"They'll think it's a good thing": Examining the dynamics of walker, cane and wheelchair use among older adults and their social ties

Karis A Pressler, Purdue University

Abstract

Older adults have become increasingly reliant on assistive devices (ADs) such as walkers, canes, and wheelchairs over the past two decades. Currently one in four individuals over the age of 65 with an activity of daily living (ADL) or instrumental activity of daily living (IADL) disability use an assistive device (AD). Despite the increase in AD use, there are relatively few systematic studies examining both the social facilitators and barriers toward AD use among disabled older adults. This dissertation consists of two studies examining the social consequences of AD use as well as the social facilitators and barriers that impact AD use among two samples of older adults. In the first study, I use a nationally representative sample of older adults (N=5,089) to identify how walker, cane, and wheelchair use impacts social contact trajectories over time. Results from this study reveal that cane users experienced a significant increase in social contact with family members, whereas wheelchair users endured a significant decline in social contact with family members even after controlling for demographics, upper body disability, and lower body disability. Findings from this research suggest that AD use affects the number of times older adults can expect to have contact with family members, independent of both age and disability. In the second study, I interviewed older adult veterans who were prescribed ADs at a Veterans Affairs Medical Center's (VAMC) Physical Medicine and Rehabilitation (PM&R) clinic. The VAMC is the largest provider of ADs in the United States and provides these devices at no cost to veterans who demonstrate ADL or IADL disability. Given the absence of a financial barrier, the VAMC is a prime setting to examine how family and friends influence older adult veterans' AD use experience. A sample of 32 inpatient and outpatient veterans over the age of 65 were interviewed both prior to receiving their prescribed AD(s) and approximately one year after acquiring their VA-issued AD(s). The Health Belief Model (HBM) was used to frame research questions relating to social barriers and facilitators toward AD use and to identify how perceived threats, benefits, barriers, and self-efficacy influenced the AD adaptation process over time. Results from this study reveal that veterans' family members were vocal in encouraging AD use and often used the threat of falling to effectively convince a veteran to adopt the prescribed AD. Additionally, experiential similarity emerged as a motivator of AD use. The findings from this dissertation address the call for research that examines social and contextual variables associated with using an AD. These findings can be applied to help older adults, their family members, health care providers, and AD designers effectively address the needs of those facing changing physical function as a result of emerging mobility disability in later life.

Degree

Ph.D.

Advisors

Sands, Purdue University.

Subject Area

Gerontology|Public policy

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