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P rob lem s W ith D ress ing in theFrail Elderly

W i l li a m C . M a n n , C h r i s t i n e K i m b l e , M i c h a e l D. J u s t i s s ,

E l e n a C a s so n , M a c h i k o T o n n i t a , S a m u e l S . W u

O J E C T I V E D r e ss i n g is a n i m p o r ta n t a c t iv i t y o f d a i i y l i y i n g , y e tma ny o ider ad u l ts haye d i f f ic

i m p a i r m e n ts . Th e p u r p o se

o f

th is s tu d y wa s

to

expio re the use

o f

a ss i s t ive d e v i ce s

fo r

d r e ss i n g b y

s o n s w i t h i m p a i r m e n t s , a n d to iook a t d it te re n ce s a m o n g f ra i i e i d e r s w i th n o dre ss ing d i f ficu

e x t r e m i t y -o n i y d r e ss i n g d i ff icu l t y , l o we r -e x t r e m i t y -o n i y d r e ss i n g d i ff icu i t y , a n d b o th u p p e r - a n d i o w

i ty d ress ing d i f f icu i ty .

M E T H O D W e co n d u c te d i n -h o m e i n te r v i e ws a n d fu n c t i o n a i a sse ssm e n ts w i th 1 ,1 0 1 e i d e r i y p e r

act iy i t ies

o f

d a i i y i i v i n g a n d /o r i n s t r u m e n ta i a c t i y i ti e s

o f

d a i i y i i v i h g l i m i ta t i o n s

in

Weste rn New

No r th e r n F i o r i d a , Pa r t i c i p a n ts we r e a ss i g n e d t o o n e o f fo u r g r o u p s b a se d o n Fu n c t i o n a i I n d

M e a su r e i te m sco r e s

fo r

u pp e r -e x t re m i ty d r e ss i n g a n d i o we r -e x t r e m i t y d r e ss i n g . D e sc r i p ti ve s ta

used t o repor t resu i ts ,

R E S U L T S Co m p a r e d to wo m e n , th e re we r e r e i a t ive i y m o r e m e n w i th i o we r -e x t r e m i t y d r e ss i n g d i f

w i th u p p e r -e x t r e m i t y d r e ss i n g d i t f i cu i t y . Th e g r o u p w i th b o th u p p e r - a n d i o we r -e x t r e m i t y d r e ss i n g

repor ted the h ighest ieve i o t pa in and scored iowest on a i i measures o t tunct iona i s ta tus and menta l s

m o s t co m m o n i y u se d d r e ss i n g d e v i ce s we r e a sso c i a te d w i th i o we r -e x i r e m i t y d r e ss i n g .

C O N C L U S I O N There a re d i t te rences in g e n d e r, h e a i th s ta tu s , fu n c t i o n a i s ta tu s , a n d m e n ta l s ta

e i d e r i y p e r so n s g r o u p e d b y u p p e r -

o r

lowe r-extrem i ty d ress ing d i f ficu i ty . Resu i ts suggest tha t the ra p

cons ider such d i f fe rences as gender and type o f dif f icu i ty (upper - o r l o we r -e x t r e m i t y d r e ss i n g ) inb

p e u t i c a p p r o a ch e s a n d r e co m m e n d a t i o n s

to r

assis t ive d evices. Pa in

is

a n o th e r i m p o r ta n t co n s i d e r a

ca n o f te n b e r e d u ce d d u r i n g d r e ss i n g b y u s i n g a ss i s t ive d e v i ce s .

Mann,

W .

C ,

Kimble,

C ,

Justiss, M. D., Casson, E., Tomita, M.,

Wu, S. S. (2005). Problems with d ressing

e l d e r l y .

A m e r ic a n J o u r n a l

o

O c c u p a t i o n a l

T h e r a p y .

5 9

3 9 8 - 4 0 8 .

W i ll ia m C . M a n n , P t iD , T R ,

is

C t ia i r a n d P r o t e s s o r ,

D e p a r t m e n t otO c c u p a t io n a l T h e r a p y , U n i v e r s i t y o t F l o r i d a ,

P O B o x 1 0 0 1 6 4 , G a in e s v il le , F l o ri d a 3 2 6 1 0 - 0 1 6 4 ;

w m a n n @ h p . u tl .e d u

C h r i s t i n e K i m b l e ,

OT is

M a s te r s S t u d e n t , D e p a r tm e n t

o t

O c c u p a t i o n a l T h e r a p y , U n i v e r s i t y o t F l o r i d a , G a i n e s v i l l e ,

F l o r i d a .

M i c h a e l D . J u s t i s s , M O T O T R / L , R e s e a rc h A s s i s ta n t ,

R E R C - T e c h - A g i n g , R e t i a b i li ta t io n S c i en c e D o c t o r a l

P r o g r a m , U n i v e r s i t y

o t

F l o r i d a , G a i n e s v i l l e , F l o r i d a .

F l e n a O a s s o n is P u b l ic a t i o n s D i r e c to r , D e p a r tm e n t o t

O c c u p a t i o n a l T h e r a p y , U n i v e r s i t y ot F l o r i d a , G a i n e s v i l l e ,

F l o r i d a .

M a c t i i k o T o m i t a , P h D , is C l i n i c a i A s s o c i a t e P r o t e s s o r ,

D e p a r t m e n t of R e h a b i l i t a t i o n S c i e n c e s , U n i v e r s i t y a t

B u t t a l o , T h e S t a t e U n i v e r s i t y

o t

N e w Y o r k , B u t t a lo ,

N e w Y o r k .

S a m u e l S . W u , P h D ,

is

A s s i s t a n t P r o t e s s o r , D e p a r t m e n t

o t S t a t i s t i c s , C o i i e g e o f M e d i c in e , U n i v e r s it y ot F l o r i d a ,

G a i n e s v i ll e , F l o r i d a .

n 1996, tbere were 33.9 million people in tbe United States more tban 65

ofage (Administration on Aging, 1996), and by 2020, tbis group will incr

53.2 million (Sigel, 1996). Tb e oldest-old elderly persons, tbose more t

years ofage, are tbe fastest g rowing seg ment of tbe po pulatio n, and tbis wil

erate witb tbe baby boom generation now reacbing 65 years of age (Sigel,

In 2000, 35% of elderly persons reported limitations in activity (Cente

Disease Control and Prevention, 2003). Sixteen percent of persons more t

years of age bave difficulty wi tb dressing an d 11% require belp (Hobbs & D

1996). Assistive devices are available tbat can be used for dressing; bowev

know relatively little about tbe use of assistive devices for dressing by elder

sons witb functional limitations. We do know tbat overall, assistive device u

been increasing wbereas use of personal assistance is declining (Mantn, C

& Stallard, 1993). We also know tbat people who use assistive devices repo

unmet need relative to tbeir personal care (Agree & Freedman, 2003). Tb

pose of tbis study was to explore tbe use of assistive devices for dressing by

based elderly persons with functional limitations.

Literature Review

Ability to complete activities of daily living (ADL) independently can affec

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al.).Using correlation

Frailty among older adults has been shown to relate to

74 1

years (5D 6.1). Thirty-

{p =.0274 ) (H o et al., 200 2) . Difficulties with

Adaptive eq uip m en t is often used to offset difficulties

sistive devices. Eight of those disc hatged particip ated in

The y were asked to rank theit m ost valued piece of

s for non-u se of adaptive eq uipm ent. Dressing equip-

vices in each hom e was 3.15 (1 .46). Of the 23

formed by others, (2) perception of lack of

need

(3) equip

m en t failure or loss, and (4) equip me nt too cumb ersome

(Gitlin et al., 1993). In a related study, Githn, Scbemmm

and Landsberg (1996) found tbat o 64 devices provide

to 86 rebabilitation in-patients, 50 percent were used fre

quently to always in the fitst 3 months following discharge

These studies illustrate the importance of assistive device

for dressing, but do not specifically examine differences i

upper- and lower-extremity dressing difficulties, as in th

present study.

Other studies have also addressed use of assistiv

devices for dressing, de Klerk, Huijsman, and McDonnel

(1997) identified variables related to the use of assistiv

devices in a study of 498 single, independent-living elderly

persons (mean age 81 years). Aids for ADL (such as but

tonbooks, raised beds) were used by 73.5% of tbe sample

Tbe most frequently used dressing aid was the long-han

dled shoehorn with 10% of subjects using this device

Women and those living in small or sheltered housing used

more assistive devices. Elderly persons who received hom

care used mo re devices than those not receiving hom e care

The investigators postulated that caregivers provide infor

mal training and stimulate their care recipients to use mor

assistive devices. No significant relationship was found

between educational level and the use of assistive devices

Subjects witb bigber income used fewer devices than thos

with lower incomes. Use and number of assistive device

used for basic A D L activities wete positively correlated w ith

having chronic illness (de Klerk et al.).

The importance of dressing devices was also identified

in a study of hospital patients' concetns, petceptions, and

beliefs regarding assistive devices (Gitlin, Luborsky, &

Schemm, 1998), with a sample of 103 stroke patients who

wete receiving rehabilitation. Devices were categorized a

addressing mobility, dressing, feeding, seating, and bathing

Mobility devices generated the most comments, followed

by dressing devices. Dressing devices received a proportion

ately larger number of positive comments compared to tb

othe r device types. User satisfaction and dissatisfaction wer

studied in more detail in the present study.

T he use of technical aids, inclu ding assistive device

for dressing, was studied in a sample of 57 subjects mor

tha n 7 4 years of age wh o re ported ly had difficulties per

forming AD L (Parker o Thorslun d, 1991). Four hu ndred

twenty-two technical aids (7.4 per person) were found in

the subjects' homes, of which 75% were being used. Aid

for personal hygiene (raised toilet seats, bathtub bencbes

and dtessing aids) composed 20 % of the aids. Subjects wb

reported diBculties in dressing, eating, and transfers wer

7/25/2019 Problems With Dressing in the Frail Elderly

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task, or avoided the activity altogether. Personal assistance

was required for 12 subjects in donning coats. Thirty-six

subjects reported difficulty dressing, with 28 (78%) using

aids.Th e m ost frequently reported difficulties in A DL were

in the areas of personal hygiene and mobility (Parker &

Thorslund). This study provides further evidence that

dressing difficulties are common among older persons, and

a significant number of them do use assistive devices to

address these difficulties.

Schemm and Citlin (1998) studied methods that occu-

pational therapists use in reh abilitation clinics to teach use of

dressing and bathing devices. They studied 86 patients and

19 occupational therapists du ring training sessions and found

to teach dressing device use, therapists averaged 2.5 sessions

of 10-minute average session duration. Teaching was primar-

ily demonstration and oral instruction. Patients receiving

train ing in device use reported it to be satisfactory. T he

importance of training in the use ofassistive devices, includ-

ing dressing devices, was clearly identified in this study.

Loss of independence in ADL, including dressing, has

a relationship to quality of life (Krach, DeVaney, DeT urk, &

Zink, 1996) and frailty (Ho et al., 2002). The importance

of assistive devices for dressing has been identified in sever-

al studies (de Klerk et al., 1997; Cithn, Levine, & Ceiger,

1993; Citlin et al., 1998; Cid in, Schem mm , Landsberg, &

Burgh, 1996; Parker & Thorsiund, 1991). Perhaps because

these studies had relatively small sample sizes, they did not

explore differences in upper- and lower-extremity dressing

difficulties. Yet, different movements are required for upper-

and lower-extremity dressing, and different assistive devices

are available to address these difficulties.

This study included a larger number of participants

than in previous studies of use of dressing devices by older

persons, and it explored differences among participants

grouped by upper- and lower-extremity dressing difficulties.

The following questions were addressed: (1) What are the

differences in demographic health, functional and psy-

chosocial status, and quality of life for frail older persons

gro uped as follows: (a) no dressing difficulty, (b) upp er-

extremity-only dressing difficulty, (c) lower-extremity-only

dressing difficulty, (d) both lower- and upper-extremity

dressing difficulty; (2) What types of dressing devices are

most commonly used; and (3) What are the reasons for dis-

satisfaction with dressing devices? Having a better under-

standing of the underlying factors that relate to upper- and

to lower-extremity dressing could help therapists in identi-

fying older persons potentially in need of assistive dressing

devices. Know ing what dressing devices are most com mo n-

ly used, and reasons for dissatisfaction with devices, could

potentially guide therapists in providing assistive dressing

Methods

mp l e

This report is based on the Rehabilitation Engin

Research Center (RERC) on Aging Consumer Asses

Study (CAS), a longitudinal study of the coping str

of elderly persons with disabilities. From 1991 to 20

senior service agencies and hospital reh abilitation pr

referred individuals they currently served, or in the

hospital rehabilitation programs, individuals disc

home, to the CAS. A comparison of the sample w

Federal Interagency Forum on Aging-Related Sta

(2000) demonstrated that the resemblance of the su

to the national pop ulatio n of elderly persons was ver

for race and living status. However, compared to the

tics of the U.S. Census Bureau (2000), the subject

older and a larger proportion of them were women

sample further closely resembled the approximately 2

cent of the elderly population who has difficulty w

least one ADL or instrumental activities of daily

(IADL) (Administration on Aging, 2004).

The CAS was initiated in Western New York (

where 79 0 elderly persons were interviewed. In th

two years, the CA S was replicated w ith 3 11 study s

in Northern Florida (NFl). For the present report, we

bined initial interviews of the NFl and WNY sampl

grouped study part icipants based on Func

Independence Measure(tm) (FIM(tm)) dressing scor

We grouped study participants based on the tw

dressing item scores (upper-extremity dressing and

extremity dressing items). FIM item scores range f

thro ug h 7 and each score is defined; for exam pl

Complete Independence, 3 = Moderate Assistanc

1 = Com plete Depen den ce. Cro ups were defined

lows: (1) N D D N o Dressing DifficulryFIM lowe

upper-dressing item scores equal to 7 ( = 295

UEODDUpper-Extremity-Only Dressing Diffic

lower-extremity FIM item score equals 7 but up per-ex

ity FIM item score less than 7 {n =23 ) ; (3 ) L EO

Lower-Extremity-Only Dressing Difficultyu

extremity FIM item score equals 7 but lower-ext

FIM item score less than 7 ( = 118); (4) BLUEDD

Lower- and Upper-Extremity Dressing Difficulty

upper-extremity and lower-extremity FIM item

below 7 {n

=

665).

Dem ograp hic informa tion for study participants

sented in Table 1, broken down by group assignmen

following information is for the entire sample {N

Participants ranged from 60 to 106 years of age, w

mean age of 75.3 years (8.3). Eight hundred one of

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1 e m o g r a p h ic I n f o rm a t i o n fo r E l d e rly P e r s o n s W i t h P r o b l e m s

NDD

(n = 295)

% or x(SD)

r e s s i n g N e w

UEODD

(/7=23)

% or x ( S D )

Y o r k a n d F l o r id a

LEODD

% or x ( S D )

P o p u l a t i o n Y e a r 1

BLUEDD

(n=665)

orx(SD)

Ail

Participan

/V=1,101

% or x(SD)

1,097)

1,099)

1,099)

1,099)

tus (A /= 1,097 )

1,100)

c Status (A /= 98 1)

s than 10,00 0

75.8 (8.3)

77.4 (7.2) 74.4 (8.2)

75.3 (8.5)

75.2 (8.3)

229

65

41

249

2

1

1

60

110

65

29

21

8

90

150

32

19

3

170

124

155

124

15

111

80

30

24

16

(77.9%)

(22.1%)

(13.9%)

(84.7%)

(0.7%)

(0.3%)

(0.3%)

(20.5%)

(37.5%)

(22.2%)

(9.9%)

(7.2%)

(2.7%)

(30.6%)

(51.0%)

(10.9%)

(6.5%)

(1.0%)

(57.8%)

(42.2%)

(52.7%)

(42.2%)

( 5.1% )

(42.5%)

(30.7%)

(11.5%)

(9.2%)

(6.1%)

20

3

6

17

7

6

6

4

5

12

4

2

15

8

15

8

10

8

1

1

(87.0%)

(13.0%)

(26.1%)

(73.9%)

(30.4%)

(26.1%)

(26.1%)

(17.4%)

(21.7%)

(52.2%)

(17.4%)

( 8.7%)

(65.2%)

(34.8%)

(65.2%)

(34.8%)

(50.0%)

(40.0%)

(5.0%)

(5.0%)

85

33

23

94

1

34

36

28

12

8

34

58

12

10

3

66

52

65

48

5

48

36

10

4

6

(72.0%)

(28.0%)

(19.5%)

(79.7%)

(0.8%)

(28.8%)

(30.5%)

(23.7%)

(10.2%)

(6.8%)

(28.8%)

(49.2%)

(10.2%)

(8.5%)

(2.5%)

(55.9%)

(44.1%)

(55.1%)

(40.7%)

(4.2%)

(46.2%)

(34.6%)

(9.6%)

(3.8%)

(5.8%)

467

197

132

523

3

3

169

253

143

54

24

13

216

315

66

57

11

338

324

359

247

59

287

176

65

32

36

(70.2%)

(29.7%)

(20.0%)

(79.1%)

(0.5%)

(0.5%)

(25.5%)

(38.0%)

(21.5%)

(8.1%)

(3.6%)

(2.0%)

(32.5%)

(47.4%)

(9.9%)

(8.6%)

(1.7%)

(50.8%)

(48.7%)

(54.0%)

(37.1%)

(8.9%)

(48.2%)

(29.5%)

(10.9%)

(5.4%)

(6.0%)

801

298

202

883

5

2

4

270

405

242

99

53

21

345

535

114

88

17

589

508

594

427

79

456

300

105

61

59

(72.8%

(27.2%

(18.4%

(80.6%

(0.5%)

(0.2%)

(0.4%)

(24.6%)

(36.9%)

(22.0%)

(9.0%)

(4.8%)

(1.9%)

(31.4%)

(48.7%)

(10.4%)

(8.0%)

(1.5%)

(53.7%)

(46.3%)

(54.1%)

(38.8%)

(7.2%)

(46.5%)

(30.6%)

(10.7%)

(6.2%)

(6.0%)

BLEDD = hothiower- and upper-extremity dressing difficuity; LEODD = lower-extremity-only dressing difficuity; NDD = no dressing ditticuity; UEODD =

Impact Ptofile [SIP] score, which represents the percent o

disability). Study participants scored a mean of 9.1 (3.9

out of 14 for IADL, and 75 (14.8) out of 91 on FIM Moto

section. Participants' mean MMSE score was 26.4 (5.7); 2

is typically the cutoff point for separating samples into cog

nitively/noncognitively impaired (Braekus, Laake, &

Engedal, 1992). Table 3 lists the frequencies of the chroni

diseases and conditions reported by the study participants

ns t rum nts

The CAS uses a battery of instruments to measure multipl

dimensions including instruments developed by othe

7/25/2019 Problems With Dressing in the Frail Elderly

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2.

H e a lt h S t at us

Functional

Status Psychosocia l and Men t a l

StatusNew Yorkand

MDD

(/7 295)

or x (SD )

Florida Population

UEODD

(n 23)

o r x ( S D )

Y e a r 1

LEODD

( n = 1 1 8 )

o r x (SD )

BLU

(/7

o

ealth

Number

of

MD visits past

6

montiis

Number

of

sick days pasf

6

monfhs*

N

1,081 )

None

Less thanaweek

1 week-1 month

1 month-3 monfhs

4 months-6 months

Number

of

days

in a

hospitai

Number

of

medications***

Numherot chronic illnesses

Eyesight (A/=1,099)

Exceiient

Good

Fair

Poor

Blind

Hearing Abiiity(/V=1,096)

Exceiient

Good

Fair

Poor

Tofaiiy Deaf

Pain (Jette) (range10-40)***

unctional Status

FIMTotai (18-126)***

FIM Motor***

FiiVl Cognition***

IADL-OARS(0-14)** *

SiP (0 -100)** *

Psyctiosocial and Mental Status

Mentai StatusMMSE (0-30)***

Self-Esteem Rosenberg (10-40)***

DepressionCESD (0- 60) **

Quaiify

ot

Lite**

Life Satisfaction***

5.7

(5.5)

5.3

(3.6)

5.0 (6.1)

5.8

170

36

35

36

9

2.4

5.7

6.2

44

130

67

47

6

59

107

72

44

9

(59.4 )

(12.6 )

(12.2 )

(12.6 )

(3.1 )

(7.1)

(3.7)

(3.5)

(15.0 )

(44.2 )

(22.8 )

(16.0 )

(2.0 )

(20.3 )

(36.8 )

(24.7 )

(15.1 )

(3.1 )

10

7

1

5

1.4

5.0

7.2

5

10

8

5

11

4

2

1

(43.5 )

(30.4 )

(4.3 )

(21.7 )

(3.5)

(3.2)

(3.3)

(21.7 )

(43.5 )

(34.8 )

(21.7 )

(47.8 )

(17.4 )

(8.7 )

(4.3 )

70

14

17

15

2

2.6

4.2

5.8

20

56

29

13

22

57

28

11

(59.3 )

(11.9 )

(14.4 )

(12.7 )

(1.7 )

(6.8)

(2.8)

(2.8)

(16.9 )

(47.5 )

(24.6 )

(11.0 )

(18.6 )

(48.3 )

(23.7 )

(9.3 )

333

109

84

71

57

2.7

5.5

6.3

77

297

172

105

13

129

263

172

105

13

(

(

(

(

(

(4

(2

(1

(1

(3

(2

(1

12.2

(4.9)

15.1 (6.7)

13.8 (4.9)

15.5

118

84.6

33.4

11.1

16.5

27.4

33.1

11.1

2.2

3.2

(5.4)

(4.4)

(2.7)

(2.7)

(11.4)

(3.4)

(4.7)

(9.1)

(0.9)

(0.9)

114.4

81.0

33.4

10.7

24.1

27.9

32.8

14.1

2.3

3.2

(6.7)

(5.4)

(2.0)

(2.6)

(10.9)

(2.3)

(4.9)

(12.0)

(1.0)

(1.1)

115.4

81.8

33.9

11.1

22.5

28.3

33.2

11.4

2.3

3.0

(4.7)

(4.4)

(1.5)

(2.6)

(12.2)

(2.5)

(4.9)

(10.3)

(1.0)

(0.9)

99.0

69.0

30.2

7.8

32.4

25.5

31.6

13.6

2.4

2.8

(2

(1

(1

(1

Note.BLUEDD=both lower- and upper-extremify dressing ditti cuity ; LEODD=lower-exfremity-only dressing difficuify; NDD= nodressing diffic ulty; UEOD

upper-extremify-oniy dressing difficuity.

*Significance