Mobility Devices in Everyday Life among Very Old Europeans: Aspects of use and changes over time

The aim of this thesis was to expand the knowledge regarding the use and need of assistive devices, in particular mobility devices, and to investigate how, from a European perspective, the use of them changed during the ageing process. An additional aim was to explore the use of mobility devices in everyday life among very old Swedish women during a five-year period. Further, the aim was to contribute to methodological development with regard to assistive device interventions and to investigate the basic psychometric proprieties of a new instrument for evaluating mobility-related participation. This thesis was based on two research projects; the ENABLE-AGE Project and the Nordic Assisted Mobility Evaluation Project (NAME). The results of this thesis give an overview of the situation regarding assistive devices across five European countries: Sweden, Germany, the United Kingdom, Hungary and Latvia. Cross-national analyses show that the proportion of users, as well as the number of assistive devices in use per person, varied among the five European samples included. Overall, a higher proportion of very old people in the West European countries used assistive devices when compared to people in the East European countries. The use of mobility devices increased over a short period of time, this was most prominent in the Western European countries, and moreover the pattern of use changed during the one year study period. The findings in this thesis also highlight the heterogeneity and complexity of being a mobility device user at a very old age. The case study revealed that for three Swedish women the use of mobility devices impacted on activity and participation aspects, such as domestic work, shopping and socialising, during the ageing process, in complex and dynamic person-environment-activity transactions. In particular rollators were found to offer support for both transportation and activity performance. Further, the findings showed that complementary use of, e.g. a walking stick or walking frame, in different situations, enabled these women to manage everyday activities in spite of their functional limitations which were increasing over time. As to methodology contribution, an outcome assessment instrument, The Nordic Mobility-Related Participation Outcome Evaluation on Assistive Devices (NOMO 1.0), is presented. The instrument has a novel approach to outcome evaluation, targeting mobility-related participation outcomes after mobility device interventions. In addition this thesis contributed to theoretical development as regards assistive device research. Overall, the knowledge generated is relevant to support optimisation of mobility device use along the ageing process. From a European perspective, the findings give implications for future policy-making, planning and organisation of health care and social services, including provision of assistive devices and advancing occupational therapy practice across Europe