Assistive Devices in Everyday Life for Very Old People - Use, Non-use and Opportunities for Use

Sammanfattning: The overarching aim of this thesis was to contribute to the existing knowledge on the use of assistive devices in everyday life, by adding the perspective of very old single living people in a European context, namely Latvia and Sweden. The aim was to investigate the socio-demographics and environmental and health aspects that impact on device use in the two national contexts. A further aim was to explore the prerequisites for use according to different aspects of the physical and institutional environment. The thesis builds on four studies in which a variety of study designs have been employed. The data derived partly from a European project on home and health – the ENABLE-AGE Project – and additional data were collected for two of the studies. Quantitative data from the Latvian and Swedish sub-samples of the ENABLE-AGE Survey Study comprising well-established instruments and study-specific questionnaires designed to capture objective and subjective aspects of home and health were used (Study I, II, IV), and additional qualitative interview data were collected through semi-structured interviews in Latvia (Study III) and Sweden (Study II, III). Study I: In a Swedish subsample no differences were seen between users and non-users of assistive devices according to socio-demographic or environmental variables at baseline or follow-up. The significant differences seen were related to aspects of health. The number of users increased over the study period and barriers in the outdoor environment turned out to predict use of mobility devices. Study II: In a Swedish subsample of three very old men using mobility devices, it was shown that the social and physical environment impacted on device use. Well-designed devices facilitated device use, while poor street conditions, crowded public transports and bad weather hampered mobility device use. Study III: Both differences and similarities were shown between Latvia and Sweden regarding the organisation and operationalization of the national service delivery systems for assistive technology. The utilisation of professional competences and national financial circumstances affected very old people’s opportunities to be provided with assistive devices. Study IV: In Latvian and Swedish subsamples, national differences were seen in number and type of reported leisure activities outside the home. Differences were also seen for the number of activities reported between users and non-users of mobility devices in relation to their self-rated physical mobility. Conclusion: The use of assistive devices increases with age and supports very old people in everyday life activities, even though there are differences between Latvia and Sweden. In order to ensure equal opportunities for activity and participation for very old people across Europe, it is important to understand what lies behind personal and environmental prerequisites for the use of assistive devices within as well as between countries.