Assistive Devices Overcoming Seniors’ Reluctance
Why do so many seniors resist using the very devices that can offer them freedom and safety? They prefer not to be seen using an assistive device (AD) even though such aids are known to increase independence and quality of life.
Currently, 40% of Canadians aged 65 and over have one or more disabilities due to the effects of aging and/or injury. Not surprisingly, the rate of disability increases with age. Sixty percent of those over age 75 and 70% of those over 85 have disabilities. Yet only 35% of Canadian seniors aged 75 and over use assistive devices (McWilliam et al., 1998).
By 2011, there will be more than 5 million seniors (65+) in Canada, a 38% increase from 3.6 million in 1998. Despite the fact that seniors are living longer and healthier lives, as life expectancy increases, so will the proportion of disabled seniors. While seniors are living longer and healthier lives, as life expectancy increases, so will the proportion of disabled seniors and the severity of their ailments. Almost half of disabled seniors have severe or very severe disabilities, with 80% of them reporting mobility as their primary problem area (PALS, 2001). However, the vast majority of seniors with disabilities do live independently – only 15% live in institutions.
Underutilization of assistive devices has individual and societal consequences as it significantly affects both the quality of life of seniors and the use of health system resources. So why don't more seniors avail themselves of assistive devices and what can be done to promote their use?
Partnering to Help
These are questions that Health Canada and Veterans Affairs Canada, through their joint partnership, the Falls Prevention Initiative, set out to examine. The Initiative funds community projects on falls prevention, targeting community-living veterans, seniors and their caregivers. The focus on assistive devices was determined at a national consultation with injury prevention stakeholders held in July 2000, prior to the launch of the Initiative. The use of assistive devices was seen as an overlooked area, one that was of great significance in falls prevention and the promotion of safe and active living.
A literature review examining the direct cause and effect relation between AD use and falls found that the data was inconclusive. This area of study is poorly researched and the consequences of using ADs are not captured in a systematic manner. What was determined was that those who use devices and fall come from the population of older, vulnerable seniors.
In general, seniors who use assistive devices have reported an increased quality of life. They cite physical and emotional safety, accomplishing desired goals or activities, and greater independence and mobility as the primary reasons for use. The most commonly used devices are mobility aids and those used in bathing and personal hygiene, which is significant as the majority of falls in the home occur in the bathroom.
Seniors who have used assistive devices report reduced dependence on others and feel that the devices helped them avoid facility placement. Yet many seniors have not adopted the assistive devices that could help them maintain their autonomy.
Why and Why Not?
Assistive device use is complex and shaped by a variety of factors. According to Gitlin (1995), age doesn't appear to be a factor in predicting use of assistive devices – the oldest segments of the seniors population are no more likely to use a device than the young old. Seniors' functional level is also not a strong predictor of use – the number and type of difficulties encountered were more significant in determining actual use. Gender differences are minimal – women and men use devices with equal frequency. However, the relationship between gender and social support shows that 66% of women and 17% of men who live alone use mechanical supports. For seniors living with relatives, the situation is reversed: 72% of men, and 24% of women use mechanical supports (NACA, Info-Age, April 1999).
Unfortunately, a significant number of assistive devices are ineffectively used, or abandoned, mobility aids being the most frequently associated with incorrect or non-use (Aminzadeh & Edwards, 1997). A lack of assessment and evaluation for assistive devices can contribute significantly to incorrect and non-use. Assessing a senior's need for aids therefore needs to become standard practice during visits to the physician.
Within each province and territory in Canada, there are programs that provide information and assistance on assistive devices. The level of assistance varies, with some provinces providing purchasing assistance and others providing none. Some provinces have a well defined and relatively simple delivery system while in others, there is no coherent assistive device program. This fragmentation can confuse the senior consumer and constitutes a considerable barrier to device procurement.
However, an overriding impediment limiting seniors' use of ADs is that of social stigma. Often, when seniors start to use an assistive device, they now see themselves as disabled – and become concerned about the negative image they project. This perception of the social effects of ADs impacts significantly on their use. To overcome the fear of stigmatization, focus is being placed on presenting ADs and their users in a positive way, rather than focusing on the disability.
To further examine Canadian seniors' and veterans' attitudes surrounding assistive device use, a national project was funded through the Health Canada/Veterans Affairs Canada Falls Prevention Initiative. Sponsored by the University of Victoria, this project held a series of focus groups with seniors, veterans, caregivers, health professionals and suppliers of assistive devices across Canada. One of the findings was that the seniors'/veterans' own perception of need significantly influences the use of assistive devices. This perception was in turn strongly influenced by the social stigma they associated with devices as well as the look and appearance of the device. Sadly, for most, devices symbolized loss of independence, disability and inevitable decline rather than reclaimed autonomy and improved quality of life.
Increasing Awareness and Access
Using the information gathered through this project and a literature review, the HC/VAC Initiative developed two additional projects focusing on increasing awareness and access to ADs, mobilizing seniors and veterans on the issue and reducing the stigma associated with AD use.
The University of Ottawa and the Canadian Association of Occupational Therapists partnered to strengthen community capacity in four pilot sites across Canada – Nanaimo, BC, Calgary, AB, Gatineau, QC and Charlottetown, PEI. The focus in the pilot sites is to foster acceptance of devices and enhance support. Senior and veteran “champions” work in their communities to increase the visibility and availability of assistive devices in new homes, stores and hotels. The goals are to support a shift in social norms from assistive devices as tools for the disabled, to assistive devices as "tools for independent living," and to enhance the ability of seniors, veterans and their community organizations to actively promote accessibility and use.
This project is also partnering with the other national HC/VAC Initiative project, sponsored by the British Columbia Institute of Technology (BCIT). BCIT is launching a social marketing campaign to reduce the stigma of AD use and broaden awareness about ADs among family members, businesses, industry, as well as seniors and veterans, on the benefits of AD use. A national public service announcement promoting positive AD use was launched this summer.
The message of the PSA is: "Pride can keep you on the sidelines of life". The PSA will be linked to a free "give-away" of Go for It! A Guide to Choosing and Using Assistive Devices. This brightly illustrated publication, developed through the HC/VAC Initiative, provides practical information on assistive devices (with a good dose of humour!) to help seniors become aware of the vast range of devices available and to help them assess which ones can assist them.
Policies and Programs
Further work is needed to support the use of assistive devices. Using the findings to date of the HC/VAC projects, Health Canada and Veterans Affairs Canada are examining ways to support and enhance practice, education, research and policy surrounding assistive devices. Partnerships have been developed within government to advance joint program and policy initiatives. An example of this is the Ministers Responsible for Seniors who, since the mid- 1990s, have been meeting to discuss seniors issues and help prepare Canadian society for the aging of its population.
The federal/provincial/territorial (FPT) Safety and Security Working Group has focused on the areas of elder abuse, crime prevention and in particular, injury prevention. This working group has contributed to the development of a handbook on best practices in falls prevention: Promising Pathways - Falls Prevention Programs for Older Canadians Living in the Community, which was produced through the HC/VAC Initiative to promote effective injury prevention strategies in communities. On a similar issue, the FPT Working Group on Day-to-day Technology has developed fact sheets to promote the use of a wide range of technologies, focusing on banking, voice-mail, computers, Internet and assistive devices.
Human Resources Development Canada is also targeting disabilities and is spearheading the federal Disability Strategy. Its recently released report Advancing the inclusion of persons with disabilities profiles issues related to seniors' disability.
Bringing Seniors Into the Process
Research has consistently demonstrated that partnering with target users (seniors) helps develop products and approaches that are effective in reaching seniors and influencing their health and independence. This extends not only to the use of assistive devices, but to their development as well. Seniors are rarely consulted in the development of AD devices, even when the devices are specifically designed for the older consumer (Fernie, 1998). In 1995, the National Advisory Council on Aging published its NACA Position on Health Care Technology and Aging, recommending that the assistive technology industry work with seniors' associations and gerontology research centres to design assistive devices that meet the real needs of older persons. It was felt that intersectoral collaboration among assistive device designers and seniors could promote both the development and use of improved assistive devices, the design of more aesthetic aids also being seen as a positive way to influence use.
Several government departments now have mechanisms to consult seniors and persons with disabilities. For example, Industry Canada's Assistive Devices Industry Office (ADIO), a key player in the national assistive device community, has an "Advisory Committee on Assistive Devices and Persons with Disabilities" that serves as a resource and consultation body. ADIO also fosters industrial growth in the assistive technology sector and works to ensure that the needs of consumers with disabilities are met.
External linkages with community groups such as the Canadian Red Cross, the Royal Canadian Legion, the March of Dimes and the Canadian Standards Association have led to other innovative work in the field of assistive devices. For example, the Canadian Standards Association, through a partnership with Health Canada, is currently developing a process for assessing products for seniors (including assistive devices) through the use of the Design for Aging Guidelines.
Still more needs to be done to enhance knowledge on the factors governing assistive device use by seniors, to promote seniors' use of ADs, to reduce the stigma, to promote seniors' involvement in AD development, to increase coordination, to share knowledge, and to encourage development of further partnerships.
As the senior population continues to increase, so will the importance of assistive devices as a vital strategy for preventing injuries, enabling seniors, and reducing costs to the health system. Promoting the use of ADs will not only improve the quality of life of seniors, it will also enhance their capacity to continue to contribute to Canadian society.
It is hoped that current efforts on all fronts at promoting seniors' health and the use of assistive technology will eventually lead to a complete change in perception: rather than creating a stigma, choosing to use assistive devices will be seen as a source of pride, evidence of a senior's wisdom and key to the continued enjoyment of community life.