21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Mobility Devices in Everyday Life - very old women’s experiences SIGNE TOMSONE AND CHARLOTTE LÖFQVIST

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Aim In Sweden Löfqvist, C., Nygren, C., Brandt, Å., & Iwarsson, S. (2008). Very old Swedish women’s experiences of mobility devices in everyday occupation – A longitudinal case study. Scandinavian Journal of Occupational Therapy, available electronic, 19, This presentation is based on two studies; with the aims to explore how very old single living women experience the use of mobility devices over time, in relation to everyday life. In Latvia Paper in progress

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist WHAT are mobility devices?

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist WHY use mobility devices?

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist WHY use mobility devices? Mobility Safety Compencate for functional limitations -independence -active, participate

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist WHY research on mobility devices? Demographic changes Most users among the ageing population Most of them living in their own homes To plan for and meet the needs ….. Increase the knowledge on use and need for mobility devices for the very old Explore experiences in everyday life How use changes over time during the ageing process

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Proportion of MD users and change in use over one year %

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Proportion of MD users and change in use over 1 and 9 year %

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Methods Design - mixed methods case studies from a longitudinal perspective, utilizing a combination of quantitative and qualitative data sources for each informant and integrated methods in analyzing data. Informants - purposeful sampling aiming for three information rich women – all having varied experience of MD use. Data collection - existing survey data (sampling and case studies), in-depth interviews (case studies), observations.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Case description - Latvia Helena (90 years) Poor perceived health and mobility, has chronic diseases. Assistance in daily activities for several years- formal, as well as informal. Uses cane indoors. Have 4-wheel walker, but do not use it approximately one year now, because do not go outdoors anymore.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Case description - Latvia Elza (89 years) Since childhood experienced polio effect as variety of functional limitations, poor perceived health and mobility. Assistance in daily activities for several years- earlier formal, recently only informal. Regularly used different assistive devices- orthotics, orthopedic shoes, crutches. Had active social life but recently have not been outdoors approximately 3 years.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Case description - Latvia Helga (89 years) Good pereceived health and mobility, reltively healthy over life time. Need for assistance in daily activities increased recently- get informal assistance. Tried several MD, but no optimal solutions. Had active social life but recently stopped going outdoors.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Findings (Latvia) Expressions about MD was very pragmatic- based on facts, little about subjective attitude or feelings; Limited possibilities to choose MD and get advice for MD use; The assistance in daily activities is in great importance- informal help, as well as formal help; Striving to keep independence and autonomy in current situation.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Findings (Latvia) Difficult to combine MD Yes, it is stable (walker), with that I could go… Yes, I walked on the street edge. And I watched, not to disturb the people around. …… I think that cane is more practical… That is the problem, in flat, it takes extra time. If I take it (walker) now to get to the kitchen.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Findings Adaptive strategies for daily activities and MD use I always have to rearrange the furniture here as well as in kitchen, to be able to get arround and hold on. I was able to walk only with that crutch, but when I turned to 89, I can not more with one hand, yes. I should hold with both hands if I stand or walk. ….. I can not go stright from that place to there. I should go arround to get there and back.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Findings Physical environment- indoors and outdoors I think, there is no good equipment to help me. That walker too, I should put it somewhere if I go for bathing. Also if I go to kitchen, to eat, I should leave it somewhere, but there is no space.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Findings Social environment Yes, I bought it myself (walker), but it is heavy, I need the help to overcome the stairs…. Int: Does there is someone who can help to overcome the stairs? Yes, I wait untill someone is coming in or out of house. Once I was on street and there was nobody for long time. I managed myself but I was too toiled to get in.

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Cases description Sweden Elisa (94 years) – rollator use already at baseline. Increase dependence on MD Mary (86 years) - from healthy, mobile and active to use of three different MDs – still social active Clare (93 years) – most frail – rappid changes from cane outdoors to more supportive rollator The cases illustrate how different factors interact and impact on the use of MD in everyday life over time

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Findings Personal factors and strategies; - How adjust, cope and adapt to situations – crucial for the role MD play in everyday life

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist ‘‘I wouldn’t manage very well without the rollator, I’m sure of that. I must have... the rollator is absolutely essential for me, I can use it for a lot of things, not just walking.’’

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Attitudes; Rollator described differently – accept – possibility – embedded in everyday life ‘‘I wouldn’t get out without the rollator but I hate to be dependent on it.’’

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist ‘‘It’s troublesome with the rollator. I can get where I want to but I think it’s troublesome for other people - there’s always someone who has to step aside to make way for the rollator.’’

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Other factors impacting on the use Social factors Technical aspects Weather conditions Environmental barrriers harder to overcome – need for supportive environment and combinations of MDs to optimize use

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Conclusion Complex Impact on activity and participation Dynamic over time Combinations of MD Environment influences Personal factors and attitudes

21 May 2013 Home and Health Workshop / Signe Tomsone and Charlotte Löfqvist Clinical implications? MD are very common and essential in very old age, the use increases over time and rapid changes occur MD per see is not enough – for optimal use we need to take into account the person, the activities and environment MDs have to be prescribed or tested out in the home environment For this we need professional competence