Fourth Year Follow-up of Assistive Devices Intervention Study Among

the Home-Based Elderly

Shin-yi Lin, MSMachiko R. Tomita, Ph. D.Linda F. Fraas, MA, OTR/L

Susan M. Nochajski, Ph. D., OTR/L

Department of Rehabilitation ScienceState University of New York at Buffalo

Introduction

AT-EI are common compensatory approaches used by occupational therapists to assist elderly people to live as independently as possible in their home. Mann, Ottenbacher, Fraas, Tomita, and Granger (1999) conducted a randomized clinical trial study to investigate the effectiveness of assistive technology (AT) and environmental intervention (EI)1.

Introduction (cont’d)

The results of this study suggest that use of AT-EI alleviates functional and cognitive decline among the frail elderly living at home1. Besides, compared to low users, high users of AT-EI demonstrated higher levels of independence and function whether or not they received intensive intervention2. However, the continued use of devices by the elderly and the long-term relationship of AT use to the maintenance of function were still unknown.

Purpose• The purpose of the present study was to conduct

a follow-up study of the AT-EI intervention study, which was conducted by Mann and colleague1,2. The current study investigated continued use of AT-EI and its effect on maintaining physical and cognitive function of the older adults four years after the AT-EI intervention.

• The differences of AT-EI use and functional performance were compared between participants in the treatment group (T) and the control group (C), as well as between AT-EI high users (H) and low users (L).

Methods• Participants: During the current follow-up study,

20 people (T: n=12; C: n=8) lived at home and agreed to participate.

• Procedures: Participants responded to the adapted questionnaire for this follow-up study regarding their demographic information, current health condition, and AT-EI use during home interview. The investigator conducted functional evaluations to examine each participant’s physical and cognitive performance. High users and low users were identified according to the number of devices used.

Results

Figure 1:

Functional Changes of Participants in the

Treatment Group (T) and Control Group (C)

from Baseline of Intervention Study to

Follow-up Study

25.00

35.00

45.00

55.00

65.00

75.00

85.00

95.00

105.00

115.00

125.00

t1 (baseline) t5 (end) t9 (follow -up)

Time

Mean

sco

res

C FIM-MC FIM-CC FIM-TT FIM-MT FIM-CT FIM-T

Figure 1

Figure 1

5.00

15.00

25.00

35.00

t1 (baseline) t5 (end) t9 (follow -up)

Time

Mea

n sc

ores

C IADLC MMSEC PainT IADLT MMSET PainC DeviceT Device

Results (cont’d)

Figure 2:

Functional Changes of Participants in High

Users (H) and Low Users (L) group from the

Baseline of Intervention Study to Follow-up

Study

25

35

45

55

65

75

85

95

105

115

125

t1 (baseline) t5 (end) t9 (follow -up)

Time

Mean

sco

res

Low FIM-MLow FIM-CLow FIM-THigh FIM-MHigh FIM-CHigh FIM-T

Figure 2

5

15

25

35

t1 (baseline) t5 (end) t9 (follow-up)

Time

Mean

sco

res

Low IADLLow MMSELow PainHigh IADLHigh MMSEHigh PainLow Dev icesHigh Dev ices

Figure 2

Results (cont’d)

Table 1:

Correlation between Functional Decline,

Demographic Variables and Number of

Illnesses

Variables 1 2 3 4 5 6 7 8

1. Age at follow-up — .30 -.11 -.62** -.48* -.62** -.59** -.44

2. Change of number of illness — -.29 -.51* -.47* -.53* -.14 -.55*

3. Number of device at follow-up — .17 .13 .17 -.07 .15

4. Change of FIM motor score — .76** .97** .60** .62**

5. Change of FIM cognition score — .90** .70** .90**

6. Change of FIM total score — .67** .76**

7. Change of IADL score — .62**

8. Change of MMSE score —

* p < .05, ** p < .01

Table 1

Conclusion

1. The results indicated that participants in T experienced significant decline in both physical and cognitive functioning four years after the end of the intervention study, while participants in C maintained their functional status. Age and number of illnesses may have accounted for these functional changes in T.

Conclusion (cont’d)

2. Four years after the intervention study, the

participants in T still owned and used twice

as many AT devices in total number as

those in C. However, while participants in C

acquired more devices after the intervention

study, those in T decreased the number of

AT devices used.

Conclusion (cont’d)

3. During the intervention study and four

years after the study, participants in T

consistently indicated they had less

pain than those in C. The use of AT-EI

might have some psychological effects on

the elderly people.

Conclusion (cont’d)

4. High users of AD minimized their functional

decline but low device users had a

significant decline in functional status over

four years. This suggests that use of AT is

an effective means to maintain

functional independence and enable frail

elders to continue living at home until

cognitive decline becomes eminent.

Conclusion (cont’d)

5. This study also suggested that education of assistive devices are very important so that after the study is over, frail elders can acquire necessary devices to maintain their functional status to live at home.

References

1. Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M., & Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: A randomized controlled trial. Archives of Family Medicine, 8(3), 210-217.

2. Mann, W. C., Ottenbacher, K. J., Fraas, L., & Tomita, M. (2000, February). Effectiveness of assistive technology and environmental interventions in maintaining dependence and reducing home care costs for the frail elderly: Three year follow-up using a randomized trial design. Paper presented at the meeting of the American Association of Retired Persons (AARP), Washington, DC.