Demographic Differences in the Relationship between Assistive Device Use and Cognition among Home Based Elderly Vidyalakshmi Sundar Graduate Student Machiko R. Tomita, Ph.D. William C. Mann, Ph.D. Kathy Stanton, MS, MNS. University at Buffalo -The International Conference on Aging, Disability and Independence 4-7 Dec 03, Washington D.C.

Introduction Most older adults have at least one type of disability or chronic condition 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) 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 Assistive devices can help to compensate for limitations – physical and cognitive

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

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 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 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) andMarital status (married/not married) and Geographic region (Buffalo vs. Florida)Geographic region (Buffalo vs. Florida)

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

Method Retrospective cross-sectional study Retrospective cross-sectional study Sample Sample Home based adults aged 60 or above (N=1027)Home based adults aged 60 or above (N=1027) With some limitation in ADLWith some limitation in ADL Living in 2 geographical locations – Buffalo & FloridaLiving in 2 geographical locations – Buffalo & Florida

Method – Data Collection Interviews - conducted by trained occupational therapists and nurses Interviews - conducted by trained occupational therapists and nurses Instruments used Instruments used Cognition – MMSECognition – MMSE Physical disability – Sickness Impact ProfilePhysical disability – Sickness Impact Profile Demographic factors – Duke’s Older Americans Resources and Services Procedure.Demographic factors – Duke’s Older Americans Resources and Services Procedure. Assistive devices – Identified by trained OT/nurseAssistive devices – Identified by trained OT/nurse

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

Results - Descriptives Mean MMSE = (SD=5.76) Mean MMSE = (SD=5.76) Mean Physical disability = (SD= 15.41) Mean Physical disability = (SD= 15.41) 27.7% males, 72.3% females 27.7% males, 72.3% females 49.7% were 75 years or less 49.7% were 75 years or less 19.7% belonged to minority ethnic groups 19.7% belonged to minority ethnic groups 52% were living alone 52% were living alone 62.3% had completed high school or less 62.3% had completed high school or less 70.4% lived in Buffalo 70.4% lived in Buffalo 54.2% owned a house 54.2% owned a house 35.4% earn less than $10,000 annually 35.4% earn less than $10,000 annually 33.1% were married 33.1% were married

Results Predicted number of assistive devices used for Physical Impairments Predicted number of assistive devices used for Physical Impairments Group 1: (1.62)Group 1: (1.62) Group 2: (1.54)Group 2: (1.54) Group 3: (1.44)Group 3: (1.44) Predicted number of assistive devices used for Cognitive Impairments Predicted number of assistive devices 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 Cognition

Relationship between AD and Cognition A curvilinear relationship was found between cognition and AD use A curvilinear relationship was found between cognition and AD use (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 impairment)Group 1 : 0-15 (severe cognitive impairment) Group 2: (mild cognitive impairment)Group 2: (mild cognitive impairment) Group 3: (no cognitive impairment)Group 3: (no cognitive impairment) (Tombaugh and Mclntyre, 1992)

Demographic Differences - Race

Demographic Differences - Geographical Region

Demographic Predictors Group 1 (MMSE 0-15) Assistive devices for physical impairments Assistive devices for physical impairments MMSE (β = -.283, p <.05)MMSE (β = -.283, p <.05) Assistive devices for cognitive impairments Assistive devices for cognitive impairments NoneNone

Demographic 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 Predictors Group 3 (MMSE 24-30) Assistive devices for physical impairments Assistive devices for physical impairments Race (β = -.235, p <.01)Race (β = -.235, p <.01) Education (β =.071, p <.05)Education (β =.071, p <.05) Assistive devices for cognitive impairments Assistive devices for cognitive impairments Geographic region (β =.182, p <.01)Geographic region (β =.182, p <.01) MMSE (β = -.094, p <.01)MMSE (β = -.094, p <.01) Living Arrangement (β = -.080, p <.05)Living Arrangement (β = -.080, p <.05)

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 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 However, no differences were observed for adults with low levels of cognition Caregiver involvementCaregiver involvement For elders with mild cognitive impairment 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 ADLiving 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 For elders with no cognitive impairment In addition to the above factors, minority elders were less likely to use ADsIn addition to the above factors, minority elders were less likely to use ADs

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