Technology use in everyday activities among older adults with mild cognitive impairment : a study of changes over time and views on technology as support

Abstract

The overall aim of this thesis was to provide new knowledge of everyday technology (ET) use and functioning over time, as perceived by persons with cognitive decline due to mild cognitive impairment (MCI). A secondary aim was to increase knowledge about their views on technology as part of and as potential support in everyday life.

The first three studies build on longitudinal instrument-based data from a cohort of 37 older adults with MCI at inclusion. The fourth study included six participants from the same cohort to a qualitative interview study. In Study I special focus was placed on changes in the perceived ability to use ET and involvement in activities. Patterns of different aspects of functioning in everyday life were explored over two years using a person-oriented approach. Study II used a mixed-linear-effect model to examine ET use over two years. Five predefined assumptions were tested regarding factors potentially influencing the amount of ET used. In Study III longitudinal involvement over four years in 15 everyday activities was investigated using differential item functioning. Furthermore, associations over time of perceived ability in ET use and overall perceived activity involvement was examined. Study IV used a grounded theory approach to explore how persons with MCI relate to technology as a part of and potential support in present and future everyday life.

The findings in Study I suggest an even distribution between a stable/ascending, a fluctuating, and a descending pattern of functioning the two first years after detection of MCI, with the highest conversion to dementia (58%) in the descending pattern. Perceived ability to use ET fluctuated or descended in 50% of the sample. Study II found a significant decrease in the overall amount of ET used over two years, but the number of users of specific ETs both decreased and increased. Less perceived ability in ET use, less activity involvement, declining cognitive state, and belonging to an older age group predicted use of less ET, while diagnostic state and length of education were non-significant factors. Study III showed that overall activity involvement decreased significantly over four years. Descending involvement was found in seven of fifteen activities. All leisure activities descended. The positive correlations between activity involvement and perceived ability in ET use became stronger over time. In Study IV the findings describe the participants’ different ways of relating to existing and potential future technology in everyday occupations as a continuum of downsizing, retaining, and updating. In connection with the participants’ actions and assumptions in relation to technology and doing, trade-offs between desired and adverse outcomes were made, challenging take-off runs were endured, and negotiations took place of the price worth paying.

In conclusion, the findings show that although overall activity involvement as well as the amount of ET used decreased significantly over time on a group level in this sample with MCI at inclusion, variations across activities, individuals and time-points were present. This means that the need for support in ET use is individual and likely to alter over time in persons with MCI. Therefore repeated evaluations of activity involvement and ability to use ET is suggested to facilitate timely interventions during cognitive decline due to MCI, not forgetting the area of leisure. Already-incorporated ETs may serve as a platform for support in daily life for this group.