Aging in Place: Young-Old Versus Old-Old Assistive Technology Decision-Making Processes

PURPOSE: In general, older adults make quicker decisions than younger adults, want fewer choices, and are generally more content with their decisions (Löckenhoff, 2017; Reed, Mikels, & Simon, 2008). There are also reported differences between the youngest older adults (60-75 years) and the oldest old or very old (80 and older). Oldest old adults are more accurate and attentive to positive stimuli than younger older adults. These changes are not explained by cognitive decline (Ruthig, Poltaviski & Petros, 2019). OT practitioners need to better understand how decision-making might change with age so they can communicate and offer options best suited to their clients. The differences in decision-making processes related to assistive technology (AT) for young-old and old-old adults has been underexplored. The purpose of the study was to develop a better understanding of the decision-making processes around assistive technology for young-old and old-old adults. The research question was: How do young-old and old-old adults differ in their decision-making regarding assistive technology?

DESIGN: This is phase two of constructivist grounded theory research that began in summer 2019 with initial interviews of seven community dwelling older adults. Initial findings from phase one supported existing literature (Peek et al., 2016) as the older adults relied on experts, preferred to delegate, and made quick, more emotional decisions. As part of the grounded theory process, researchers sought to further define and understand age-related differences in older adults’ decision-making processes using theoretical sampling from young-old (60-75) and old-old (80 and over) community dwelling older adults with some experience using assistive technology. Recruitment used snowball sampling starting with older adults known to the researchers.

METHOD: Paired teams of researchers conducted seven semi-structured interviews (four young-old and three old-old participants) via Google Meet or a face to face. Interviews were transcribed. Participants’ transcripts from phase one that met the age criteria (60-75 and 80+) were also included. Researchers used initial codes and categories from phase one research as a starting point and then developed additional codes and categories using consensus coding and constant comparative analysis of the transcripts and analytical memos to develop core categories and then a conceptual category related to all process categories.

FINDINGS: The main conceptual category, Making Life Better, was supported by common core categories: Reacting to Functional Change, Making Life Easier, and Changing with Age. Older adult participants regardless of age sought decisions designed to make life their lives better. In seeking to make life better, participants made choices that made life easier and enabled them to react to functional change. For decision-making processes that changed with advancing age, old-old participants preferred narrowed options, sought less information, were less likely to keep up with new technology, and tended to live in the moment. In conflict to findings from Chen and Chan (2011), both age groups chose quality and functional gain over cost.

CONCLUSION: Older adults regardless of age made assistive technology-related decisions based on whether the tool was seen to improve their quality of life. Limiting options and letting go of the need to keep up with technology were preferred age-based strategies from the old-old group. By understanding the decision-making process in AT among young-old and old-old adults, occupational therapy (OT) practitioners and those in other disciplines can enhance services to promote aging in place and provide a more client-centered approach for assistive technology recommendations.

References

Löckenhoff, C. (2017). Aging and decision-making: A conceptual framework for future research - a mini-review. Gerontology, 64, 140-148. https://doi.org/10.1159/000485247

Reed, A., Mikels, J., & Simon, K. (2008). Older adults prefer less choice than young adults. Psychology and Aging, 23(3), 671-671. https://doi.org/10.1037/a0012772

Ruthig, J., Poltavski, D., & Petros, T. (2019). Examining positivity effect and working memory in young-old and very old adults using EEG-derived cognitive state metrics. Research on Aging, 41(10), 1014-1035. https://doi.org/10.1177/0164027519865310

Chen, K., & Chan, A. H. S. (2011). A review of technology acceptance by older adults. Gerontechnology, 10(1), 1-12. https://doi.org/10.4017/gt.2011.10.01.006.00