in Integrative Psychological and Behavioral Science (2022)
This paper presents the “Actional Model of Older people´s Coping with Health-Related Declines” to explain the use of a broad range of action alternatives of older persons for dealing with current or anticipated diseases, functional declines, activity limitations and participation restrictions. The general background is the action-theoretical model of intentional self-regulation of human development (e.g., Brandtstädter, 2006; Rothermund & Brandtstädter, 2019). Yet, our model provides an increased specification of major model components toward the situation of older people coping with current or anticipated health-related declines. The model development follows an adapted theory construction methodology (TCM) by Borsboom et al. (2021) and adapted principles for constructing practically useful theories by Berkman & Wilson (2021). Regarding content, we further draw on models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using ATs, and quantitative studies on health-related goals. The resulting model includes these components: (1) Discrepancies between perceived or anticipated and desired health-related development, (2) health-related discrepancy reduction and prevention goals, (3) action possibilities for reducing or preventing health-related discrepancies, (4) further motivating and demotivating goals, (5) beliefs about effective means for reaching the goals (2) and (4), (6) generation of the particular coping actions by goals (2) and (4) in combination with beliefs about effective means, (7) external context factors, and (8) modes of joint decision-making and decision-making on behalf of older people. The explanatory and practical value of the model are discussed as well as its implications for future research and geropsychology teaching.
in European Psychologist (2020), 25(3), 211-228
Many older people suffer from functional declines and activity limitations, which reduce their autonomy and quality of life. Assistive technologies (ATs) could dampen such effects. However, many older people do not use ATs and it is important to understand, why they give away their benefits. In this article, we look at older peoples´ use of ATs from an action perspective on human development elaborated by Brandtstädter and colleagues. We review from this viewpoint models of AT use created mostly in information systems technology, business administration, and management sciences. The major focus is on the extent to which these models consider the relevant internal (mental) and external context of AT use, possible action alternatives, and autonomous, vicarious, and joint modes of decision-making about ATs use. Systematic literature searches in PsycINFO, MEDLINE, and Google Scholar led us to 23 models. None of them contained as central variables any perceived discrepancies between the actual and desired developmental situation or any goals to reduce these discrepancies. No model included action alternatives to AT use beyond non-use such as trying harder on oneself, making environmental adaptations or using personal support. All models conceive of AT use as an act of the individual user, but neglected decision making about AT use by other persons on his or her behalf or a joint decision making of a potential user together with other persons (e.g., relatives). We discuss the background of these gaps, possibilities of a more comprehensive modeling of AT use, and practical implications (e.g., developmental counseling).
Poster (2019, May 24)
The number of older people with limitations of activities of daily living in developing countries is predicted to increase by a factor of four between 2015 and 2050. One possibility to overcome such limitations is to promote the use of assistive technologies (ATs) in the aging population. Despite evident benefits of ATs in this context, the use rate is still low. To find out why this is the case, we performed systematic literature searches in PsycINFO, MEDLINE, and Google Scholar databases about subjective reasons of older people for use and non-use of these devices. We then performed a meta-synthesis of the relevant studies in order to arrive at a comprehensive view of older people’s reasons for the use or non-use of ATs. Beliefs about ease to use and reliability of AT use as well as perceived suggestion by significant others to use ATs were important reasons for using them. Beliefs about insecurity, uselessness and other attributes of ATs as well as desires to avoid burden for others were major reasons for not using of ATs. We systematized the identified subjective reasons for using versus not using as referring to (1) situation of need and demand for an AT, (2) suggestion by significant others, (3) act of using, and (4) consequences of AT use. Most of the reasons were reasons for non-use such as beliefs about negative attributes of ATs, and the consequences of their use. In contrast, desires were only rarely mentioned as reasons for use or non-use of ATs. Comparing subjective reasons of our meta-synthesis with predictors in ATs use models, we found that only 5 out of 25 identified subjective reasons have already been considered in these models. Thus, these models appear not yet to be sufficiently comprehensive. We suggest integrating the identified subjective reasons from our meta-synthesis as additional predictors in a comprehensive AT use model with an improved predictive power.
in GeroPsych: Journal of Gerontopsychology and Geriatric Psychiatry (2019), 32(2), 79-92
Models of the use of assistive technologies (ATs) have only moderate value for predicting older people´s use of ATs. To find further predictors we performed a systematic literature review and – applying an action-theoretical approach – a meta-synthesis of seven qualitative studies about older people´s reasons for use or non-use of ATs. We found 25 reasons referring to user´s beliefs and desires (e.g., about demand, act of using ATs, its consequences) of which 18 were not contained in existing AT use models. Some reasons generalized across ATs (e.g., perceived unreliability), whereas others (e.g., privacy concerns, desire to avoid burden to others) appeared specific to tele-alarm or smart home technology. We discuss findings with respect to improving AT use models and developmental counseling.
Scientific Conference (2018, July 06)
The baby boomer generation is aging and the proportion of older people in the population is increasing. While people age, functional, cognitive, and physical problems increase. Assistive technology (AT) can help to overcome some activity limitations relevant to aging. Although ATs have potential benefits (e.g., to reduce the burden of caregivers, to increase independence), their usage rate is still low. Whereas several reviews of quantitative studies on factors of ATs use already exist, a systematic review of qualitative research about AT use is still missing. The aim of the current review is to provide more differentiated answers about what makes some older people use ATs while others not. Based on systematic literature searches in PsycINFO, MEDLINE, and Google Scholar databases 18 relevant papers were identified according to our selection criteria. These studies were based on to self-reported reasons of older people for using or not-using diverse types of ATs designed for many different activities. We classified the key reasons as referring to three aspects: attributes of “potential technology users”, “context”, and “technology”. Perceived usefulness and attitudes towards use were the most common “personal” reasons and social impact by significant others was the most common “contextual” reason, and technology design was the most common “technological” reason influencing use or non-use of ATs. We discussed the identified reasons in relation to the major models of developmental self-regulation and action-theoretical approaches to development in age. Based on the current review, we generated methodological and theoretical recommendations for future research and for practical applications.
Scientific Conference (2018, July 06)
Many older people have functional limitations and are at risk of losing their ability to live autonomously. Assistive Technology (AT) could help to reduce that risk. However, many older people don’t use ATs. Our presentation reviews existing models of ATs use, their applicability to specific types of AT, predictive value, fundamental elements, and critiques of such models. In systematic literature searches in PsycINFO, MEDLINE, and Google Scholar 46 papers were identified that met our inclusion criteria. 32 papers covered models of ATs use, applicability to special types of ATs, components of models, and their predictive value. 14 papers cover criticisms of models of AT use. We classified the models into two groups: The first included 11 models focusing on individuals’ mental states (e.g., beliefs, desires) as factors explaining ATs use; the second included 22 models that also considered contextual factors (e.g., social influence, physical environment) in addition to individuals’ mental states. Across both groups the most frequently included explanatory components were subjective norm and personal attitudes towards AT use, followed by perceived usefulness, perceived ease of use and then intention to use. Models were most frequently applied to information technologies followed by application to socially assistive robots. Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) and an extended version of Technology Acceptance Model showed the highest amount of explained variance in intention to use (56-74%) and an extended model of UTAUT in actual use of ATs (64%). We conclude with recommendations for further improvement of AT use models.
Scientific Conference (2018, April)
Many older people have functional impairments which increase their risk of losing the ability to live autonomously and to become dependent on care by others. However, assistive technologies (ATs) can help to overcome some limitations of activities of daily living and can thus be assumed to prevent, delay or reduce the need for personal long-term care as well as the burden on caring family members (e.g., spouses, adult children). Yet, the use rate of ATs is still rather low. This paper reviews positive effects of ATs and factors that influence their use. We performed systematic literature searches in PsycINFO, MEDLINE, and Google scholar databases. We found convergent results that the use of ATs for several kinds of activities of daily living such as self-care and mobility was associated with a reduced amount of self-reported personal (in particular informal) care hours. Regarding factors of ATs use, we found that feeling loneliness, cognitive impairments, and difficulty of use were some of barriers for the use of ATs. There is converging evidence that indicators of situation of need (in particular: disabilities in preforming self-care activities) are associated with an increased use of ATs. Slight to moderate functional limitations, chronic illnesses, and home-based training were some of the facilitators for the use of ATs. We concluded with recommendations for further improvement of studies relevant to ATs use.
in Boll, Thomas; Ferring, Dieter; Valsiner, Jaan (Eds.) Cultures of care in aging (2018)
A gradual decline in functional and mental capacity as well as a growing risk of care dependency constitute major concerns of life in old age. These should become larger and more urgent in future, because the number of people 80+ is projected to more than double from 2010 to 2050 at least in EU and OECD countries. On the other side, there is a strong desire of older people, their relatives and policy makers to maintain the autonomy in old age as long as possible. In reaction to this, there have been strong social policy recommendations to develop and promote the use of assistive technologies (ATs). Whereas systematic reviews already exist for several other kinds of ATs, reviews about self-care ATs are still missing. Based on systematic literature searches in PsycINFO, MEDLINE, and Google Scholar databases 203 papers were identified of which 12 were included according to our selection criteria. The methodological quality of all the reviewed studies is evaluated. We reviewed findings on indicators of independent living as efficiency criteria as well as evidence about facilitators and barriers of using these technologies. Self-care ATs turned out to be efficient with respect to reduced care hours and increased independence level. The actual use of these ATs was associated with personal, contextual, and device factors. Lack of randomized control trial studies and a need for further research about ATs in several domains of self-care activities is revealed. Based on the findings of the current review, we generate recommendations for future research.
Scientific Conference (2017, July 05)
A gradual decline in functional and mental capacity, as well as a growing risk of care dependency constitute major concerns of life in old age. These are expected to become more urgent in the future, because the old-age dependency ratio in the EU is projected to nearly double until 2060 due to demographic change. On the other side, there is a strong desire to maintain the autonomy of older people as long as possible. In reaction to this, there have been strong health and social policy recommendations across Europe to develop and promote the use of assistive technologies (ATs). Whereas systematic reviews already exist for several kinds of ATs, reviews about self-care ATs are still missing. Based on a systematic literature search in PsycINFO, MEDLINE, and Google Scholar databases 203 papers were identified of which 13 were included according to our selection criteria. The methodological quality of all the reviewed studies is evaluated. We reviewed findings on objective and subjective indicators of independent living as efficiency criteria as well as evidence about facilitating and inhibiting factors in the use of these technologies. Self-care ATs turned out to be efficient, with respect to care hours, independence level, and self-reported satisfaction. The actual use of these ATs was influenced by diverse personal, contextual, and device aspects. Lack of randomized control trial studies and the need for a further research about ATs in the diverse subdomains of self-care activities is revealed. Based on the findings of the current study, we generate recommendations for future research.