Conditions of everyday technology use and its Interplay in the lives of older adults with and without dementia

Background: Increased reliance on technology in society incurs a risk that older adults with and without dementia could become excluded from participating in aspects of everyday life in and outside home. This thesis responds to a gap in present understanding about the conditions for Everyday Technology (ET) use (i.e. ticket machines, smartphones) in different international and geographical contexts. By generating new knowledge about the interplay of these conditions on participation, practical information and guidance follow to support both dementia- and age-friendliness as well as general inclusivity in society.

Aim: To illuminate the conditions, particularly different country and geographical contexts, of ET use and the interplay of these conditions with participation and inclusion in everyday life both in and outside the home for older adults living with and without mild stage dementia.

Methods: Participants with dementia (n =99) and with no known cognitive impairment (n =216) were recruited in the US (sub-study i, n =114), Sweden (sub-study i, n =73, ii, n =69), and England (sub-studies i, iv, n =128, rural sub-study iii, n =10). These four cross-sectional studies used multiple predominantly quantitative methods (i, ii, iv) and a case study approach also involved qualitative data (iii). Structured home-based interviews used the Everyday Technology Use Questionnaire to map respondents’ use of technologies, and the Participation in Activities and Places Outside Home Questionnaire to investigate the amount and pattern of participation outside home. Qualitative data included field notes, observations, annotated maps and more. The findings of the four studies were synthesised using an approach to triangulation.

Findings: The triangulation approach yielded three themes: 1) Dementia as a condition of ET use, 2) National, geographical, public and home context as a condition of ET use, 3) Interplay of conditions with participation.1) Dementia was generally not found to be a condition that impacted the challenge of ETs, however groups with dementia typically regarded less ETs to be relevant. There were notable exceptions in both instances. 2) The varying social, infrastructural, and service conditions surrounding national and geographic contexts were seen to shape the constitution and use of ETs outside home. 3) There was a complex interplay between the conditions of ET use and participation outside home. Close and distant human relationships, structural inequalities and transportation options were implicated as stabilising and de-stabilising everyday life.

Conclusions: Insights are provided into the interplay between the conditions of ET use and participation in everyday life outside home among older adults with and without dementia. These insights provide opportunities for many different people in societies, communities, neighbourhoods and household to take action. Reducing any friction that people encounter when using ETs in public places and allowing opportunities for manualised participation in occupations outside home could lead to a more inclusive everyday life.

List of scientific papers

I. Wallcook S, Malinowsky C, Nygård L, Charlesworth G, Lee J. … Kottorp A. (2020). The perceived challenge of everyday technologies in Sweden, the United States, and England: exploring differential item functioning in the Everyday Technology Use Questionnaire. Scandinavian Journal of Occupational Therapy. 2020 Nov;27(8):554-566.
https://doi.org/10.1080/11038128.2020.1723685

II. Wallcook S, Malinowsky C, Kottorp A & Nygård L. (2019). The use of Everyday Information Communication Technologies in the lives of older adults living with and without dementia in Sweden. Assistive Technology. 2019 Aug 20;1-8.
https://doi.org/10.1080/10400435.2019.1644685

III. Wallcook, S., Malinowsky, C, Ryd, C., Charlesworth, G., Nygård, L. Illuminating the everyday technological lives of rurally dwelling older adults with dementia in the North of England: A multiple case study. [Manuscript]

IV. Wallcook, S., Nygård, L., Kottorp, A., Gaber, S. N., Charlesworth, G. & Malinowsky, C. (2020). Kaleidoscopic associations between life outside home and the technological environment that shape occupational injustice – revealed with cross-sectional statistical modelling. Journal of Occupational Science.
https://doi.org/10.1080/14427591.2020.1818610