Technology to Promote Technology to Promote IndependenceIndependence

William C. Mann, OTR, PhDDistinguished Professor

University of Florida

OASIS ConferenceNovember 4, 2009

Florida Institute on Disability and RehabilitationUniversity of Florida

nn National Institute on Disability and Rehabilitation National Institute on Disability and Rehabilitation ResearchResearch

nn Veterans Health AdministrationVeterans Health Administrationnn Centers for Disease Control and PreventionCenters for Disease Control and Preventionnn Federal Highway AdministrationFederal Highway Administrationnn AARPAARPnn Florida Dept. of Elder AffairsFlorida Dept. of Elder Affairsnn Florida Dept. of TransportationFlorida Dept. of Transportationnn DonorsDonors

SponsorsSponsors

Why Focus on IndependenceWhy Focus on Independence

1910 1930 1950 1970 1990 2010 2030 20501910 1930 1950 1970 1990 2010 2030 2050

18.918.9

8.88.86.06.03.03.0

1.41.40.60.60.30.30.20.2

Population 85+ 1910 to 2050(in millions)

Population 85+ 1910 to 2050(in millions)

Percent of Population by Age Group Who Need Assistance with ADLs

49.5 %

31.2 %

19.5 %

11 %9.2 %2.4 %

15-64 65-69 70-74 75-79 80-84 85+

Age Group

65-69 70-74 75-79 80-84 85-89 90-94 95+65-69 70-74 75-79 80-84 85-89 90-94 95+

Number of Men per 100Women by Age GroupNumber of Men per 100Women by Age Group

33.533.543.743.7

26.526.5

55.455.467.467.4

76.376.382.382.3

9.0

10.9

15.2

0

2

4

6

8

10

12

14

16

1990 2005 2020Year

Projected Increase in Number of People 65+ living Alone: 1990 - 2220

Our Research Path: 1991 -2009

n 1991- 2001 Consumer Assessments Study: How do frail elders cope in face of impairment / disability / pain, including cognitive impairment?

n 1994 Correlation / Matched Pair Analysis: Relationship of Functional Independence to Assistive Device Use

n 1995-1999 Randomized Controlled Trial: Effectiveness of Comprehensive Approach to AT/Home Modifications Service Delivery

Mean Total Costs over 4 yearsMean Total Costs over 4 years

nn TreatmentTreatment$93,089$93,089

nnControlControl$177,637$177,637

Our Research Path: 1991 -2009

n 1999-2002 Randomized Controlled Trial: Computer-based Monitoring of Self-care Needs of Physically Frail Elders

n 2002-2004 VA Demonstration: LAMP: Low ADL Monitoring Program

n 2001-Present Smart Technology; Distance Approaches to Services

Examples of Assistive Examples of Assistive TechnologyTechnology

Abledata.com is an excellent resource for information on assistive devices.

Related ResearchRelated Research

Verbrugge L, Rennert C, Madans J. The Great Verbrugge L, Rennert C, Madans J. The Great Efficacy of Personal Assistance and Equipment in Efficacy of Personal Assistance and Equipment in Reducing Disability. Am J Public Health. 1997; Reducing Disability. Am J Public Health. 1997; 87:38487:384--392392

nn Purpose:Purpose: This study sought to determine how This study sought to determine how often assistance reduces or even completely often assistance reduces or even completely resolves healthresolves health--related difficulties in everyday related difficulties in everyday tasks. tasks.

nn RESULTS / Conclusions:RESULTS / Conclusions: “Equipment only” “Equipment only” proves to be the most efficacious strategy for proves to be the most efficacious strategy for reducing and resolving limitations. Equipment's reducing and resolving limitations. Equipment's success may be due to greater perceived gains success may be due to greater perceived gains when people accomplish the assistance by when people accomplish the assistance by themselves.themselves.

Ellis, M., Hooper, E., Glucksman, E., Jackson, S., & Swift, C. Ellis, M., Hooper, E., Glucksman, E., Jackson, S., & Swift, C. (1999) Prevention of Falls in the Elderly Trial (PROFET): A (1999) Prevention of Falls in the Elderly Trial (PROFET): A Randomized Controlled Trial Close, J., THE LANCET, 353, Randomized Controlled Trial Close, J., THE LANCET, 353, 9393--9797

nn PurposePurpose: Assess the benefit of a structured : Assess the benefit of a structured interdisciplinary assessment of people who have fallen in interdisciplinary assessment of people who have fallen in terms of further falls using RCT design. . terms of further falls using RCT design. .

nn Results/Conclusions:Results/Conclusions:At 12At 12--month followmonth follow--up, the risk of up, the risk of falling was significantly reduced in the intervention group falling was significantly reduced in the intervention group as was the risk of recurrent falls (0.33 [0.16as was the risk of recurrent falls (0.33 [0.16--0.68]). In 0.68]). In addition, the odds of admission to hospital were lower in addition, the odds of admission to hospital were lower in the intervention group (0.61 [0.35the intervention group (0.61 [0.35--1.05]) whereas the 1.05]) whereas the decline in Barthel score with time was greater in the decline in Barthel score with time was greater in the control group (p<0.00001). The study shows that an control group (p<0.00001). The study shows that an interdisciplinary approach to this highinterdisciplinary approach to this high--risk population can risk population can significantly decrease the risk of further falls and limit significantly decrease the risk of further falls and limit functional impairment. functional impairment.

Cummings, R., Thomas, M., Szonyi, G., Salkeld, G., O'Neil, E., Cummings, R., Thomas, M., Szonyi, G., Salkeld, G., O'Neil, E., Westbury, C., & Frampton, G. (1999) Home Visits by an Westbury, C., & Frampton, G. (1999) Home Visits by an Occupational Therapist for Assessment and Modification of Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trail of Falls Prevention Environmental Hazards: A Randomized Trail of Falls Prevention Journal of the American Geriatrics Society, 47, 1397Journal of the American Geriatrics Society, 47, 1397--1402.1402.

nn PURPOSE:PURPOSE:To determine whether occupational therapist To determine whether occupational therapist home visits targeted at environmental hazards reduce the home visits targeted at environmental hazards reduce the risk of falls, using randomized controlled trial design. risk of falls, using randomized controlled trial design.

nn RESULTS/Conclusions:RESULTS/Conclusions:Home visits by occupational Home visits by occupational therapists prevented falls among older people who are at therapists prevented falls among older people who are at increased risk of falling. However, the effect may not be increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by caused by home modifications alone. Home visits by occupational therapists may also lead to changes in occupational therapists may also lead to changes in behavior that enable older people to live more safely in both behavior that enable older people to live more safely in both the home and the external environment. the home and the external environment.

Agree, E. M., & Freedman, V. A. (2000). Incorporating assistive Agree, E. M., & Freedman, V. A. (2000). Incorporating assistive devices into communitydevices into community--based longbased long--term care: an analysis of the term care: an analysis of the

potential for substitution and supplementation. potential for substitution and supplementation. J Aging Health,J Aging Health,

nn Purpose: Purpose: Examine the use of assistive devices as a part of the longExamine the use of assistive devices as a part of the long--term care arrangements of communityterm care arrangements of community--dwelling older Americans and dwelling older Americans and the potential for assistive devices to substitute for and supplement the potential for assistive devices to substitute for and supplement personal care assistance. personal care assistance.

nn Results / Conculusions: Results / Conculusions: The capacity of equipment to substitute for or The capacity of equipment to substitute for or supplement personal care is highly tasksupplement personal care is highly task--specific and depends on the specific and depends on the characteristics of the devices and the personal care providers. In characteristics of the devices and the personal care providers. In general, those using simple devices are less likely to use informal care, general, those using simple devices are less likely to use informal care, whereas those using complex devices are more likely to use formal whereas those using complex devices are more likely to use formal care services. Technology has the potential to confer quality of life care services. Technology has the potential to confer quality of life enhancements for older persons and their caregivers and cost savings enhancements for older persons and their caregivers and cost savings for payers. for payers.

Gitlin, Laura N.; Winter, Laraine; Dennis, Marie P.; Gitlin, Laura N.; Winter, Laraine; Dennis, Marie P.; Corcoran, Mary; Schinfeld, Sandy; Hauck, Walter W (2006). Corcoran, Mary; Schinfeld, Sandy; Hauck, Walter W (2006). A Randomized Trial of a Multicomponent Home Intervention A Randomized Trial of a Multicomponent Home Intervention to Reduce Functional Difficulties in Older Adults. Journal of to Reduce Functional Difficulties in Older Adults. Journal of the American Geriatrics Society 54(5): 809the American Geriatrics Society 54(5): 809--816(8)816(8)

nn Purpose: To test the efficacy of a multicomponent intervention to reduce Purpose: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance functional difficulties, fear of falling, and home hazards and enhance selfself--efficacy and adaptive coping in older adults with chronic conditions.efficacy and adaptive coping in older adults with chronic conditions.

nn RESULTS: At 6 months, intervention participants had less difficulty than RESULTS: At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living and activities of daily controls with instrumental activities of daily living and activities of daily living , with largest reductions in bathing and toileting. They also had living , with largest reductions in bathing and toileting. They also had greater selfgreater self--efficacy, less fear of falling, fewer home hazards, and greater efficacy, less fear of falling, fewer home hazards, and greater use of adaptive strategies. Benefits were sustained at 12 months for most use of adaptive strategies. Benefits were sustained at 12 months for most outcomes. A multicomponent intervention targeting modifiable outcomes. A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality environmental and behavioral factors results in life quality improvements in communityimprovements in community--dwelling older people who had functional dwelling older people who had functional difficulties, with most benefits retained over a year.difficulties, with most benefits retained over a year.

The advance of technologyThe advance of technology

Wheelchairs

Explore the history of a few devices. Is assistiveExplore the history of a few devices. Is assistivetechnology advancing?technology advancing?

1300 B.C.1300 B.C.

nn Oldest evidence of a Oldest evidence of a wheeled chair wheeled chair ––spoked wheels on spoked wheels on chairs.chairs.

15951595nn King of Spain had his King of Spain had his

own rolling chair own rolling chair with foot rest.with foot rest.

16551655nn SelfSelf--propelled chair propelled chair

built by a built by a watchmaker with watchmaker with paraplegia. paraplegia.

1700’s1700’s

nn Convertible chair Convertible chair ––reclining back and reclining back and adjustable foot rest. adjustable foot rest.

19331933

nn First folding First folding wheelchair, wheelchair, manufactured with manufactured with metal. metal.

TodayToday nn “High Tech,” light“High Tech,” light--weight materialsweight materials

nn Improved designImproved designnn Wheelchairs used for Wheelchairs used for

sportssports

AdvancesAdvancesnn Power Assisted Power Assisted

WheelchairsWheelchairsnn Stair climbing Stair climbing

wheelchairswheelchairsnn Smart WheelchairsSmart Wheelchairs

Why support research and Why support research and development in this area?development in this area?

Hearing Aids

Assistive technology advances….. example

Early 1700’sEarly 1700’s

An ear trumpet. An ear trumpet. Similar devices were Similar devices were used for thousands used for thousands of years. of years.

1800’s1800’s

Combination of Combination of spectacles with a spectacles with a light tortoiseshell light tortoiseshell ear trumpet.ear trumpet.

1850’s1850’s

Acoustic table urn. Acoustic table urn. Meant to capture Meant to capture sound from any sound from any angle in the room. angle in the room.

1930’s1930’sFirst electrical hearing First electrical hearing

aid.aid.

1940’s1940’s

Vacuum tube model.Vacuum tube model.

19531953

Oticon Pocket model.Oticon Pocket model.

19571957

Ear aid that could Ear aid that could hang over the ear hang over the ear from the wearer's from the wearer's eyeglasses.eyeglasses.

1970’s1970’s

"In"In--thethe--Canal," or ITC, Canal," or ITC, aids aids -- fill the ear fill the ear canal without canal without anything worn anything worn outside the ear.” outside the ear.”

1980’s1980’s

This unit could be This unit could be concealed concealed completely in the completely in the ear canal. ear canal.

1990’s1990’s

Hearing aids with Hearing aids with digital processing digital processing

The Past /The FutureThe Past /The Future

Advancement of TechnologyAdvancement of Technology

Time

PowerOf Technology

2006

Smart House FunctionsSmart House Functions

University of Florida University of Florida Smart HomeSmart Home

Location MonitoringLocation Monitoring

Smart Front DoorSmart Front Door

Robotics……Robotics……

Momoko – Experimental Theater

My Spoon

Toyota Robots

Farmer Wu’s home made robot

Rollin Justin (preparing tea)

Paro – robotic baby seals

I’m back….. (robotic arm)

International Conference on Aging, Disability And Independence

Newcastle, England

September 6-10, 2010