Demographic Differences in the Demographic Differences in the Relationship between Assistive Relationship between Assistive

Device Use and Cognition among Device Use and Cognition among Home Based ElderlyHome Based Elderly

Vidyalakshmi SundarVidyalakshmi SundarGraduate StudentGraduate Student

Machiko R. Tomita, Ph.D. Machiko R. Tomita, Ph.D. William C. Mann, Ph.D. William C. Mann, Ph.D.

Kathy Stanton, MS, MNS.Kathy Stanton, MS, MNS.

University at Buffalo-The International Conference on Aging, Disability and Independence

4-7 Dec 03, Washington D.C.

IntroductionIntroduction

Most older adults have at least one type of Most older adults have at least one type of disability or chronic conditiondisability or chronic condition

The proportion of older adults The proportion of older adults experiencing activity limitations increases experiencing activity limitations increases with age with age (Hartke, Prohaska and Furher, 1998)(Hartke, Prohaska and Furher, 1998)

Assistive devices can help to compensate Assistive devices can help to compensate for limitations – physical and cognitivefor limitations – physical and cognitive

Assistive TechnologyAssistive Technology

Assistive device (AD) use varies with Assistive device (AD) use varies with age, gender, race, etc. age, gender, race, etc. (Edwards and Jones, (Edwards and Jones, 1998)1998)

Persons with cognitive impairments Persons with cognitive impairments use fewer devices than persons with use fewer devices than persons with physical impairments physical impairments (Mann, Karuza, Hurren (Mann, Karuza, Hurren and Tomita, 1992)and Tomita, 1992)

PurposePurpose To understand the differences in demographic To understand the differences in demographic

factors in the use of assistive devices by older factors in the use of assistive devices by older adults with and without cognitive impairment. adults with and without cognitive impairment. Specifically, to examine differences in Specifically, to examine differences in

• GenderGender• Age (less than or greater than 75)Age (less than or greater than 75)• Race (white/minority)Race (white/minority)• Education (less than or more than high school)Education (less than or more than high school)• Housing status (own/renting)Housing status (own/renting)• Living arrangement (living alone/with someone)Living arrangement (living alone/with someone)• Income (less than or greater than $10,000)Income (less than or greater than $10,000)• Marital status (married/not married) and Marital status (married/not married) and • Geographic region (Buffalo vs. Florida)Geographic region (Buffalo vs. Florida)

Purpose Purpose

1.1. To identify the pattern of device use To identify the pattern of device use among older adults with and among older adults with and without cognitive impairments without cognitive impairments

2.2. To determine demographic factors To determine demographic factors predicting assistive device use predicting assistive device use among elders with and without among elders with and without cognitive impairment cognitive impairment

MethodMethod

Retrospective cross-sectional studyRetrospective cross-sectional study SampleSample

• Home based adults aged 60 or above Home based adults aged 60 or above (N=1027)(N=1027)

• With some limitation in ADL With some limitation in ADL • Living in 2 geographical locations – Living in 2 geographical locations –

Buffalo & FloridaBuffalo & Florida

Method – Data CollectionMethod – Data Collection

Interviews - conducted by trained Interviews - conducted by trained occupational therapists and nursesoccupational therapists and nurses

Instruments usedInstruments used• Cognition – MMSECognition – MMSE• Physical disability – Sickness Impact ProfilePhysical disability – Sickness Impact Profile• Demographic factors – Duke’s Older Americans Demographic factors – Duke’s Older Americans

Resources and Services Procedure. Resources and Services Procedure. • Assistive devices – Identified by trained Assistive devices – Identified by trained

OT/nurseOT/nurse

Methods – Statistical AnalysisMethods – Statistical Analysis ANCOVAANCOVA

• To determine the adjusted value for AD use (after To determine the adjusted value for AD use (after controlling for physical disability, hearing and controlling for physical disability, hearing and vision)vision)

Scatter plot Scatter plot • To identify the relationship between cognition and To identify the relationship between cognition and

assistive devices (AD) usedassistive devices (AD) used

Hierarchical Multiple regression Hierarchical Multiple regression • To identify the demographic predictors for AD use To identify the demographic predictors for AD use

for older adults with and without cognitive for older adults with and without cognitive impairmentimpairment

Results - DescriptivesResults - Descriptives Mean MMSE = 26.28 (SD=5.76)Mean MMSE = 26.28 (SD=5.76) Mean Physical disability = 27.32 (SD= 15.41)Mean Physical disability = 27.32 (SD= 15.41)

27.7% males, 72.3% females27.7% males, 72.3% females 49.7% were 75 years or less49.7% were 75 years or less 19.7% belonged to minority ethnic groups 19.7% belonged to minority ethnic groups 52% were living alone52% were living alone 62.3% had completed high school or less 62.3% had completed high school or less 70.4% lived in Buffalo70.4% lived in Buffalo 54.2% owned a house54.2% owned a house 35.4% earn less than $10,000 annually 35.4% earn less than $10,000 annually 33.1% were married33.1% were married

Results Results

Predicted number of assistive devices Predicted number of assistive devices used for Physical Impairments used for Physical Impairments • Group 1: 12.45 (1.62)Group 1: 12.45 (1.62)• Group 2: 12.03 (1.54)Group 2: 12.03 (1.54)• Group 3: 11.42 (1.44)Group 3: 11.42 (1.44)

Predicted number of assistive devices Predicted number of assistive devices used for Cognitive Impairments used for Cognitive Impairments • Group 1: 0.27 (.04)Group 1: 0.27 (.04)• Group 2: 0.27 (.04)Group 2: 0.27 (.04)• Group 3: 0.28 (.04)Group 3: 0.28 (.04)

Physical Device Use and CognitionPhysical Device Use and Cognition

Relationship between MMSE and

Altered ADPI Use

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Relationship between AD and Relationship between AD and CognitionCognition

A curvilinear relationship was found between A curvilinear relationship was found between cognition and AD usecognition and AD use(Tomita, Mann, Stanton and Fraas, 2001)(Tomita, Mann, Stanton and Fraas, 2001)

Cut-off points for MMSE were established Cut-off points for MMSE were established • Group 1 : 0-15 (severe cognitive Group 1 : 0-15 (severe cognitive

impairment)impairment)• Group 2: 16-23 (mild cognitive impairment)Group 2: 16-23 (mild cognitive impairment)• Group 3: 24-30 (no cognitive impairment)Group 3: 24-30 (no cognitive impairment)(Tombaugh and Mclntyre, 1992)(Tombaugh and Mclntyre, 1992)

Demographic Differences - RaceDemographic Differences - RacePhysical Device Use - Race and MMSE

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Demographic Differences Demographic Differences - Geographical Region- Geographical Region

Cognitive Device Use - Geographical Region and MMSE

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Demographic Predictors Demographic Predictors

Group 1 (MMSE 0-15)Group 1 (MMSE 0-15) Assistive devices for physical Assistive devices for physical

impairmentsimpairments• MMSE MMSE ((ββ = -.283, p <.05) = -.283, p <.05)

Assistive devices for cognitive Assistive devices for cognitive impairmentsimpairments• None None

Demographic PredictorsDemographic Predictors

Group 2 (MMSE 16-23) Assistive devices for physical

impairments• Geographic region (β = .228, p <.05)• Education (β = .215, p <.05)

Assistive devices for cognitive impairments• Race (β = -.263, p <.01)• Housing status (β = .183, p <.05)

Demographic PredictorsDemographic Predictors

Group 3 (MMSE 24-30)Group 3 (MMSE 24-30) Assistive devices for physical Assistive devices for physical

impairmentsimpairments• RaceRace ( (ββ = -.235, p <.01) = -.235, p <.01)• EducationEducation ( (ββ = .071, p <.05) = .071, p <.05)

Assistive devices for cognitive Assistive devices for cognitive impairmentsimpairments• Geographic region Geographic region ((ββ = .182, p <.01) = .182, p <.01)• MMSEMMSE ( (ββ = -.094, p <.01) = -.094, p <.01)• Living ArrangementLiving Arrangement ( (ββ = -.080, p <.05) = -.080, p <.05)

ConclusionConclusion This study hypothesized that based on the demographic This study hypothesized that based on the demographic

factors there are differences in the pattern of AD use among factors there are differences in the pattern of AD use among elders with and without cognitive impairmentelders with and without cognitive impairment

However, no differences were observed for adults However, no differences were observed for adults with low levels of cognitionwith low levels of cognition• Caregiver involvementCaregiver involvement

For elders with mild cognitive impairmentFor elders with mild cognitive impairment• Living alone, higher education, owning a house and living Living alone, higher education, owning a house and living

in the south were factors associated with increased use of in the south were factors associated with increased use of ADAD

For elders with no cognitive impairmentFor elders with no cognitive impairment• In addition to the above factors, minority elders were less In addition to the above factors, minority elders were less

likely to use ADs likely to use ADs

DiscussionDiscussion

Assistive devices can help promote Assistive devices can help promote independence and autonomy in older adultsindependence and autonomy in older adults

Knowledge of who uses assistive devices and Knowledge of who uses assistive devices and under what circumstances is essentialunder what circumstances is essential

Occupational therapists should work towards Occupational therapists should work towards increasing the awareness of ADs and focus increasing the awareness of ADs and focus their intervention on the predisposed groupstheir intervention on the predisposed groups