Long-term Mobility Disabilities Research Articles

TECHNOLOGY AS A CATALYST FOR SUPPORTING AGING WITH DISABILITY

Abstract Individuals aging with long-term disabilities may need support to perform and participate in everyday activities associated with well-being and quality of life. Technology solutions have potential to effectively promote autonomy and aging-in-place for this population. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. Mumma et al. will present insights from interviews of adults aging with vision loss due to glaucoma and macular degeneration regarding their challenges and response strategies for everyday activities. Lee et al. will discuss findings from interview data exploring how wisdom is manifested from the lived experiences of individuals aging with disability (i.e., hearing, vision, and mobility). Mitzner et al. will describe characteristics of the participant sample from a clinical trial examining the effect of a Tele Tai Chi intervention on physical activity and social connectedness for adults aging with long-term mobility disabilities. Sanford et al. will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities: DigiHand, KeyStroke, and 3DP for AT. Together these studies illustrate the needs and coping strategies of older adults with disabilities and the potential of technology to support those needs. This is a collaborative symposium between the Lifelong Disabilities and Technology and Aging Interest Groups.

TECHSAGE TELEWELLNESS TOOL: GUIDELINES FOR DELIVERING INCLUSIVE WELLNESS CLASSES VIA VIDEO-CONFERENCING

Abstract Many older adults, particularly those with mobility disabilities, experience barriers to participation in exercise classes, including lack of accessibility and transportation. Tele-technologies (e.g., Zoom) provide an opportunity to facilitate both physical and social wellness through remote group classes. We developed the TechSAge Telewellness tool to provide guidelines for designing wellness classes delivered via video-conferencing for older adults with and without disabilities. The protocols and guidelines presented within it have been tested for usability and acceptance with older adults with long-term mobility disabilities. Throughout the tool, we present examples from the TechSAge Tele Tai Chi study as a case study to provide helpful insights on developing a Telewellness program. The tool includes guidance on selecting a software, safety considerations, class organization and logistics, social time, and tech support. The contents of the tool provide insights for research and design regarding telehealth technology, as well as health and wellness interventions.

Understanding Home Activity Challenges of Older Adults Aging with Long-Term Mobility Disabilities: Recommendations for Home Environment Design

As age-related changes progress, individuals with long-term mobility disabilities experience more challenges in engaging with everyday activities. This archival analysis identified common activity challenges older adults with long-term mobility disabilities report and the type of strategies they employed to respond to these challenges, using the interview data (n = 60) from the Aging Concerns, Challenges, and Everyday Solution Strategies Study. We discovered that activity challenges come from intrinsic factors (i.e., mobility limitations, strength, health conditions) as well as extrinsic factors (transferring and physical access). With these challenges in mind, we constructed home environment design strategies that could meet the needs of people aging with mobility disabilities.

Personal and Environmental Challenges of Aging in Place with Long-Term Mobility Disabilities

Maintaining independence while aging in place at home requires support, especially for older adults aging with long-term mobility disabilities. As age-related changes progress, individuals with long-term mobility disabilities experience more challenges engaging with daily living activities (ADLs) and instrumental activities of daily living (IADLs). To understand the activity challenges of these older adults, we analyzed the interview data from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, a comprehensive user needs assessment of 60 older adults who have had mobility disabilities for at least ten years (Koon et al. 2019). We selected interview data that focused on the conduct of ten activities at home: bathing, dressing, moving around, toileting, transferring, doing hobbies, housekeeping, home maintenance, managing diet and nutrition, and caring for others. This archival study used the coding schemes from the ACCESS study that were developed using both conceptual- and data-driven approaches (Koon et al., 2019). The ecological theory of adaptation and aging (Nahemow and Lawton, 1973) was the underlying framework to identify the challenges related to older adults' functional capacity (personal) and physical environmental barriers (environmental). We identified five main challenges: physical strength, general health limitations, mobility limitations, physical access, and transferring. Older adults' responses to overcoming the challenges involved personal, environmental, and person-environment interaction strategies. This study provides insights into the relationship between the source of environmental barriers and personal coping strategies to guide the design of appropriate aging in place supports for older adults with mobility disabilities.

Delivering a Tai Chi Intervention to Adults Aging with Mobility Disabilities Using Zoom

Many individuals aging with mobility disabilities experience barriers to participating in physical activity, including transportation challenges and the need for specialized instruction. Since the COVID-19 pandemic began, these participation barriers have been amplified due to lockdowns and restrictions. Tele-technologies, including videoconferencing platforms like Zoom, can facilitate access to exercise classes from one’s home. Virtual group exercise classes that incorporate social interaction have particular potential to support the physical and mental health of this population. This session will highlight lessons learned from launching the ‘Tele Tai Chi’ study, in which we are delivering an evidence-based Tai Chi program (Tai Chi for Arthritis) via Zoom to small group classes of older adults with long-term mobility disabilities. We will describe adaptations made in translating the in-person program to an interactive, online class, and provide an overview of a ‘Telewellness’ Tool that provides guidelines for using Zoom to deliver exercise classes to older adults.

Technology is the New Normal for Individuals Aging-In-Place With Disabilities

Technology designers often exclude individuals aging with diverse needs, capabilities, and disabilities from engaging in the design process, which can hinder the usability and usefulness of emerging technologies. In this symposium, investigators report on research and development efforts aimed at understanding the needs of, and developing supportive technologies for, people aging with long-term disabilities. This symposium features projects from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge), which is an interdisciplinary collaboration between Georgia Tech and the University of Illinois at Urbana-Champaign. First, Bayles et al. will discuss findings from the Aging Concerns, Challenges, and Everyday Solution Strategies II study, focused on Deaf older adults’ use of technologies as solution strategies for common everyday challenges. Next, Mitzner et al. will highlight the development of an evidence-based group exercise intervention (Tellewellness Tai Chi for Arthritis) aimed at promoting both physical exercise and social interaction for older adults with long-term mobility disabilities. Kadylak et al. will describe how voice-activated digital assistants can support older adults aging with mobility disabilities by reporting on findings from a longitudinal demonstration project with older adults in assisted and independent living communities. Exploring the potential for smartbathroom technology to promote aging in place, Sanford et al. will discuss how smartbathroom sensor data can be analyzed and vizualized to identify ways to communicate insight from sensor data to improve training of occupational therapy practitioners. Susy Stark from Washington University will serve as the discussant for the symposium.

Tele-Technology Evaluation and User Testing with Persons Aging with Long-Term Mobility Disabilities

Persons aging with mobility disabilities are at risk of social isolation, which is associated with negative health outcomes. Tele-technology is well-suited for supporting social connectedness by facilitating communication using two-way audio/video. However, the software and hardware requirements of tele-technology for this population are not well understood. The goal of this research was to 1) assess the usability of teletechnologies for this population, and 2) identify design recommendations for improving their usability of tele-technology. We conducted two studies: a heuristic evaluation to compare tele-technology design to usability standards, and a usability study with persons aging with long-term mobility disabilities. The following usability issues emerged: hardware limitations related to the size of technology and height adjustability; interface issues, such as system navigation; and network and privacy concerns. We conclude that there is a need for design improvement and design recommendations were proposed.

Using Inclusive Design to Develop a Tele–Tai Chi Intervention for Older Adults With Long-Term Mobility Disability

Tele-technologies may be able to increase access to evidence-based exercise interventions for adults aging with long-term mobility disabilities. This population experiences substantial barriers in attending such programs in person, including lack of transportation to classes, inaccessible buildings where classes are held, and lack of appropriate modifications offered for this population of older adults. It is critical to overcome such barriers to ensure this population has an opportunity to receive the benefits of evidence-based programs. In this study we are translating an in-person evidence-based tai chi intervention, Tai Chi for Arthritis, to an online platform using videoconferencing software for those aging with long-term mobility disabilities. We will describe our approach of including users from the target population and industry representatives (videoconferencing software developer, Tai Chi for Arthritis program developer as well as local master trainer) in the adaptation of the intervention and present the key findings from doing so.

Digital Home Assistant Health Applications for Older Adults With Long-Term Mobility Disabilities

The aim of the current study was to evaluate the feasibility, usability, safety, and efficacy of digital home assistant health applications (e.g., meditation applications, medication reminders, hydration management) for older adults with mobility disabilities. We used a multi-pronged approach. First, we compiled, categorized, and assessed a list of commercially available health applications compatible with Amazon Alexa devices. We reviewed data from the National Health and Aging Trends Study and the ACCESS study to identify challenges that older adults with mobility disabilities face within the home. We also reviewed the literature on the acceptance and use of digital home assistant health applications by older adults. Lastly, we conducted user testing in a laboratory and in a home-simulation environment to assess usability of different health applications. Our results provide guidance for the implementation of digital home assistant health applications to support older adults with long-term mobility disabilities.

Developing Digital Home Assistant User Guides for Older Adults With and Without Long-Term Mobility Disabilities

The aim of the current study was to understand how to integrate digital home assistant technologies and smart appliances into older adults’ homes by developing supportive user guides that facilitate adoption and continued use. We conducted a series of interviews among older adults, with and without mobility disabilities, to understand their attitudes towards digital assistants and to identify needs for instructional support and user guides. Subsequently, we developed and tested specific user guide modules for older adults aimed at addressing the identified concerns and desired instructional support. Specifically, we developed and field-tested user guides for the initial Amazon Echo device setup, basic device use (e.g., playing music and checking the weather), and separate modules for other domestic use cases (e.g., how to pair an Alexa enabled device with smart lights or appliances). Our results provide guidance for implementation of smart voice technologies to support older adults with long-term mobility disabilities.

Innovative Approaches to Inclusive Design for Technology to Support Aging With Disability: Examples From TechSAge

Technology research and development often exclude older adults with disabilities from participating in the design process. As a result, technologies may not be useful or usable by older adults with diverse abilities. This symposium, featuring projects at the TechSAge Rehabilitation Engineering Research Center, highlights ongoing efforts toward inclusive design, representing unique approaches to engage older adults with disabilities and their stakeholders in the research and development of technology supports. First, Mitzner et al., will describe the development of an online, group Tai Chi intervention, and the integral involvement of older adults with mobility disabilities, the exercise program developers, and technology partner in all steps of the process. Exploring the potential of voice-activated assistants, like Amazon Alexa, to support health management activities of older adults with mobility disabilities, Kadlyak et al. will present findings from a needs assessment of the target population and user testing in the lab and home environments. Koon et al. will present findings from a subject matter expert interview study with caregivers and medical professionals designed to identify the scope of activity challenges among people aging with long-term mobility and sensory disabilities that should be explored in more depth through our future interview study with the target population. Sanford et al., will describe a student design competition and hackathon that incorporates immersive experiences with people aging with disabilities to inspire innovative design concepts that respond to the needs of real people. NIDILRR Project Officer, Anne Ordway, will serve as the discussant.

Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) for adults aging with a long-term mobility disability

BackgroundThere are growing numbers of adults aging with long-term mobility disabilities. Very little is known about the challenges this population experiences with everyday activities, and such challenges are likely to be greater and more complex than those of older adults who experience mobility declines later in life. ObjectivesThe current manuscript presents in-depth insights on the specific activity challenges experienced by older adults with long-term mobility disabilities, and the response strategies they employ to overcome those challenges. MethodsIn-depth, structured interviews designed to assess challenges and response strategies for a range of daily activities were conducted with sixty older adult participants (ages 60–79) who self-identified as having a mobility disability for a minimum of 10 years. A coding scheme was developed to classify emerging themes. We identify the most common challenges and responses reported across all 6 broad categories as well as for a single activity category as an exemplar of an in-depth activity analysis. ResultsA needs taxonomy revealed challenges and response themes in relation to the most difficult activities identified by the participants. Frequently reported challenges included physical limitations and accessibility challenges. Common response strategies (e.g., utilizing tools or technologies, obtaining assistance from others, or modifying the approach to the task) were successfully mapped onto the Selection, Optimization, and Compensation model. ConclusionsFindings reveal the unique challenges individuals face when engaging in everyday activities, and the potential of affordable and effective supports to promote aging-in-place, functional independence, and community engagement for adults aging with long-term mobility disability.

UTILIZING TECHNOLOGY NETWORKS TO SUPPORT SOCIAL NETWORKS FOR PEOPLE AGING WITH DISABILITY

A growing number of new smart, internet-enabled technologies from smart phone applications, to teleconferencing, to the Internet of Things (IoT), provide great promise and potential to support successful aging-in-place for people with long-term disabilities. This symposium highlights ongoing research at the TechSAge Rehabilitation Engineering Research Center to identify technology needs and develop/adapt new technologies to promote independence, health, and participation of this population. To understand user needs, Harris et al. will present findings from a large-scale interview study with older adults with long-term vision and mobility disabilities (N=120) that explored specific task-based challenges with community activities (e.g., going to entertainment events, volunteering) as well as solutions and strategies to overcome them. Koon et al. will present findings on perceived facilitators and barriers to using digital assistants (e.g., Amazon Alexa) to facilitate a variety of everyday tasks at home, from shopping to communicating with others, among adults aging with mobility disabilities. Levy et al. will discuss findings from research driving the creation of augmented reality tools that can enable individuals to experience how IoT devices, such as smart thermostats and lightbulbs, could be used within the context of one’s own abilities and home. Mitzner et al., will describe the development of a Tele Tai Chi intervention for older adults with long-term mobility disabilities that employs teleconferencing software to translate an in-person, evidence-based class to an online, social experience. TechSAge Program Officer, Sarah Ruiz (National Institute on Disability, Independent Living, and Rehabilitation Research), will serve as the discussant.

SMART HOME TECHNOLOGY FOR OLDER ADULTS WITH MOBILITY DISABILITIES: POTENTIAL AND CHALLENGES

Recently, there has been a significant expansion in the number of smart and connected technologies for assisting individuals with a variety of tasks within the home. Examples include digital home assistants (e.g., Amazon Echo), smart lights, smart plugs, robotic vacuums, as well as a multitude of other devices. Such technologies hold the potential to support independence for older adults with long-term mobility disabilities, as they may experience challenges engaging in daily activities. The aim of the current study was to utilize a comprehensive approach with an interdisciplinary team to improve understanding of how to integrate smart technology into older adults’ homes. We focused on identifying functionality that would be useful to them, understanding their perceptions, and developing instructional support. We conducted interviews among older adults with, and without, long-term mobility disabilities to better understand their attitudes towards digital assistants, identify needs for instructional support, and test the usability of our instructional protocol. The overall goal of this research is to improve understanding of older adults’ perceptions of these technologies and identify usability challenges within the home. The instructional protocol offers support by reducing the identified barriers to initial adoption and continued use to promote aging-in-place and improving overall quality of life for older adults with long-term mobility disabilities.

VOICE-ACTIVATED DIGITAL ASSISTANTS: PERCEPTIONS FROM NOVICE USERS WITH LONG-TERM MOBILITY DISABILITY

Voice-activated digital assistants (e.g., Amazon Echo, Google Home) are an emerging technology that have great potential to provide support for adults aging with a long-term mobility disability. Digital assistant technologies allow the user to perform a variety of everyday tasks and activities through voice interactions. Such tasks may include environmental control (e.g., turning on/off lights, voice-activated temperature control); supporting self-health management (e.g., providing medication reminders, encouraging physical activity engagement); and fostering opportunities for social engagement (e.g., messaging/calling others, playing games remotely). This presentation will focus on the perceived facilitators and barriers to digital assistant use in the home among adults aging with mobility disabilities. The findings provide design guidelines and insight for intervention implementation for the use of these technologies for the target population.

IDENTIFYING COMMUNITY PARTICIPATION CHALLENGES FOR ADULTS AGING WITH MOBILITY AND VISION DISABILITIES

There are growing numbers of older adults with mobility and vision disabilities acquired in early to mid-life who are a part of a population described as “aging with disability”. For these individuals, the addition of normative age-related declines (e.g., vision loss, arthritis) on top of a long-term disability can create extensive barriers to community participation. We present findings on activity challenges with community participation among older adults with long-term vision and mobility disabilities (N=120) from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) interview study. Results provide detailed insights on the specific task-based challenges experienced when engaging in one’s community (e.g., going to entertainment events, doing activities with a group or organization, and participating in religious services and activities) as well as the solutions and strategies employed to overcome those challenges. Findings provide guidance for the design of supportive technologies that promote participation and independence for this understudied population.

CURRENT EFFORTS TO UNDERSTAND AND IMPROVE OLDER ADULTS’ FUNCTIONAL RECOVERY AFTER HIP FRACTURE

The annual number of hip fractures in the US is projected to increase from 258,000 in 2010 to 458,000 by 2050. Globally, annual hip fractures are projected to reach 4.5 million by 2050. Yet the majority of older adults experience long-term mobility disability following hip fracture and do not return to pre-fracture functional capacity. Published reviews have concluded there is insufficient evidence regarding effectiveness of interventions designed to reduce residual disability and enhance mobility post-hip fracture. This Symposium features current efforts to understand and improve functional recovery post-hip fracture. Dr. Magaziner will present results from the recently-completed Community Ambulation Project (CAP), a multi-site randomized trial in which two in-home physical therapy interventions were compared: PUSH, which included aerobic conditioning, strengthening, balance and functional training; and PULSE, which included transcutaneous electrical nerve stimulation, flexibility and active range of motion exercises. Dr. Fortinsky will present CAP data examining the role of psychological resilience, optimism, depression, and balance confidence on mobility measures. Dr. Gruber-Baldini will present CAP data examining differences between PUSH and PULSE on study participants’ cognition and the impact of cognition on community ambulation. Dr. Binder will present the study design and early results from the STEP-HI study, a multi-site randomized trial evaluating whether structured exercise and topical testosterone therapy can improve function post-hip fracture among older women. Discussant Dr. Latham will comment on design, results, and implications of these two studies for research, policy, and practice intended to improve older adults’ recovery after hip fracture.

A Systematic Approach for Prescribing Posthospitalization Home-Based Physical Activity for Mobility in Older Adults: The PATH Study

BackgroundOlder patients experience increased loss of mobility after hospitalization, largely because of physical disabilities and inactivity. There are, however, no current recommendations for prescribing physical activity (PA) at hospital discharge. ObjectivesDevelop a decisional tree for the systematic prescription of an individualized, adapted, nonsupervised home-based PA program for older adults after hospital discharge; investigate its feasibility, acceptability, and safety; and estimate its efficacy at improving physical function and mobility. DesignPragmatic prospective single-arm pilot study. Setting and participantsGeriatric assessment unit (GAU). Participants: Age ≥65 years, Mini-Mental State Examination score ≥18, hospitalization >7 days, discharge to home, no PA contraindications, understand French or English. MethodsDevelopment of a decisional tree for prescription of home-based exercise programs (Preventing loss of Autonomy by Treatment Post-Hospitalization: PATH tool) through meetings with a group of experts. The PATH tool was implemented in a short-term geriatric hospital. Feasibility, acceptability, and safety outcomes were measured and potential efficacy estimated after a 12-week period. ResultsThe decisional tree has 3 main components (cognitive, cardio strength, and balance) and comprises 27 different mobility profiles and PA programs. Fifty-six of the first 100 successively admitted GAU patients were found eligible, of whom 29 agreed to participate and 17 completed the protocol. Most were satisfied (14/17) and enjoyed (13/17) the program, and most health professionals found it relevant to patients (7/8) without extra burden (6/8) to patient care. Adherence to the PA program was 5 sessions/wk, and a medium to large effect size on walking speed (P < .01, d = 1.04), chair stand performance (P = .04, d = 0.75), and PA level (P = .07, d = 0.56) was observed after a 12-week period. Conclusions and implicationsThis study suggests that implementing the PATH tool might be feasible across GAUs, as well as safe and acceptable for patients and health care professionals. If this intervention proves beneficial after conducting a randomized controlled trial, this hospital-initiated care transition strategy should be implemented in short-term geriatric hospitals to prevent long-term mobility disability.

The bidirectional association between body weight and mobility disability: A population-based cohort

BackgroundObesity is more common in people with mobility disability than in non-disabled individuals, but less is known about the longitudinal effects leading to this health state. ObjectiveTo explore the potential bidirectional association between mobility disability and obesity. MethodsParticipants were identified in the population-based Stockholm Public Health Cohort (2002–2010, n = 17 945). Observations with schizophrenia, depression, eating disorder, or cancer within 5 years during and prior to baseline were excluded. Mobility disability and height and weight to calculate BMI (kg/m2) were self-reported. We used multivariate-adjusted regression models to estimate relative risks (RRs) and 95% confidence intervals (CI) based on new cases of mobility disability in cohorts that were obese, overweight or normal weight at baseline, and increases in BMI over time by mobility disability status. ResultsObesity at baseline was associated with incident mobility disability. The highest risk was observed in middle-aged women (RR = 3.95, CI = 2.35–6.65). Young men and middle-aged women with long-term mobility disability increased more in BMI (men: 1.55 kg/m2, 0.61–2.49; women: 0.38, 0.01–0.75), as well as young and middle-aged people with incident mobility disability (young men: 0.68 kg/m2, 0.10–1.27; middle-aged men: 0.49, 0.20–0.77; young women: 1.41, 0.94–1.87; middle-aged women: 0.64, 0.36–0.93) compared to the groups without any mobility disability. ConclusionsIn this paper, we demonstrated the bidirectional and longitudinal associations between body weight and mobility disability and thus the increased risk of developing the combination over time from either condition. Effective health-promotion and prevention strategies are needed to prevent worse health for these vulnerable groups in society.