The participation of older people with and without dementia in public space, through the lens of everyday technology use

Participation in activities and places within public space has been linked to numerous health benefits and yet, little is known about participation among older people with and without dementia. Insights about participation in activities and places within public space can contribute to the somewhat ambiguous definition of participation, as “involvement in a life situation”, by acknowledging the complexity and interrelatedness of subjective, social, contextual, temporal, and technological aspects of participation. Thus, the overarching aim of the four studies was to explore participation in activities and places within public space, among older people with and without dementia in two European countries (Sweden and UK), and to evaluate how different aspects, such as the relevance and perceived ability to use Everyday Technologies (ETs), interact with and influence participation, over time.

Across all studies, interviews used the Participation in Activities and Places Outside Home Questionnaire (ACT-OUT) and the Everyday Technology Use Questionnaire (ETUQ), in order to focus on the perspectives of older people with and without dementia themselves. Study one explored stability and changes in participation in places visited within public space in relation to the relevance of ETs used in public space, among a baseline Swedish sample. Study two utilised ordinal regression to investigate the ways in which perceived risks and ET use were associated with out-of-home participation, among a UK sample of older people. Using a mixed methods design and data visualisations, study three delved into aspects of social participation in more depth, including ET use and social deprivation of the living environment, among two UK sub-samples of older people with and without dementia. Study four’s longitudinal design and multilevel modelling deepened the knowledge about how use of ET outside home, relates to participation in places visited within public space among a Swedish sample of older people with dementia over time.

Study one’s findings demonstrated a statistically significant positive association between a higher person measure of ability to use ETs and higher participation in places visited within public space, among the Swedish sub-sample of older people with dementia but not those without dementia. According to the ordinal regression model in study two, a higher probability of ET use was associated with a higher level of out-of-home participation, among the UK sample of older people. By elucidating motivators, considerations that require extra attention, and management strategies among UK sub-samples of older people with and without dementia, study three provided insights into the nuances of social participation. Finally, study four’s findings revealed that decreasing use of ET outside home was associated with decreasing participation in places visited within public space, in a statistically significant way when accounting for age.

In summary, this thesis contributes empirical insights about the participation of older people with and without dementia in activities and places within public space, through the lens of ET use. Such knowledge can be used to develop targeted health and social care planning and the design of more inclusive places, technologies, and services.

List of scientific papers

I. Gaber, S. N., Nygård, L., Brorsson, A., Kottorp, A., & Malinowsky, C. (2019). Everyday technologies and public space participation among people with and without dementia. Canadian Journal of Occupation Therapy. 86(5), 400-411.
https://doi.org/10.1177/0008417419837764

II. Gaber, S. N., Nygård, L., Kottorp, A., Charlesworth, G., Wallcook, S., & Malinowsky, C. (2020). Perceived risks, concession travel pass access and everyday technology use for out-of-home participation: Cross-sectional interviews among older people in the UK. BMC Geriatrics. 20(1), 1-12.
https://doi.org/10.1186/s12877-020-01565-0

III. Gaber, S. N., Nygård, L., Brorsson, A., Kottorp, A., Charlesworth, G., Wallcook, S., & Malinowsky, C. (2020). Social participation in relation to technology use and social deprivation: A mixed methods study among older people with and without dementia. International Journal of Environmental Research and Public Health. 17(11), 4022.
https://doi.org/10.3390/ijerph17114022

IV. Gaber, S. N., Nygård, L., Malinowsky, C., Brorsson, A., Kottorp, A., & Hedman, A. (2020). Enacting citizenship through participation in a technological society: A longitudinal three-year study among people with dementia in Sweden. [Submitted]