Psychosocial Predictors of Non-adherence to Prescribed Mobility Assistive Devices by Community-dwelling Older Adults: Development of a Predictive Model
Bibliographic record
Abstract
Mobility is essential to healthy aging and is closely related to health and overall quality of life. Mobility impairment is an early predictor of disability, and is intimately linked to falling injuries, loss of independence, hospitalization, and mortality. Mobility Assistive Devices (MADs), such as canes, walkers, and wheelchairs, provide support to older adults to improve their balance, coordination, and strength. Despite the acknowledged benefits of MADs for the older adult population research shows that as many as 75% of older adults are non-adherent to prescribed MADs. As non-adherence is a contributing factor to declines in mobility and overall quality of life, it is important to consider the reasoning behind it. Therefore, this doctoral project took a psychosocial perspective and investigated the psychosocial factors that predict non-adherence to MADs among older adults. This study considered a sample of older adult MADs users from long-term care units at the Perley Health Centre in Ottawa with different types of mobility limitations. The study examined the role of psychosocial variables using the Psychosocial Impact of Assistive Devices Scale (PIADS), social support using the Medical Outcomes Study Social Support Survey (MOS-SS), and the demographic variable of sex in the prediction of MADs non-adherence. Predictor variables that were associated with non-adherence in a univariate regression analysis were subsequently entered into a multiple regression analysis. Of the 96 residents invited to participate in the study, 49 gave their consent to participate, and out of this number, 48 completed the study, for a response rate of 51%. The data from the 48 residents (26 females and 22 males), with a mean age of 86.8 (Standard Deviation (SD) = 10.2, age range= 66 - 101), were therefore available for analysis. The most common reported mobility limitations were due to balance problems and leg weakness (29.17% for each). The most common device used was a walker (47.92%), followed by a manual wheelchair (33.33%). No statistical difference was detected between the groups of sexes regarding any of the study variables (P≥0.05). In the univariate regression analysis, the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, were significantly correlated with non-adherence (p < 0.001). Sex was an insignificant variable, while social support was significantly correlated with Competence, Adaptability, Self-esteem, and non-adherence. In the multiple regression analyses, only Self-esteem showed significant associations (p < 0.05), and the Self-esteem multivariate model explained 43.5 - 54.3% of the variance in non-adherence. This study revealed that the Self-esteem construct, which includes several concepts related to psychological wellbeing, was the only significant predictor of non-adherence among the studied sample of older adults. The theoretical and clinical implications of the findings are subsequently discussed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".