Aging With Long-Term Mobility Impairment: Maintaining Activities of Daily Living via Selection, Optimization, and Compensation.

BACKGROUND AND OBJECTIVES: There is a growing number of adults with long-term mobility impairment aging into the older adult population. Little is known about the experiences of these individuals in maintaining activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as they face age-related changes in addition to a pre-existing mobility impairment. RESEARCH DESIGN AND METHODS: Through in-home interviews with 21 participants (ages 52-86) with long-term mobility impairment, the present study employed a qualitative description design to explore perceptions of how and why select ADL/IADL routines (e.g., bed transfer, toileting) have changed over time. The selection, optimization, and compensation (SOC) model was used as a framework to organize participants' adaptations. RESULTS: Among the ADL/IADL routine changes mentioned, elective selection strategies, in which a person continues to work at maintaining a task, were more frequently endorsed than loss-based selection strategies, in which a person does a task less or gets help from someone. Findings suggest that this population is actively adapting their routines to preserve their involvement in, and frequency of doing, these ADLs/IADLs. Counter to expectation, perceived age-related changes underlying activity routine changes were subtle and generally did not include sensory and cognitive declines. DISCUSSION AND IMPLICATIONS: Findings provide insights into the difficulties adults with long-term mobility impairment experience as they age, as well as the adaptations they employ to overcome those challenges. Results highlight the need for customizable, mobility supports (e.g., assistive technologies, home modifications) that can adjust to an individual's changing abilities across the life span.

Older Adults' Acceptance of Activity Trackers.

OBJECTIVE: To assess the usability and acceptance of activity tracking technologies by older adults. METHOD: First in our multimethod approach, we conducted heuristic evaluations of two activity trackers that revealed potential usability barriers to acceptance. Next, questionnaires and interviews were administered to 16 older adults ( Mage = 70, SDage = 3.09, rangeage = 65-75) before and after a 28-day field study to understand facilitators and additional barriers to acceptance. These measurements were supplemented with diary and usage data and assessed whether and why users overcame usability issues. RESULTS: The heuristic evaluation revealed usability barriers in System Status Visibility, Error Prevention, and Consistency and Standards. The field study revealed additional barriers (e.g., accuracy, format) and acceptance-facilitators (e.g., goal tracking, usefulness, encouragement). DISCUSSION: The acceptance of wellness management technologies, such as activity trackers, may be increased by addressing acceptance-barriers during deployment (e.g., providing tutorials on features that were challenging, communicating usefulness).

Responding to home maintenance challenge scenarios: the role of selection, optimization, and compensation in aging-in-place.

This study examined potential issues faced by older adults in managing their homes and their proposed solutions for overcoming hypothetical difficulties. Forty-four diverse, independently living older adults (66-85) participated in structured group interviews in which they discussed potential solutions to manage difficulties presented in four scenarios: perceptual, mobility, physical, and cognitive difficulties. The proposed solutions were classified using the Selection, Optimization, and Compensation (SOC) model. Participants indicated they would continue performing most tasks and reported a range of strategies to manage home maintenance challenges. Most participants reported that they would manage home maintenance challenges using compensation; the most frequently mentioned compensation strategy was using tools and technologies. There were also differences across the scenarios: Optimization was discussed most frequently with perceptual and cognitive difficulty scenarios. These results provide insights into supporting older adults' potential needs for aging-in-place and provide evidence of the value of the SOC model in applied research.

Older Adults' Changes in Intent to Adopt Wellness Management Technologies.

Individuals are becoming more involved in managing their own health. Health self-management technologies have the potential to help older adults remain well by promoting exercise and a good diet. However, older adults may or may not decide to adopt wellness management technologies. Adoption is a process and the intent to adopt may change over time. Sixteen older adults (8 females; M age=70.06, SD=3.09; range=65-75) used one of two wellness management technologies (the Fitbit One or myfitnesspal.com) over a 28-day period. Initially, all participants were open or neutral to adopting their technologies. After 28 days, 12 participants intended to adopt and 4 participants did not intend to adopt. The diary data revealed that over time, adopters made more positive comments than non-adopters. Both adopters and non-adopters mentioned perceived ease of use praises and complaints, whereas only adopters mentioned praises regarding usefulness. Results are interpreted within the frameworks of the unified theory of acceptance and use of technology (Venkatesh et al., 2003) and the diffusion of innovation (Rogers, 2003). Changes in intent to adopt suggest that experience is important in the adoption decision. Adoption of wellness management technologies by older adults may increase if designers attend to the perceived ease of use and perceived usefulness factors identified in this study.

Older Adults' Use of and Attitudes toward Activity Monitoring Technologies.

Self-management of health is becoming increasingly important in today's healthcare climate. Activity monitoring technologies have the potential to support health self-management by tracking, storing, compiling, and providing feedback about an individual's engagement in movement activities. Older adults represent a fast growing segment of the population who may benefit from such technologies. To understand how to facilitate technology acceptance and adoption, more information is needed about older adults' attitudes and usage of such technologies. Eight older adult participants (M age = 65.0 years; SD = 3.2; range = 61-69) used one of four activity monitoring technologies in their own homes for two weeks. Attitudes and usability issues were assessed and evaluated within a technology acceptance framework. Participants' initial attitudes were positive, but after using the technology for two weeks, attitudes were mixed. Three participants indicated they would continue using the technology, whereas five said they would abandon the technology. These data offer insight into older adults' use of and attitudes toward activity monitoring technologies and provide improvement opportunities for designers. The results suggest that efforts should focus on conveying the usefulness and personal benefits of activity monitoring technologies specific to older adults.

Challenges to Aging in Place: Understanding Home Maintenance Difficulties.

Age-related declines in capabilities may compromise older adults' ability to maintain their homes thus threatening successful aging in place. Structured interviews were conducted with forty-four independently living older adults (M(age) = 76.1, SD = 4.7) to discuss difficult home maintenance tasks and how they managed those tasks. Solutions to managing difficulties were categorized as person-related or environment-related. The majority (85%) of responses were person-related solutions. An understanding of the specific challenges that older adults face in maintaining their homes can guide redesign efforts and interventions to effectively support older adults' desire to age in place.

Older Adults Talk Technology: Technology Usage and Attitudes.

Older adults (n = 113) participated in focus groups discussing their use of and attitudes about technology in the context of their home, work, and healthcare. Participants reported using a wide variety of technology items, particularly in their homes. Positive attitudes (i.e., likes) outnumbered negative attitudes (i.e., dislikes), suggesting that older adults perceive the benefits of technology use to outweigh the costs of such use. Positive attitudes were most frequently related to how the technology supported activities, enhanced convenience, and contained useful features. Negative attitudes were most frequently associated with technology creating inconveniences, unhelpful features, as well as security and reliability concerns. Given that older adults reported more positive than negative attitudes about the technologies they use, these results contradict stereotypes that older adults are afraid or unwilling to use technology. These findings also highlight the importance of perceived benefits of use and ease of use for models of technology acceptance. Emphasizing the benefits of technology in education and training programs may increase future technology adoption.

Understanding Aging in Place for Older Adults: A Needs Analysis.

A goal of many older adults is to remain in their own homes as they age (Beyond 50.05 Survey, 2005). However, a detailed assessment is lacking of the needs of older adults as they age in place. Using focus groups, twenty-six independently living older adults (mean age 78.8 years) from the Atlanta metropolitan area were asked to describe the tasks they perform to maintain their homes, as well as any difficulties they have performing these tasks. Participants described performing a wide range of tasks and focused primarily on physical difficulties. However, participants also reported solutions to manage these difficulties that fell into three broad categories: "Cessation," "Perseverance," and "Compensation." These categories represent classes of opportunities for interventions that may help older adults remain independent in their homes longer. By understanding the nature of home maintenance problems older adults encounter while aging in place, interventions and redesign efforts can be more effective. These data suggest that interventions should start with answering physical issues.

Older Adults' Training Preferences for Learning to Use Technology.

Older adults may benefit from using technology in their everyday lives. However, adults over 65 may need more training than their younger counterparts given they have had less experience with technology. In this study, 113 adults between the ages of 65 and 85 participated in focus group interviews discussing their training needs and preferences for technology items used in the home. Participants expressed an interest in receiving additional training, particularly for specific tasks. Participants also discussed preferences for various characteristics of training, such as who should conduct the training and for their preferred method of training. One of the most frequently discussed preferences was for self-training using text materials, such as a manual.

Understanding the Required Resources in Line Graph Comprehension.

Visual line graphs are a prevalent form of communication as they provide a pictorial means to display relationships between entities. As such, understanding the cognitive resources required in processing line graphs would inform designers how to optimize the use of graphical displays. This study systematically investigated how graph task performance changes as a function of attention allocation (full or divided) and concurrent memory task (spatial or verbal). Twenty-four younger adults (mean age 19.2 years) completed either a trend comparison task or a point estimation task and a concurrent spatial or verbal task. Trend comparison performance did not significantly differ between the full and divided attention conditions; mean performance for all conditions was over 90% accurate. Interestingly, participants' point estimation performance was significantly better for the two divided attention conditions compared to the full attention condition which may be attributed to a motivational or stimulus effect. This study provides a base from which more research can be conducted to understand the verbal and spatial resources required in graph comprehension.