The impact of assistive devices on community-dwelling older adults and their informal caregivers

Background \nCanadians are aging and living longer with chronic conditions, multimorbidity, and disabilities, which can have negative impacts on the health and quality of life of both older adults and their informal caregivers. Assistive devices (AD) can be beneficial to community-dwelling older adults and their informal caregivers; however, researchers have not investigated all outcomes of using AD. Two under-investigated outcomes in aging populations are: (a) the change in life satisfaction (LS) over time, and (b) the change in the number of informal caregiving hours received over time. The Consortium for Assistive Technology Outcome Research (CATOR) framework was used to frame the following objectives, which identifies LS and the amount of informal caregiving hours received as key outcomes of AD use. \nObjectives \nThe objectives of this thesis were addressed via three studies: Study 1 (Chapter 3) examined existing evidence on the associations between (a) AD use and LS, and (b) AD use and informal caregiving hours received; Study 2 (Chapter 4) and Study 3 (Chapter 5) investigated the associations between self-reported AD use within the past 12 months (assessed at baseline) and: (a) the change in LS over time (three-years), (b) the change in informal caregiving hours received over time (three-years), respectively. All studies focused on community-dwelling older adults aged 65 years or older. \nMethods \nStudy 1 consisted of a systematic review adhering to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies 2 and 3 used unweighted data from the Tracking and Comprehensive cohorts of the Canadian Longitudinal Study on Aging (CLSA) and multiple linear regression models to investigate the associations between AD use and the change in LS or informal caregiver time. The regression analyses controlled for comprehensive sets of covariates. \nResults \nStudy 1 suggested AD use was not linked with LS and was associated with reductions in informal caregiving hours. However, due to the scarcity of existing studies, their limitations (e.g., high risk of bias, residual confounding, cross-sectional nature), and very low or moderate strength of evidence, conclusions about the associations of interest could not be drawn with certainty. Results from Study 2 did not find evidence of an association between AD use and increases in LS over time, after accounting for covariates (Tracking: n = 5,502, β = 1.16, 95% Confidence Interval [CI] = -0.57 to 2.89; Comprehensive: n = 9,760, β = 0.47, 95% CI = -0.89 to 1.82). Similarly, after controlling for covariates, Study 3 did not find associations between AD use and changes in informal caregiving hours received over time (Tracking: n = 236, β = 3.10, 95% CI = -77.98 to 84.17; Comprehensive: n = 420, β = -5.05, 95% CI = -47.19 to 37.09). \nConclusion \nIn an aging society, empirical evidence regarding the effects of AD on the changes in LS and informal caregiver hours is imperative for evidence-based decision-making and effective recommendations on the provision of AD to older adults. Although the findings of this thesis were non-significant, null findings can be informative because they can contribute to guiding future studies, informing existing theories, and avoiding misleading research conclusions or biased evidence-based practices and policies. \nTo overcome the limitations of existing studies, future research should aim to extend beyond three years, use large sample sizes, conduct analyses based on the type of AD used (e.g., mobility versus vision-related AD) and the duration of AD use (e.g., short, long, intermittent use), and control for additional potential confounders (e.g., device satisfaction, time-varying confounders). LS questions should be specifically tailored to AD use and informal caregivers should be directly interviewed to promote the accuracy of data on informal caregiving hours. Data sets designed to collect information primarily on AD should be used in future investigations to address the research questions in this thesis. These data sets should ideally be culturally representative and have minimal bias (e.g., selection bias, missing data) to assure reliability and generalizability of the findings. \nThis thesis further highlighted various implications for future research, theory, policy and practice. These implications included the complexity of research questions and concepts (i.e., life satisfaction, accurate capture of informal caregiving hours from care receivers and caregivers), overcoming limitations of existing studies, the importance of stratified analysis to inform sub-theories in the CATOR framework, integration of evidence from multiple sources (e.g., experimental studies), funding for improved research, recognition of null findings, and collaborative efforts among stakeholders to make informed decisions related to AD use among community-dwelling older adults.

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