasurementsThe outpatients and their caregivers were divided into 2 groups according to the Center for Epidemiologic Studies Depression Scale for caregivers. To identify the patient-related factors that cause depressive state in caregivers, Mini-Mental State Examination (MMSE), the Physical Self-Maintenance Scale for fundamental activities of daily living (ADL), and the instrumental ADL scale (IADL) scores for instrumental ADL and the neuropsychiatric inventory (NPI) subscale score for behavioral and psychological symptoms of dementia were compared between the 2 groups. We used logistic regression to determine the independent predictors of caregiver depressive state.ResultsThere was no significant difference in MMSE score between the 2 groups. Logistic regression analysis revealed that the depressive state in caregivers was related with IADL score and delusion in NPI subscale of patients.ConclusionsDepressive state in caregivers was independent of the decline in cognitive function in patients with dementia but was associated with decline in instrumental ADL and severity of delusion.     

中国听力残疾老年人生活自理能力影响因素分析

目的分析中国听力残疾老年人生活自理能力现状及其影响因素。方法运用2006年第二次全国残疾人抽样调查数据,以≥60岁单纯听力残疾者为研究对象,对听力残疾的老年人基础性生活自理能力现状进行描述性分析,运用多因素logistics回归对听力残疾的老年人生活自理能力相关因素进行分析。结果中国≥60岁听力残疾老年人生活不能自理率为23.62%。多因素logistics回归分析结果显示,年龄越高听力障碍残疾等级越高(极重度OR=2.97,95%CI=2.68~3.29)、家庭人均户收入低于等于国家平均水平听力障碍老年人发生生活不能自理的风险越高(OR=1.17,95%CI=1.08~1.28);居住在农村(OR=0.86,95%CI=0.79~0.95)、所在地为东部(OR=0.59,95%CI=0.55~0.63)、受教育程度高(高中及以上OR=0.62,95%CI=0.53~0.72)听力障碍老年人发生生活不能自理的风险越低。结论个体因素和环境因素构成的情境因素与听力残疾老年人活动受限密切相关,影响其日常生活功能。