Older people's use of assistive technologies and alternative means to cope with health-related declines

Health-related declines are risk factors for autonomous living and quality of life of older people. Yet, they have various action possibilities (e.g., use of technical and personal support, health services, environmental adaptation) which may reduce these risks. Sadly, the use rates of these options are far from perfect, so that their positive effects are not sufficiently realized. With this in mind, the main goal of this dissertation was to gain a better understanding of the factors that influence older people's use of the various action possibilities to cope with illness, functional decline, activity limitations, and participation restrictions. Five studies using different but complementary methods pursued this goal.
Study I provided a systematic review of 12 empirical studies on the effectiveness and use of self-care assistive technologies (ATs). It found that self-care ATs are efficient with respect to reduced care hours and increased independence level. The use of such technologies was associated with three different kinds of factors including personal, contextual, technological device factors.
Study II conducted a systematic review of 23 theoretical models of AT use from an action-theoretical
perspective on lifespan development. It revealed that these models considered a limited range of internal and external context factors of AT use. None of them contained perceived discrepancies between the actual and desired developmental situation, goals to reduce these discrepancies, action alternatives to AT use, and decision-making about AT use by other persons or a joint decision-making.
Study III contained a qualitative meta-synthesis of 7 qualitative studies on subjective reasons for the use or nonuse of ATs. It thus considered a branch of research that is independent from the ones covered by Study 1 and 2 and it used a different method. It found 25 subjective reasons referring to user’s beliefs and desires of which 18 were not contained in AT use models. However, they could be included in more comprehensive models to increase their predictive value.
Study IV focused on the construction of an “Actional Model of older people´s coping with health related declines” for explaining the use of 8 major action possibilities (7 beyond ATs). Its development followed a recent theory construction methodology and recent principles for constructing a practically useful theory. It integrated results from the studies 1, 2 and 3 as well as from other relevant literature. Central explanatory variables are perceived discrepancies between actual and desired development, discrepancy reduction and prevention goals and internal as well as external context factors. Outcome variables are the 8 courses of action and their results.
Study V examined the view of experts (professional caregivers of older people) regarding central components of the Actional Model of Older people´s Coping with Health-Related Declines developed in study 4. Theory generating expert interviews were conducted to further clarify key components of the model. The results led to their further specification, such as the contents of discrepancy reduction and prevention goals, further motivating and demotivating goals, and external context factors as barriers and facilitators of their use.
The findings of the dissertation are discussed with respect to the advancement of empirical, theoretical and methodological knowledge. Implications for future research and for the improvement of practical applications in gerontological case management and developmental counselling are highlighted.