7/25/2019 Problems With Dressing in the Frail Elderly
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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
7/25/2019 Problems With Dressing in the Frail Elderly
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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
5/12
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
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