Assistive Devices and Cognitive Impairment: Review of Safety and Effectiveness

1. Assistive Devices and Cognitive Impairment: Review of Safety and Effectiveness Jamal Alkadri, BHsc (candidate) and Jeffrey Jutai, PhD Interdisciplinary School of Health Sciences University of Ottawa, Bruyère Research Institute Introduction In recent years much research has revolved around assistive devices and their effectiveness, but not many studies have focused on how cognitive impairment may affect device use. This is troubling considering that the percentage of the world population represented by people over the age of 65 is steadily increasing, with a constant rate of about 10% of Americans aged 65 and over being diagnosed with dementia1. The literature reviewed demonstrated that the rate of misuse and abandonment of device use among patients with cognitive impairment is expected to be higher than those without cognitive impairment. The purpose of this review was to examine the risks and outcomes of assistive device use among cognitively impaired geriatric patients. Mann, Karuza, Hurren, Tomita (1992) 2 noted that persons with cognitive impairment are more likely to use assistive devices to aid with physical impairments rather than cognitive impairments, this is mainly associated to their perceived worries of relating to safety. During this review both cognitive and physical assistive devices were examined among geriatric patients, especially those with cognitive impairment. Methods Data Sources: English-language articles for people aged 65 and over were identified by searching MEDLINE and Embase (1985­–January 2014) for key words self-help devices and cognition disorders. Bibliographies of retrieved articles were also examined. 480 articles were selected for further evaluation. Study Selection: Abstracts of the remaining articles were then evaluated and all studies that concerned one or more of the following criteria were included: geriatric, long-term care residents or cognitively impaired patients using assistive devices that addressed benefits, risks, adverse effects or other problems. This yielded 41 articles that were fully reviewed. An additional 27 articles were omitted because of irrelevant outcomes. Data Extraction: The population, assistive device, domain, methodology and findings relevant to the effects of cognitive impairment on assistive device use were summarized. Refer to Figure 1 for a summary of the methodology. Conclusions Cognitively impaired patients are more likely to misuse an assistive device; unfortunately not much research is done to assess the risks they face. Considering it was concluded that the rate of misuse is higher among the cognitively impaired, mistakes reported among the cognitively stable would be expected to be amplified in those with cognitive impairment. Bradley and Hernandez (2011)4 found that problems for canes and walkers included incorrect height of the device, poor maintenance of the device and incorrect use. Unfortunately in this review it was also found that a great gap of information exists concerning the specific risks that these individuals face from misusing their devices. A focus on this in the future will allow clinicians and physicians to better aid the cognitively impaired in not only properly using the devices to avoid safety risks, but as well to improve their quality of life. To aid in a future study a draft tool was created to capture both demographic information and patient device use of the cognitively impaired. The demographic form was based on issues of importance when studying the elderly as outlined by Quinn (2010)5. The form created to collect data was based on results of this review and, is demonstrated in Table 1. 480 potentially relevant articles identified through literature searches and bibliographic searches (including duplicates) 230 in MEDLINE 247 in EMBASE 3 from bibliographic searches 439 excluded from further evaluation after review of titles and abstracts. Reasons for omission: Duplicates No Cognitive impairment No Assistive device Outcome measure not relevant 41 full-text studies reviewed 27 articles excluded: Outcomes not relevant Did not meet at least 1 of population criteria 14 articles included in the review Figure 1. Flowchart of the methods used in searching the literature and extracting relevant data. Results Cognitively impaired patients have a much higher rate of misuse and abandonment of assistive devices when compared to cognitively intact individuals. The success and effectiveness of cognitive aids is well documented, but a lack of training leads to an abandonment of cognitive aids as well. Through the review it was found that the cognitively impaired faced more problems than the cognitively intact when it came to using assistive devices. It was found that the cognitively impaired have more errors when it came to putting on prosthetic limbs, are slower at learning how to use a device and had a significantly higher rate of assistive device abandonment. The higher rates of misuse are worrying when one considers the risks associated with misuse of assistive devices. Bateni and Maki (2005)3 specifically mention that improper use of canes and walkers lead to tendonitis, osteoarthritis and carpal tunnel syndrome. Several articles revealed that the misuse of devices can be avoided through the proper implementation of cognitive aids and training for proper device use. Table 1. Draft proposal of survey tool for observing assistive device use in cognitively impaired patients. • Bibliography • Yang J-, Mann WC, Nochajski S, Tomita MR. Use of assistive devices among elders with cognitive impairment: A follow-up study. Topics in Geriatric Rehabilitation. 1997;13(2):13-31. • Mann WC, Karuza J, Hurren D, Tomita M. Assistive devices for home-based elderly persons with cognitive impairments. Topics in Geriatric Rehabilitation. 1992;8(2):35-52. • Bateni H, Maki BE. Assistive devices for balance and mobility: Benefits, demands, and adverse consequences. Arch Phys Med Rehabil. 2005;86(1):134-145. • Bradley SM, Hernandez CR. Geriatric assistive devices. American Family Physician. 2011;84(4):405-411. • Quinn K. Methodological considerations in surveys of older adults: Technology matters. International Journal of Emerging Technologies and Society. 2010;8(2):114-133. • Acknowledgements • This work was supported in part by a summer student award from Technology Evaluation in the Elderly Network.