Characteristics and Range of Reviews About Technologies for Aging in Place: Scoping Review of Reviews.

BACKGROUND: It is a contemporary and global challenge that the increasing number of older people requiring care will surpass the available caregivers. Solutions are needed to help older people maintain their health, prevent disability, and delay or avoid dependency on others. Technology can enable older people to age in place while maintaining their dignity and quality of life. Literature reviews on this topic have become important tools for researchers, practitioners, policy makers, and decision makers who need to navigate and access the extensive available evidence. Due to the large number and diversity of existing reviews, there is a need for a review of reviews that provides an overview of the range and characteristics of the evidence on technology for aging in place. OBJECTIVE: This study aimed to explore the characteristics and the range of evidence on technologies for aging in place by conducting a scoping review of reviews and presenting an evidence map that researchers, policy makers, and practitioners may use to identify gaps and reviews of interest. METHODS: The review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Literature searches were conducted in Web of Science, PubMed, and Scopus using a search string that consisted of the terms "older people" and "technology for ageing in place," with alternate terms using Boolean operators and truncation, adapted to the rules for each database. RESULTS: A total of 5447 studies were screened, with 344 studies included after full-text screening. The number of reviews on this topic has increased dramatically over time, and the literature is scattered across a variety of journals. Vocabularies and approaches used to describe technology, populations, and problems are highly heterogeneous. We have identified 3 principal ways that reviews have dealt with populations, 5 strategies that the reviews draw on to conceptualize technology, and 4 principal types of problems that they have dealt with. These may be understood as methods that can inform future reviews on this topic. The relationships among populations, technologies, and problems studied in the reviews are presented in an evidence map that includes pertinent gaps. CONCLUSIONS: Redundancies and unexploited synergies between bodies of evidence on technology for aging in place are highly likely. These results can be used to decrease this risk if they are used to inform the design of future reviews on this topic. There is a need for an examination of the current state of the art in knowledge on technology for aging in place in low- and middle-income countries, especially in Africa.

Barriers for Accessing Assistive Products in Low- and Middle-Income Countries (LMICs).

WHO implemented the Rapid Assistive Technology Assessment in 2021. This is a household survey on self-reported use, need and barriers for accessing AT in 35 countries globally. In order to obtain comparable data, all surveys followed guidelines developed by WHO, including national two-stage random sampling of households. The 2021 rATA survey included 32 of a total of 140 LMICs globally. Around 40 % of the total respondents (all countries) estimated travel distance to be <5 km, varying from less than 10 % to almost 60 % among the countries. Around 15 % had to travel more than 50 km, varying from 1.3 % to 37.5 %. More individuals living in rural as compared to urban areas had to travel more than 25 km to get their main assistive product. Gender differences were marginal. By far the most prevalent barrier to access assistive products was "Cannot afford", amounting to 39.9% and varying from 6.7 % to 79.1 % among countries. This was followed by "No support" with 14.3 %, varying from 2.3 % to 36.9 %, and "Not available" with 8.1 %, varying from 1 % to 21.5 %. More barriers were reported in rural than urban areas and women report more barriers than men. Variation between countries in both travel time and barriers is substantial and country-specific service development is needed to guide service development.

On the Relation between Assistive Technology System Elements and Access to Assistive Products Based on 20 Country Surveys.

The objective of this study was to explore the relationship between assistive technology system elements and access to assistive products. Data on assistive technology system elements and self-reported survey data on access to assistive products from 20 countries were analyzed using multivariate statistical methods, including orthogonal partial least squares analyses. Access to assistive products was primarily associated with the geographic coverage of assistive technology services in a country, followed by system elements related to policy and personnel. To achieve universal access to assistive technology, geographic coverage of assistive technology services is an instrumental system element. However, it requires the implementation of appropriate policies along with sufficient funding, recruitment of adequately trained personnel, and availability of assistive products in need.

Addressing data deficiencies in assistive technology by using statistical matching methodology: a case study from Malawi.

PURPOSE: To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa. MATERIALS AND METHODS: The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors. RESULTS: Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997). CONCLUSIONS: The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings. Implications for RehabilitationIn resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities.The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers.

Participation and Inclusion of Children and Youth with Disabilities in Local Communities.

This research aimed at strengthening the evidence base for interventions to promote the participation and inclusion of children and youth with disabilities in their communities. Four selected municipalities in four different regions of Norway participated. Focus group discussions (FGDs) were carried out in all four municipalities with service providers, children and youth with disabilities, and parents of children and youth with disabilities. The FGDs were used to develop a questionnaire to measure participation indicators. A survey was carried out among 186 children and youth, combining (a) random sampling of children and youth without disabilities and (b) invitations to all children and youth with disabilities, as registered by the municipalities. High-level analyses of the FGDs are presented, indicating the barriers and facilitators for participation for children and youth with disabilities, as well as requests for improvement of services to stimulate participation. The categories of family, technology, and volunteering were identified primarily as facilitators of participation, while school environment was primarily identified as a barrier. The survey measured four different aspects of perception of one's own participation. Data analyses revealed higher level of environmental barriers among children and youth with disabilities, and lower level of actual participation, satisfaction with one's own participation and one's own participation compared with that of peers.

Change in Disability Associated with Psychological Distress among Internally Displaced Persons in Central Sudan.

Individuals with disabilities are particularly vulnerable in conflict settings, and a high rate of psychopathology is well documented among persons with disabilities. The objective of this study was to explore the change in disability prevalence among IDPs in two settlement areas in central Sudan and the association between disability and psychological distress. In this one-year follow-up study, 1549 IDPs were interviewed twice using the General Health Questionnaire (GHQ) to investigate emotional distress. Disability was measured using the Washington Group Short Set. Households were randomly selected using the community health center as the starting point. All household members above eighteen years of age in the sampled households were interviewed. There is an increase in disability prevalence among internally displaced persons over time, associated with rural residency and poverty, low education, unemployment, IDP status, originating from western Sudan, young age, male gender, and being married. Disability was further found to be associated with psychological distress. Disability among displaced persons should be considered as a risk factor for increase in psychopathological disorders and is closely related to poverty. The study is limited to individual-level data and does not incorporate relevant environmental variables that may have influenced the changes in disability rates.

Measuring Self-Reported Access to Assistive Technology Using the WHO Rapid Assistive Technology Assessment (rATA) Questionnaire: Protocol for a Multi-Country Study.

In 2018, the World Health Assembly adopted a resolution on improving access to assistive technology (AT), and mandated the WHO to prepare a global report on assistive technology based on the best available evidence and international experience. As limited data on access to AT at country and global levels were available, there was a need to conduct representative population surveys in order to inform the development of the global report, national AT programs, and global initiatives. The objective of this protocol is to describe a multi-country study of access to assistive technology in six self-reported areas: use, source, payer, satisfaction, unmet need, and barriers. In collaboration with WHO Regional and Country offices, Member States, and other stakeholders, the Assistive Technology Access team in WHO coordinates the study. Data are collected through household surveys using the rapid Assistive Technology Assessment (rATA) questionnaire. Findings from the surveys will be published in the global report.

Scoping review of economic evaluations of assistive technology globally.

The paper presents a scoping review of existing economic evaluations of assistive technology (AT). The study methodology utilized a PRISMA flow approach with final included studies that met an adapted PICOS framework. Types of economic evaluations employed, study type and rigor and domains of AT impact were considered and analyzed. The economic evaluations in this study included 13 CBA, 9 CMA, 18 CEAs and 10 CUA. The majority of studies (32 studies in total) mentioned or recorded that AT investment, access and/or usage had impacts on the domain of both informal and formal health care. Specifically, care costs, time, and resources were affected. Our study has found that current AT economic evaluations are limited. This study advocates for a wider use of robust alternative evaluation and appraisal methodologies that can highlight AT value and which would subsequently provide further evidence that may make governments more willing to invest in and shape AT markets.

Using locational data in a novel mixed-methods sequence design: Identifying critical health care barriers for people with disabilities in Malawi.

The primary aim of this study was to determine which health care barriers were most important for people with disabilities in Malawi. To accomplish this, we devised a sequential mixed-methods research design that integrated locational survey data and qualitative data from field studies. Our secondary aim was to evaluate this research design not only as a design-solution to our particular research objective, but as a tool with more general applicability within social sciences. Malawi has one of the most underserved health service populations in the world with chronic resource shortages and long travel distances where people with disabilities are at a particular disadvantage. Nevertheless, our results show that even in a resource scarce society such as Malawi it is the interpersonal relationships between patients and health service providers that has the largest impact on the perception of access among patients. Our results also suggest that the sequential mixed-methods design is effective in guiding researchers towards models with strong specifications.

Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study.

BACKGROUND: Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach. METHODS: This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses. RESULTS: Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56). CONCLUSIONS: We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.

Gaps in access and school attainments among people with and without disabilities: a case from Nepal.

AIM: Many children with disabilities in low- and middle-income countries do not attend school and one-third are out of school. In order to ensure that education is for all including children with disabilities, research is needed on barriers to schooling to identify targets for intervention. The study will examine the determinants of school achievement among persons with and without disabilities as well as among each type of impairment. METHODS: The study will utilize data from a recent national, representative household survey on living conditions among persons with and without disabilities. The individual level data used in this article comprise 2123 persons with and 2000 persons without disabilities. RESULTS: The results show that an alarmingly high proportion of persons in Nepal have not accessed formal education, with access being significantly lower among persons with disabilities. While the results may be influenced by the assumed relationship between disability and poverty, results from analyzing the cross-sectional data cannot be conclusive on the influence of disability vs. poverty in determining differences in access and school attainments. Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement. Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest. CONCLUSIONS: It is necessary both to strengthen the entire educational sector and at the same time allocate resources that will ensure that all children are on board and that particular efforts are implemented to cater for those who are easily side-lined.Implications for rehabilitationAn alarmingly high proportion of persons in Nepal have not attended school.Substantially more individuals with than without disabilities have never attended school.Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement.Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest.It is necessary both to strengthen the entire educational sector in Nepal and at the same time ensure that particular efforts are implemented to cater for those who are easily sidelined.

Changes in prevalence of mental disorders among internally displaced persons in central Sudan: a 1-year follow-up study.

BACKGROUND: Sudan has one of the largest numbers of internally displaced persons (IDPs) in the world, estimated at five million. The main cause of displacement was the civil war. Attention to the health and in particular the mental health of IDPs has been lacking. That includes limited population longitudinal data describing the "natural" fluctuations of mental morbidity among these groups. The aim of this study is to investigate the level and stability of mental disorders among IDPs over a 1-year period. METHOD: In this 1-year follow-up of IDPs in two settlement areas in central Sudan, 1549 persons 18 years or older were interviewed twice using the MINI International Neuropsychiatric Interview. Trained psychologists collected the data in a random household survey in the selected IDP areas. RESULTS: We found overall high stability among those having and those free of mental disorders in this 1-year follow-up study. There were, however, discernible and statistically significant increases in overall new cases of mental disorders from T1 to T2 as major depression increased by 1.4%, generalized anxiety by 2.8% and social phobia by 1.4%. CONCLUSION: The study revealed continued high levels and increases of mental disorders over time, although with a pattern of substantial persistence among those initially ill and limited recovery. This might be due to a complex set of factors such as unavailability of mental health services, poverty, low educational level and social exclusion.

Resident-to-resident aggression in Norwegian nursing homes: a cross-sectional exploratory study.

BACKGROUND: Resident-to-resident aggression in nursing homes is a public health problem of growing concern, impacting the safety, health and well-being of all residents involved. Despite this, little research has been conducted on its occurrence particularly in large-scale national studies. The aim of this study was to explore the extent and nature of resident-to-resident aggression in Norwegian nursing homes, as reported by nursing staff. METHODS: We conducted a cross-sectional exploratory study, where nursing staff in 100 randomly selected Norwegian nursing homes completed a pen and paper survey measuring how often they had observed incidents of resident-to-resident aggression during the past year. These rates were separated according to nursing home size, location and units of workplace. RESULTS: Of the 3693 nursing staff who participated (response rate 60.1%), 88.8% had observed one or more incidents of resident-to-resident aggression during the past year, with acts of verbal and physical aggression being the most commonly reported. Nursing staff working in dementia special care units, larger nursing homes and nursing homes located in suburban/urban municipalities, reported more incidents of resident-to-resident aggression than staff in short-term and long-term units, small institutions, and nursing homes located in rural municipalities. CONCLUSIONS: This is the first national study of resident-to-resident aggression in Norwegian nursing homes and is one of the largest surveys worldwide exploring the extent and nature of resident-to-resident aggression in long-term care settings. Overall, we found a high occurrence of all types of aggression, suggesting a need for strategies to improve residents' safety and quality of life in nursing homes.

Elder abuse in Norwegian nursing homes: a cross-sectional exploratory study.

BACKGROUND: Elder abuse is a global public health and human rights problem that is predicted to increase as many countries experience a rapid growth in their population of older adults. Elder abuse undermines an older person's well-being and is associated with a range of serious health consequences. In institutional care settings, older residents are particularly vulnerable and hence at higher risk of being abused, but few countries have explored the extent and nature of this phenomenon in national studies. The aim of this study is to estimate the prevalence of observed and perpetrated staff-to-resident abuse in Norwegian nursing homes. METHODS: We conducted a cross-sectional exploratory study of nursing staff in 100 randomly drawn Norwegian nursing homes. Nursing staff completed a pen and paper survey measuring how often during the past year they had observed staff commit acts of neglect and psychological, physical, financial/material, and sexual abuse towards residents. They also reported how often they had perpetrated acts of abuse themselves, and these rates were disaggregated by nursing staff's gender, age and education. RESULTS: Of 3693 nursing staff (response rate 60.1%), 76% had observed one or more incidents of elder abuse during the past year, and 60.3% reported they had perpetrated one or more incidents of abuse in the same period. Psychological abuse and neglect were most commonly reported. Male staff reported more acts of physical abuse, while female staff reported more acts of neglect. Higher education of staff was associated with higher rates of self-reported psychological abuse, physical abuse and neglect. CONCLUSIONS: This first national survey of staff in Norwegian nursing homes is one of the largest studies globally estimating the prevalence of elder abuse in institutional settings. Overall, we found staff-to-resident abuse to be relatively common, and our findings propose a need for preventive strategies to improve the quality of life and safety of residents in Norwegian nursing homes.

PTSD as a consequence of past conflict experience, recent exposure to violence and economic marginalization in post-conflict contexts: A study from Nepal, Guatemala and Northern Ireland.

BACKGROUND: Exposure to war and conflict increases the risk of mental health problems. Poor living conditions are known to negatively impact mental health. HYPOTHESIS: It is hypothesized that exposure to negative events after armed conflict interacts with past negative experiences, socioeconomic factors and current mental health problems. METHODS: A cross-sectional survey was carried out in three contexts of previous internal armed conflict: Nepal, Guatemala and Northern Ireland. Three nationally representative samples were drawn, comprising a net sample of 3,229 respondents. RESULTS: Both recent negative events and past negative events linked to the previous conflicts were found to be associated with elevated risk of post-traumatic stress syndrome (PTSD). Economic marginalization and urban residency also contributed to current risk of PTSD. CONCLUSIONS: The results support the study hypothesis that both past and recent negative events in combination with economic marginalization contribute to explain current risk of PTSD. It is necessary both to improve living conditions more broadly and to establish and develop health services that have the capacity to screen, prevent and treat mental health problems also in poor contexts, in particular against a background of previous armed conflict.

Change in Mental Health Stigma After a Brief Intervention Among Internally Displaced Persons in Central Sudan.

Stigmatizing attitudes towards people with mental illness is a worldwide phenomenon, This Longitudinal study aimed to determine the level of stigma, among the internal displaced persons in central Sudan and explore possible changes in stigma associated with an intervention. 1549 persons were interviewed using standardized stigma attitude tools. The study reveled high level of stigma among our respondents and there was no significant difference in attitudes towards mental illness observed after the intervention. The intervention was not associated with change in stigma. However, the findings can inform policy to create sustainable national mental health strategies to address the stigma.

The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa.

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues - particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals - 322 persons with disability and 451 comparisons (without disability) - covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. Implications for rehabilitation Persons with disabilities in rural South Africa have poorer reported health outcomes. Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. Better access to health care for persons with disabilities is needed in rural South Africa.

Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape.

BACKGROUND: Understanding caregivers' views on rehabilitation services is important as it may assist in informing healthcare services and patient management. OBJECTIVES: The aim of this study was to explore caregivers' perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field. METHOD: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts. RESULTS: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery. CONCLUSION: Based on the participants' feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention.

Access to assistive technology in two Southern African countries.

BACKGROUND: Millions of people in Southern Africa are deprived of basic human rights such as the right to education and work because of the large and growing unmet demand for assistive technologies (AT). Evidence is needed to better characterize the lack of AT access. METHODS: This study serves to identify the sociodemographic factors that are associated with access to AT in two countries in Southern Africa, Botswana and Swaziland. To achieve this aim, logistics regression was applied to a subset of variables from two Living Conditions Studies, nationally representative surveys that were conducted in Southern Africa (2014 and 2010). RESULTS: In Botswana, 44% of people who needed AT did not receive it, while in Swaziland the unmet need was 67%. Among the sociodemographic variables tested, the type of disability was the most important factor in determining AT access in both countries. The likelihood of AT access was highest in both countries for those who had mobility limitations (i.e., difficulty walking/climbing stairs) [Botswana: 6.4 odds ratio (OR) = 6.4., 95% confidence internal (CI) (3.6-11.3); Swaziland: OR = 3.2, CI (1.4-7.3)], in comparison to those with non-mobility types of disabilities. CONCLUSIONS: These findings provide support for governments and other stakeholders in the AT sector to prioritize AT to address the large unmet demand, and expand the range of AT products provided so that people with hearing, seeing, self-care, communication and cognition difficulties have equal access to AT as those with mobility impairments. A step toward achieving these aims is to inventory AT product types that are commonly covered through the public sector in each country, and identify common gaps (e.g., daily living aids). Advancing the AT sector as a whole within Southern Africa will require large scale qualitative studies that achieve a comprehensive understanding of the bottlenecks in regional AT supply, procurement, and delivery systems.