Need For Personal Assistance Research Articles

The Role of Personal Assistance in the Uptake of Smartphone-Based Tele-Audiology—An Extension of the Technology Acceptance Model

The arrival of new technologies in Hearing Healthcare is evident. The ability to connect hearing aids to smartphones via Bluetooth has opened up a host of new possibilities. By using an associated app, it is possible, among other things, to make an appointment with the Hearing Care Professional remotely. This function is nothing other than a further development of the classic Tele- Audiology. However, since the user base is mostly older, the question arises about the importance of the personal assistant in the clinic in setting up and explaining the technology for successful use. For this reason, a study was conducted among 110 patients who had already received such a form of intervention. For this purpose, the existing Technology Acceptance Model was further developed to include the latent variable of personal assistance. Existing basic hypotheses from other areas of application were confirmed and an additional relevant variable was identified. It could be concluded that due to a further shift of the patient generation towards baby boomers, the need for personal assistance might decrease.

Financial support for unmet need for personal assistance with daily activities: Implications from China's long-term care insurance pilots

This study investigates the association between income and unmet need for personal assistance with daily activities and introduces four policy options for financial support for the unmet need, particularly the public long-term care insurance (LTCI) system. Using the logit model and random forest algorithm, we find that household income is a significant contributing factor to unmet need. Moreover, we find that older adults in the low-income group have a higher level of unmet needs. China's policy experimentation shows that financial support can be provided in the policy arrangements of LTCI financing with low individual contributions and benefits with a high reimbursement rate.

Recovery from Severe Disability that Develops Progressively Versus Catastrophically: Incidence, Risk Factors, and Intervening Events.

Few prior studies have evaluated recovery after the onset of severe disability or have distinguished between the two subtypes of severe disability. To identify the risk factors and intervening illnesses and injuries (i.e., events) that are associated with reduced recovery after episodes of progressive and catastrophic severe disability. Prospective longitudinal study of 754 nondisabled community-living persons, aged 70 years or older. Greater New Haven, CT, March 1998 to December 2016. A total of 431 episodes of severe disability were evaluated from 385 participants: 116 progressive (115 participants) and 315 catastrophic (270 participants). Candidate risk factors were assessed every 18 months. Functional status and exposure to intervening events leading to hospitalization, emergency department visit, or restricted activity were assessed each month. Severe disability was defined as the need for personal assistance with three or more of four essential activities of daily living. Recovery was defined as return to independent function (no disability) within 6 months of developing severe disability. Recovery occurred among 35.3% (95% confidence interval [CI] = 26.0%-48.0%) and 61.6% (95% CI = 53.5%-70.9%) of the 116 progressive and 315 catastrophic severe disability episodes, respectively. In the multivariable analyses, lives alone, frailty, and intervening hospitalization were each independently associated with reduced recovery from progressive disability, with adjusted hazard ratios (95% CIs) of 0.31 (0.15-0.64), 0.23 (0.12-0.45), and 0.27 (0.08-0.95), respectively, whereas low functional self-efficacy, intervening restricted activity, and intervening hospitalization were each independently associated with reduced recovery from catastrophic disability, with adjusted hazard ratios (95% CIs) of 0.56 (0.40-0.81), 0.55 (0.35-0.85), and 0.45 (0.31-0.66), respectively. Recovery of independent function is considerably more likely after the onset of catastrophic than progressive severe disability, the risk factors for reduced recovery differ between progressive and catastrophic severe disability, and subsequent exposure to intervening illnesses and injuries considerably diminishes the likelihood of recovery from both subtypes of severe disability.

Risk Factors and Precipitants of Severe Disability Among Community-Living Older Persons

Severe disability greatly diminishes quality of life and often leads to a protracted period of long-term care or death, yet the processes underlying severe disability have not been fully evaluated. To evaluate potential risk factors and precipitants associated with severe disability that develops progressively (during ≥2 months) vs catastrophically (from 1 month to the next). Prospective cohort study conducted in greater New Haven, Connecticut, from March 1998 to December 2016, with 754 nondisabled community-living persons aged 70 years or older. Data analysis was conducted from November 2018 to May 2019. Candidate risk factors were assessed every 18 months. Functional status and potential precipitants, including illnesses or injuries leading to hospitalization, emergency department visit, or restricted activity, were assessed each month. Severe disability was defined as the need for personal assistance with at least 3 of 4 essential activities of daily living. The analysis was based on person-months within 18-month intervals. The mean (SD) age for the 754 participants was 78.4 (5.3) years, 487 (64.6%) were women, and 683 (90.5%) were non-Hispanic white participants. The incidence of progressive and catastrophic severe disability was 3.5% and 9.7%, respectively, based on 3550 intervals. In multivariable analysis, 6 risk factors were independently associated with progressive disability (≥85 years: hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; hearing impairment: HR, 1.7; 95% CI, 1.0-2.8; frailty: HR, 2.4; 95% CI, 1.6-3.7; cognitive impairment: HR, 2.0; 95% CI, 1.3-3.1; low functional self-efficacy: HR, 1.8; 95% CI, 1.2-2.8; low peak flow: HR, 1.7; 95% CI, 1.2-2.4), and 4 were independently associated with catastrophic disability (visual impairment: HR, 1.4; 95% CI, 1.1-1.8; hearing impairment: HR, 1.3; 95% CI, 1.0-1.7; poor physical performance: HR, 1.8; 95% CI, 1.3-2.5; low peak flow: HR, 1.3; 95% CI, 1.0-1.7). The associations of the precipitants were much more pronounced than those of the risk factors, with HRs as high as 321.4 (95% CI, 194.5-531.0) for hospitalization and catastrophic disability and 48.3 (95% CI, 31.0%-75.4%) for hospitalization and progressive disability. Elimination of an intervening hospitalization was associated with a decrease in the risk of progressive and catastrophic severe disability of 3.0% (95% CI, 3.0%-3.1%) and 12.3% (95% CI, 12.1%-12.5%), respectively. Risk differences were 0.6% (95% CI, 0.6%-0.6%) and 1.3% (95% CI, 1.3%-1.4%) for emergency department visit and 0.1% (95% CI, 0.1%-0.2%) and 0.4% (95% CI, 0.4%-0.4%) for restricted activity, and ranged from 0.1% (95% CI, 0.1%-0.1%) to 0.3% (95% CI, 0.3%-0.3%) for the independent risk factors, for progressive and catastrophic disability, respectively. The findings of this study suggest that whether it develops progressively or catastrophically, severe disability among older community-living adults arises most commonly in the setting of an intervening illness or injury. To reduce the burden of severe disability, more aggressive efforts will be needed to prevent and manage intervening illnesses or injuries and to facilitate recovery after these debilitating events.

The Cumulative Structure of Personal and Instrumental ADL. A Study of Elderly People in a Health Service District

Katz' Index of ADL has been supplemented by five well-defined instrumental activities, namely cooking, washing, transportation, cleaning, and shopping. Eighty-five persons, mainly elderly, who had consecutively consulted a district occupational therapist, were assessed in their homes in order to study the reliability, the scalability, and the validity of the expanded index. The inter-observer reliability was high. The coefficient of scalability was well above the acceptance level, indicating construct validity. No person was dependent in personal ADL and totally independent in instrumental ADL. Persons who were dependent in both personal and instrumental ADL were older and lived in sheltered accommodation more often than persons who were dependent only in instrumental ADL, indicating external validity. This study shows that there was a cumulative relationship between certain well-defined instrumental activities and between personal and instrumental activities. This supplemented index can be useful for assessing and differentiating the need for personal assistance and homecare among disabled elderly people.

Assessment of activities of daily living in the elderly. A study of a population of 76-year-olds in Gothenburg, Sweden

The cumulative structure of personal daily activities (Katz' Index of ADL) and four well-defined instrumental activities (cooking, transportation, shopping, and cleaning) have been studied in a population of 76-year-olds (N = 659) in Gothenburg, Sweden. Sixty-five percent of the population were independent, 22% were dependent in instrumental activities, and 13% were dependent in both instrumental and personal activities. No person was dependent in personal ADL and independent in instrumental ADL. The internal consistency and the coefficient of scalability were well above the acceptance level, which indicated an internal reliability and validity of the new scale. The frequency of personal and home-assistance care, type of accommodation, self-assessment of self-care and domestic activities were compared with the level of dependence in ADL and indicated external validity. This cumulative instrument of ADL can be used to describe and compare the level of disability in elderly populations and to define the need for personal assistance in home care among disabled persons.

Choice and quality in home-based and community-based aged care: insights from two rapid evidence reviews

AbstractAs consumer-directed care programmes become increasingly common in aged care provision, there is a heightened requirement for literature summarising the experience and perspectives of recipients. We conducted rapid evidence reviews on two components of consumer experience of home- and community-based aged care: (a) drivers of choice when looking for a service (Question 1 (Q1)); and (b) perceptions of quality of services (Question 2 (Q2)). We systematically searched MEDLINE and EMBASE databases, and conducted manual (non-systematic) searches of primary and grey literature (e.g. government reports) across CINAHL, Scopus, PsychINFO, and Web of Science, Trove and OpenGrey databases. Articles deemed eligible after abstract/full-text screening subsequently underwent risk-of-bias assessment to ensure their quality. The final included studies (Q1: N = 21; Q2: N = 19) comprised both quantitative and qualitative articles, which highlighted that consumer choices of services are driven by a combination of: desire for flexibility in service provision; optimising mobility; need for personal assistance, security and safety, interaction, and social/leisure activities; and to target and address previously unmet needs. Similarly, consumer perspectives of quality include control and autonomy, interpersonal interactions, flexibility of choice, and safety and affordability. Our reviews suggest that future model development should take into account consumers’ freedom to choose services in a flexible manner, and the value they place on interpersonal relationships and social interaction.

HABITAT: An IoT Solution for Independent Elderly.

In this work, a flexible and extensive digital platform for Smart Homes is presented, exploiting the most advanced technologies of the Internet of Things, such as Radio Frequency Identification, wearable electronics, Wireless Sensor Networks, and Artificial Intelligence. Thus, the main novelty of the paper is the system-level description of the platform flexibility allowing the interoperability of different smart devices. This research was developed within the framework of the operative project HABITAT (Home Assistance Based on the Internet of Things for the Autonomy of Everybody), aiming at developing smart devices to support elderly people both in their own houses and in retirement homes, and embedding them in everyday life objects, thus reducing the expenses for healthcare due to the lower need for personal assistance, and providing a better life quality to the elderly users.

Unmet need for assistance with activities of daily life among older adults in Brazil.

ABSTRACTOBJECTIVE To estimate the proportion of unmet need for personal assistance for basic and instrumental activities of daily life and to evaluate socioeconomic inequalities related to the unmet need among community-dwelling Brazilian older adults.METHODS This was a cross-sectional study with data from the last National Health Survey in Brazil. Unmet need was considered as the presence of at least one unmet need for basic or instrumental activities of daily life among individuals reporting the need for assistance. Logistic regression models were used to assess the correlates and probabilities of unmet need.RESULTS The proportion of unmet need was 18% and 7.1% for basic and instrumental activities of daily life, respectively. Unmet need was significantly related to living arrangements and socioeconomic status. Individuals in the first quintile of wealth status had about 50% higher probability of having an unmet need. A family member was the most prevalent type of caregiver.CONCLUSIONS Long-term care policy is needed to reduce the proportion of unmet need, especially among socioeconomically disadvantaged groups. Future studies should address the availability, training, and remuneration of caregivers, as those are an indispensable labor force in an aging society.

Self-perception during the Transition to the Fourth Age in the Czech Republic

Le vieillissement de la population signifie également un nombre croissant de personnes dans le soi-disant quatrième âge : l’expérience combinant la vieillesse avec un certain degré d’incapacité et la nécessité de recevoir des soins. Alors que certains auteurs identifient le quatrième âge avec la mort sociale, en parlant de l’impossibilité de la recherche empirique, notre article présente une interprétation des récits des personnes âgées concernant les changements dans leur quotidien par rapport à la transition vers cette période, montrant comment une telle interprétation est liée à leur perception de soi et leur identité.

Elderly Parents, Adult Children and the Romanian Transnational Family: An Intergenerational Solidarity Approach

Abstract Recent demographic changes such as ageing, low-fertility, and large out-migration from Eastern European countries, brought into discussion the vivid question of the future of intergenerational solidarity within families. In the context of increasing geographical mobility of young people in search for better paid jobs, the unmet need for personal assistance among the elderly, the underdeveloped system of care services, Romania knows new dynamics of intergenerational support. Contrary to perspectives that consider spatial proximity between adult children and their elder parents the indisputable enabling factor for intergenerational support transfers (Rossi and Rossi, 1990), emerging literature on transnational families highlights that such tight kinship relations continue to exist even across borders (Baldassar et al., 2007). Using recent data from the nationwide survey “The Impact of Migration on Older Parents Left Behind in Romania” (2011), this paper examines the complex dynamics of intergenerational solidarity involving adult children as transnational migrants and their elder parents who remain at home. The statistical models used indicate the migrants’ role as providers of remittances, but also the ways in which other forms of support are distributed among the dyads. Despite a possible presupposition that parents who were left at home might only be beneficiaries of support, the data show the opposite: elderly persons, depending on their age, were active providers of help as well.

Functioning and Self-Rated Health in the Oldest Old Community-Dwelling Women: A Four-Year Longitudinal Study

ABSTRACTAims: The aim of this study was to investigate functioning and self-rated health (SRH) among the oldest old community-dwelling women. Methods: The numbers of community-dwelling women who took part in this four-year study with three study waves were 113 (T1), 79 (T2), and 41 (T3), respectively. The participants mean baseline (T1) age was 88 years. Functioning measurements were: Activities of Daily Living (ADL), Timed Up and Go (TUG) and Mini-Mental State Examination (MMSE-12). Results: A statistically significant increase in the prevalence of disability (need for personal assistance in at least one basic ADL item) was revealed from T1 through to T3. The TUG, MMSE-12 and SRH declined significantly from T1 to T2; however, the decline attenuated from T2 to T3. Better baseline TUG and MMSE-12 were independently associated with remaining nondisabled at T3. Conclusions: Our results indicate the importance of enhancing mobility aiming at reducing the period of disability.

Nurturing longevity: Sociological constructions of ageing, care and the body

This paper examines assumptions that surround the way that aged care and assistance is conceptualised and discussed. Problems with the concept of care became apparent with the critique of care theory by the disability movement in the 1980s and continue to this day. Debates arose initially between those who sought to identify care as a gender-based duty that serves to burden those who take responsibility for it, and those who reject the concept as a form of socially constructed dependency. The paper considers the problematic sociological foundations of this critique – the failure to incorporate an understanding of the body into much sociological theory and the significance that the conceptualisation has for understanding the need for personal assistance in advanced old age. While the disability critique of care is firmly grounded in a sociological analysis, it overemphasises the social construction of social relations and ignores the visceral reality of the body. Longevity care, in contrast, needs to explicitly acknowledge that ageing is an embodied and physical process that generates a need for care. The conclusions are tested against recent Australian data and research on care needs and preferences amongst older people.

Met and unmet need for personal assistance among community-dwelling New Zealanders 75 years and over

Ageing in place initiatives that aim to keep older people out of hospitals and rest homes and in their own homes for longer have been at the forefront of aged care policy since the early 1990s. The success of these policies depends largely on the availability of a suitable home environment, a supportive social network and regular assessment to detect changes in the older person's health status and needs for support. The BRIGHT Trial was a randomised control trial investigating the effectiveness of introducing case finding in primary care settings to detect unmet need and risk of disability among older people. We used baseline questionnaire data collected in 2008-2009 from 3753 community-dwelling older people to estimate and describe use and need for additional personal assistance. Logistic regression was used to identify the most important predictors of reporting some need for support and unmet need. Eighty-one per cent of participants required support with at least one instrumental activity of daily living. Sixty-six per cent were meeting their needs with the support they were currently receiving. Unmet need was most frequently reported for heavy housework (65%) and light housework (53%). While spouses, family members and friends were the main providers of support for light housework, meal preparation, shopping, finances and transportation, paid staff most frequently provided personal care and heavy housework assistance. Reporting mobility difficulty (OR = 3.5), identifying as a care provider (OR = 1.7) and being female (OR = 1.9) were all significant predictors of some need for assistance as well as unmet need for assistance (OR = 2.5, 1.7 and 1.7 respectively). The findings highlight the importance of regular needs assessment for older people living in the community particularly, given the reliance on spousal support for the majority of activities.

A Clinical Index to Stratify Hospitalized Older Adults According to Risk for New‐Onset Disability

Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study's objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge. Data analyses derived from two prospective studies. Two teaching hospitals in Ohio. Eight hundred eighty-five patients aged 70 years and older were discharged from a general medical service at a tertiary care hospital (mean age 78, 59% female) and 753 patients discharged from a separate community teaching hospital (mean age 79, 63% female). All participants reported being independent in five activities of daily living (ADLs: bathing, dressing, transferring, toileting, and eating) 2 weeks before admission. New-onset disability, defined as a new need for personal assistance in one or more ADLs at discharge in participants who were independent 2 weeks before hospital admission. Seven independent risk factors known on admission were identified and weighted using logistic regression: age (80-89, 1 point; ≥90, 2 points); dependence in three or more instrumental ADLs at baseline (2 points); impaired mobility at baseline (unable to run, 1 point; unable to climb stairs, 2 points); dependence in ADLs at admission (2-3 ADLs, 1 point; 4-5 ADLs, 3 points); acute stroke or metastatic cancer (2 points); severe cognitive impairment (1 point); and albumin less than 3.0 g/dL (2 points). New-onset disability occurred in 6%, 13%, 18%, 34%, 35%, 45%, 50%, and 87% of participants with 0, 1, 2, 3, 4, 5, 6, and 7 or more points, respectively, in the derivation cohort (area under the receiver operating characteristic curve (AUC)=0.784), and in 8%, 10%, 27%, 38%, 44%, 45%, 58%, and 83%, respectively, in the validation cohort (AUC=0.784). The risk score also predicted (P<.001) disability severity, nursing home placement, and long-term survival. This clinical index determines risk for new-onset disability in hospitalized older adults and may inform clinical care.

Functional Trajectories in Older Persons Admitted to a Nursing Home with Disability After an Acute Hospitalization

To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization. Prospective cohort study of 754 community-living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs). Greater New Haven, Connecticut. The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization. Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair. The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5-75.5), and the mean number+/-standard deviation of ADLs that participants were disabled in upon admission was 3.0+/-1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function. The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes.

Socioeconomic determinants of the need for personal assistance reported by community-dwelling elderly: Empirical evidence from a French national health survey

A bivariate probit model with sample selection is used to estimate the conditional probability of reporting a need for personal assistance (NPA) with at least one activity of daily living among French community-dwelling elderly. 71.8% of men and 77.3% of women reported impairments and among those who reported impairments, 7.5% of men and 10.8% of women reported NPA. NPA is associated not only with age (i.e., the oldest individuals, for women only) and health status (such as a specific type of impairment), but also with socioeconomic (living with intermediate income; living with someone, partner or other) and environmental factors (having and using assistive technologies).

The Importance of Preconception Care for Women With Disabilities

The Importance of Preconception Care for Women With Disabilities

Hospitalization, Restricted Activity, and the Development of Disability Among Older Persons

Preventing the development of disability in activities of daily living is an important goal in older adults, yet relatively little is known about the disabling process. To evaluate the relationship between 2 types of intervening events (hospitalization and restricted activity) and the development of disability and to determine whether this relationship is modified by the presence of physical frailty. Prospective cohort study, conducted in the general community in greater New Haven, Conn, from March 1998 to March 2003, of 754 persons aged 70 years or older, who were not disabled (ie, required no personal assistance) in 4 essential activities of daily living: bathing, dressing, walking inside the house, and transferring from a chair. Participants were categorized into 2 groups according to the presence of physical frailty (defined on the basis of slow gait speed) and were followed up with monthly telephone interviews for up to 5 years to ascertain exposure to intervening events and determine the occurrence of disability. Disability, defined as the need for personal assistance in bathing, dressing, walking inside the house, or transferring from a chair. During the 5-year follow-up period, disability developed among 417 (55.3%) participants, 372 (49.3%) were hospitalized and 600 (79.6%) had at least 1 episode of restricted activity. The multivariable hazard ratios for the development of disability were 61.8 (95% confidence interval [CI], 49.0-78.0) within a month of hospitalization and 5.54 (95% CI, 4.27-7.19) within a month of restricted activity. Strong associations were observed for participants who were physically frail and those who were not physically frail. Hospital admissions for falls were most likely to lead to disability. Intervening events occurring more than a month prior to disability onset were not associated with the development of disability. The population-attributable fractions associated with new exposure to hospitalization and restricted activity, respectively, were 0.48 and 0.19; 0.40 and 0.20, respectively, for frail participants and 0.61 and 0.16, respectively, for nonfrail participants. Illnesses and injuries leading to either hospitalization or restricted activity represent important sources of disability for older persons living in the community, regardless of the presence of physical frailty. These intervening events may be suitable targets for the prevention of disability.

Disability and Transition to Adulthood: The Politics of Parenting

What enables young people with significant impairments to make the transition to adulthood? Becoming householders, finding work, becoming parents, feeling included as citizens: these are all more challenging in the context of housing needs, a discriminatory labour market, the need for personal assistance and transport. Our study interviewed a group of 31 young adults in receipt of disability living allowance, who had jobs and independent households, and smaller comparative groups, who had one or neither of these. We explored disabled people’s own accounts of adulthood and what had facilitated their achievement of jobs and independent living. Education, family, employment, personal assistance, housing, benefits and welfare services were on our agenda, but respondents’ own accounts are of ‘exceptional’ parents as the key.However, not everyone can have exceptional parents. We discuss the politics and economics of parenthood that prevailed while our respondents grew up, when parental responsibilities were extended and parental resources reduced. And we ask how much the politics of parenthood under New Labour offers to families with disabled children.