Demographic Differences in the Relationship between Assistive Device Use and Cognition among Home Based Elderly

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

2. Introduction • 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) • Assistive devices can help to compensate for limitations – physical and cognitive

3. Assistive Technology • 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)

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

5. Purpose • To identify the pattern of device use among older adults with and without cognitive impairments • To determine demographic factors predicting assistive device use among elders with and without cognitive impairment

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

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

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

9. Results - Descriptives • Mean MMSE = 26.28 (SD=5.76) • Mean Physical disability = 27.32 (SD= 15.41) • 27.7% males, 72.3% females • 49.7% were 75 years or less • 19.7% belonged to minority ethnic groups • 52% were living alone • 62.3% had completed high school or less • 70.4% lived in Buffalo • 54.2% owned a house • 35.4% earn less than $10,000 annually • 33.1% were married

10. Results • Predicted number of assistive devices used for Physical Impairments • Group 1: 12.45 (1.62) • Group 2: 12.03 (1.54) • Group 3: 11.42 (1.44) • Predicted number of assistive devices used for Cognitive Impairments • Group 1: 0.27 (.04) • Group 2: 0.27 (.04) • Group 3: 0.28 (.04)

11. Physical Device Use and Cognition

12. Relationship between AD and Cognition • A curvilinear relationship was found between cognition and AD use (Tomita, Mann, Stanton and Fraas, 2001) • Cut-off points for MMSE were established • Group 1 : 0-15 (severe cognitive impairment) • Group 2: 16-23 (mild cognitive impairment) • Group 3: 24-30 (no cognitive impairment) (Tombaugh and Mclntyre, 1992)

13. Demographic Differences - Race

14. Demographic Differences - Geographical Region

15. Demographic Predictors Group 1 (MMSE 0-15) • Assistive devices for physical impairments • MMSE (β = -.283, p <.05) • Assistive devices for cognitive impairments • None

16. 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)

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

18. 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 • However, no differences were observed for adults with low levels of cognition • Caregiver involvement • 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 AD • For elders with no cognitive impairment • In addition to the above factors, minority elders were less likely to use ADs

19. Discussion • Assistive devices can help promote independence and autonomy in older adults • 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