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Eldre og velferdsteknologi for å fremme aktivitet og deltakelse. En kompleks intervensjon
No full textThis PhD study is part of the Assisted Living Project (2015-2019) and explores assistive
technology as a complex intervention to facilitate occupation and participation in everyday
life among home-dwelling older adults, both with and without mild cognitive impairment and
dementia (MCI/D). The demographic changes with bigger cohorts in the oldest age groups
challenge the future healthcare services. Assistive technology refers to devices or systems
whose purpose is to maintain or improve an individual’s functioning and independence, to
facilitate occupation and participation, and to enhance overall well-being, and is perceived as
means for independent living, to improve the quality of healthcare services and to avoid costs.
In the past decade, several research projects have aimed to support older adults at home,
facilitate their independent living and safety, provide cognitive stimulation and entertainment,
and contribute to their ageing in place. Despite many examples of technological failures, false
alarms and a lack of infrastructure robustness a general optimism about technology is evident.
Access to assistive technology may foster or hinder participation in meaningful occupation in
older home-dwelling citizens. Implementation of assistive technology is seen as a complex
intervention. The Medical Research Council (MRC) framework was used in this PhD study to
explore this complexity and develop new knowledge.
Occupational science emphasises human occupation as important for health and well-being
and provides a theory for understanding human occupation through the life course as a
dynamic and transactional process; i.e. a dynamic on-going interaction between human,
occupation and objects within a specific context.
This thesis is based on four studies; a systematic literature review (Paper I), a study of health
care workers’ experiences of using assistive technology with care recipients with MCI/D
(Paper II), a technology feasibility study (Paper III), and a user inclusion study on technology
development (Paper IV).
Study I found that a wide variety of assistive technologies was used to support home-dwelling
older adults and their family caregivers. The types of technologies can be categorised into
four groups; for 1) safe walking indoors and outdoors; 2) safe living; 3) independent living;
and 4) entertainment and social communication. Users; i.e. persons with MCI/D, family
caregivers, staff or other older adults were involved in different research occupations such as
focus groups, workshops, technology trials and interviews. A major finding was that user
inclusion was both necessary and important to learn about the design features required to
enhance usability and acceptability. Surprisingly, less than half the studies reported on
citizens with MCI/D’s experiences of technology use regarding quality of life, occupational
performance, or human dignity. Rather family caregivers and staff were asked about
feasibility and technical functionality.
Study II explored how community healthcare workers talked about and worked with assistive
technology for care recipients with MCI/D. Twenty-four healthcare workers with different
professional backgrounds took part in focus group discussions about technology to support
people with MCI/D at home. We found that the participants’ knowledge and practice of
technology varied. Some regarded technology as efficient services provision, such as physical
training programmes to several patients at the same time, and remote monitoring of patients
via screens. Others feared that technology might increase loneliness and confusion in the care
recipients and was motivated only by economic reasons. Technology did not appear to be in
the repertoire of healthcare workers’ clinical practice due to low knowledge of and
competence in technology, and lack of management. This study demonstrated that homedwelling
older citizens with MCI/D who are deprived access to supportive assistive
technology may experience occupational injustice.
Study III described the feasibility of the implementation of environmental sensors in one of
eight apartments, in order to learn about the strengths and weaknesses of the implementation
process and of the technology. This process evaluation drew on the Medical Research Council
(MRC) framework. A major finding was that a feasibility study was important for identifying
strengths and weaknesses of the intervention, critical evaluation of the research plan to
facilitate implementation in the other apartments.
Study IV sought to investigate how eight older adults in an assisted living facility evaluated
user inclusion in a 3-year technology development project. Individual structured interviews,
dialogue cafés, interventions with environmental sensors, follow-up home visits and a final
focus group discussion constituted sites for development of knowledge. The older adults with
and without documented MCI/D could nevertheless meaningfully contribute with opinions
about needs and preferences. One major finding was that they wanted to contribute with their
opinions. User inclusion of older citizens in research projects may contribute to extended
knowledge about user needs and technology requirements, as well as user inclusion processes.
Applying a critical occupational perspective raised awareness regarding sociocultural
assumptions about older adults in assisted living facilities, which may reinforce ageist and
ableist stereotypes, as well as promote occupational injustice.Denne PhD studien er en del av Assisted Living prosjektet (2015-2019) og utforsker
velferdsteknologi for å fremme aktivitet og deltakelse hos hjemmeboende eldre med og uten
kognitiv svikt (MCI) og demens (D). Demografiske endringer med større kohorter i de eldste
aldersgruppene er en utfordring for helse- og velferdstjenestene i framtida. Velferdsteknologi
kan bidra til økt selvstendighet hos eldre, økt kvaliteten i tjenestene og unngåtte kostnader.
Flere prosjekter har det siste ti-året vist at teknologi kan fremme selvstendighet og mestring,
sikkerhet og trygghet, men også å tilby kognitiv stimulering og underholdning.
Velferdsteknologi er produkter og løsninger som har til hensikt å vedlikeholde eller bedre
individets fungeringsevne og selvstendighet, og å fremme aktivitet og deltakelse, og sikre
generelt velvære. Til tross for mange eksempler på tekniske feil, falske alarmer og manglende
eller utilstrekkelig teknologisk infrastruktur, er det stor optimisme omkring teknologi som
framtidig løsning i helsetjenestene. Tilgang til velferdsteknologi, eller mangel på dette, kan
fremme eller hemme deltakelse i meningsfulle dager for hjemmeboende eldre.
Aktivitetsvitenskap (occupational science) anser menneskets deltakelse i aktiviteter og sosialt
liv som viktig for helse og trivsel, og som en moralsk rettighet. Aktivitetsvitenskap forstår
menneskelig aktivitet og deltakelse gjennom livsløpet som en transaksjonalistisk prosess, en
dynamisk interaksjon mellom mennesket, aktiviteten og objektene i en gitt kontekst.
Implementering av velferdsteknologi anses som en kompleks intervensjon. Rammeverket
MRC (Medical Research Council) ble benyttet i PhD-studien for å utforske denne
kompleksiteten og utvikle ny kunnskap.
Avhandlingen baseres på fire studier; en systematisk litteraturstudie (artikkel I), en studie av
ansatte i hjemmetjenestens erfaringer med teknologi til hjemmetjenestemottakere med MCI/D
(artikkel II), en mulighetsstudie med teknologi (artikkel III), og en studie om eldre i en
omsorgsbolig og brukerinkludering i teknologiutvikling (artikkel IV).
Studie I viste stor variasjon av typer teknologi som var prøvd ut med hjemmeboende personer
med MCI/D og deres pårørende og ansatte. Disse kan kategoriseres i fire grupper; Teknologi
for 1) gå trygt inne og ute; 2) trygg i egen bolig; 3) selvstendighet i hverdagen; og 4)
underholdning og sosial kommunikasjon. Brukerne deltok i fokusgrupper, workshop,
utprøvinger og intervjuer som fokuserte på design-prosessen og på evaluering av utprøvinger i
hjemmet. Et viktig funn var at brukerinvolvering var både nødvendig og viktig for å adressere
brukerbehov og brukerkrav for å forbedre bruk og aksept av produkter/løsninger. Under
halvparten av studiene rapporterte erfaringene om teknologibruken i forhold til livskvalitet,
aktivitetsutførelse og verdighet fra personer med MCI/D. I stedet ble pårørende og ansattes
oppfatninger av teknologiens muligheter og funksjonalitet rapportert.
Studie II handlet om hvordan ansatte i hjemmetjenestene snakket om og arbeidet med
velferdsteknologi til hjemmetjenestemottakere med MCI/D. Tjuefire helsearbeidere med ulik
profesjonsbakgrunn ble invitert til fokusgruppediskusjon om teknologi til personer med
MCI/D i hjemmetjenesten. Vi fant at deltakernes kunnskap om og praksis med
velferdsteknologi varierte. Et viktig funn var at mens noen så teknologi som en styrke for å
kunne tilby treningsprogram til flere samtidig eller å ha tilsyn med mange eldre via en skjerm,
var andre redde for at teknologi kunne forsterke ensomhet og forvirring. Teknologi synes ikke
å være på repertoaret i hjemmetjenestens kliniske praksis. Årsaker til dette var lav
teknologikompetanse hos ansatte, og manglende organisering av tjenesten. Konsekvenser er at
hjemmeboende personer med MCI/D ikke fikk tilbud om teknologi som kan støtte dem og
deres pårørende.
Studie III var en mulighetsstudie der sensorene som skulle benyttes i til sammen åtte
leiligheter først ble montert i én leilighet for å lære om styrker og svakheter ved
implementeringen. En prosessevaluering ble gjennomført i tråd med MRC’s anbefalinger.
Hovedfunnet var at det er viktig å gjøre en slik forstudie for å lære om teknologiens styrker og
svakheter, om forskningsplanen holder mål og for å forberede en effektiv implementering i de
andre leilighetene.
Studie IV undersøkte hvordan åtte beboere i en omsorgsbolig, evaluerte deltakelsen i et treårig
forskningsprosjekt om teknologi. Metoder som individuelle strukturerte intervju, dialogkaféer,
fokusgruppeintervju, samtaler under oppfølgingsbesøk, og deltakelse i en intervensjon
med omgivelsessensorer ble benyttet i brukermedvirkningsprosessen. Eldre med og uten
dokumentert MCI/D formidlet egne behov og preferanser. Et viktig funn var at deltakerne
ønsket å være til nytte, og bidra med sine meninger. Eldres deltakelse i forskningsprosjektet
bidro til mer kunnskap om brukerbehov og brukerkrav til teknologi, og om
brukermedvirkningsprosesser. Ut ifra et kritisk aktivitetsperspektiv bidro studien til å skape
bevissthet omkring sosiokulturelle antakelser om eldre som kan forsterke diskriminering på
grunn av alder og funksjonssvikt, og retten til å delta i aktiviteter - «occupational injustice».publishedVersio
Older Adults and Assistive Technology to Facilitate Occupation and Participation: A complex intervention
No full textOsloMet Avhandling 2020 nr 31, av Torhild Holthe. Thesis submitted for the degree of Philosophiae Doctor (PhD). Department of Occupational Therapy, Prosthetics and Orthotics. Faculty of Health Sciences. OsloMet – Oslo Metropolitan University. Autumn 2020
ISSN 2535-471X (trykket) / ISSN 2535-5414 (online) ISBN 978-82-8364-276-6 (trykket) / ISBN 978-82-8364-287-2 (online
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