Date Presented 3/31/2017
New empirical knowledge defines four distinct skill profiles among older people with and without cognitive limitations when using everyday technology, which supports targeted occupational therapy interventions to promote technology use in home and society that goes beyond a specific diagnosis.
Primary Author and Speaker: Anders Kottorp
Contributing Authors: Mandana Fallahpour, Camilla Malinowsky, Maria Larsson Lund, Louise Nygård
RATIONALE AND PURPOSE: The use of technology can enable people with and without disabilities to manage everyday activities in ways that were not possible a few years ago. But the use of everyday technology (ET) also comes at a cost; new skills need to be continuously developed and modified in the use of ET, which creates several challenges in everyday life, especially for people with cognitive limitations. In order to develop targeted interventions for people with cognitive limitations demonstrating problems in managing ET, a detailed level of description of problems is needed—for example, what specific skill limitations are demonstrated when using a specific ET. The purpose of this study was therefore to explore specific skill clusters in using ET in a heterogeneous sample of older persons without and with various age-related cognitive limitations and, moreover, to determine if specific skill clusters could be defined to further evaluate if they were associated with age, gender, and diagnostic group.
DESIGN AND METHOD: This cross-sectional descriptive study used 661 data records from earlier recruited samples of 203 participants in total, divided into four diagnostic groups: persons with (1) mild cognitive impairment, (2) Alzheimer’s dementia, and (3) acquired brain injury and (4) older people without known cognitive limitations. The Management of Everyday Technology Assessment (META) was used to observe and evaluate each participant’s ability to manage a variety of his or her own, relevant, and sufficiently challenging selected ET. The META was developed to assess the ability to manage ET in everyday activities for older adults in general and for persons with cognitive impairments in particular. The META consists of 17 items divided into four parts: (A) performance skills (10 items), (B) intrapersonal capacities (3 items), (C) environmental characteristics (2 items), and (D) safety and importance of the technology (2 items). The psychometric properties of the META have previously been evaluated in older persons with various types of cognitive impairments (Malinowsky, Nygård, & Kottorp, 2011).
A cluster analysis was implemented to allocate the 661 data records into distinct groups (clusters) based on their similarity to each other as compared with the data records in other groups, using Ward’s method and squared Euclidean distances to identify the optimum number of clusters, followed by a hierarchical tree cluster analysis. In order to further explore the demographics of the sample across clusters identified, independent t tests were used for mean age comparison, and chi-square analysis was used for comparing distribution of gender and diagnoses across groups. The p value was set at < .05 for all of the statistical analyses.
RESULTS: Four clusters were found in the data, demonstrating various distinct skill profiles in management of ET use. The clusters had distinct skill profiles in all aspects of META Parts A to C but no differences in relation to safety issues in using ET (Part D). Many participants also demonstrated skill profiles that belonged to more than one cluster in the ET observed, indicating that competence in ET use is not similar across technologies. Further, no significant differences were found between cluster groups in relation to age, gender, type of ET, or diagnostic group.
CONCLUSION: This new knowledge defines four distinct skill profiles when using ET, supporting targeted occupational therapy interventions to promote technology that go beyond a specific diagnosis.
IMPACT STATEMENT: Given the increased use of ET in both home and society among older people, it is important that occupational therapy base intervention strategies on these empirical evidence-based findings to promote clients’ functional cognition in everyday life.
References
Malinowsky, C., Almkvist, O., Kottorp, A., & Nygård, L. (2010). Ability to manage everyday technology: A comparison of persons with dementia or mild cognitive impairment and older adults without cognitive impairment. Disability and Rehabilitation: Assistive Technology, 5, 462–469. https://doi.org/10.3109/17483107.2010.496098
Malinowsky, C., Almkvist, O., Nygård, L., & Kottorp, A. (2012). Individual variability and environmental characteristics influence older adults’ abilities to manage everyday technology. International Psychogeriatrics, 24, 484–495. https://doi.org/10.1017/S1041610211002092
Malinowsky, C., Nygård, L., & Kottorp, A. (2011). Psychometric evaluation of a new assessment of the ability to manage technology in everyday life. Scandinavian Journal of Occupational Therapy, 18, 26–35. https://doi.org/10.3109/11038120903420606
