The proportion of older Hispanics who have disabilities and are living independently in Puerto Rico is substantially higher than older adults from any other race and ethnicity living in the United States. Loss of function in old age eventually leads to institutionalization and early death. Use of assistive technology (AT) is an important strategy to manage disabilities, increase independence, and ensure the safety of older adults. Despite evidence that older Hispanics experience more functional disabilities throughout their later life, they are among the least likely to use and access AT devices. Barriers to AT use among people with a variety of disabilities have been studied, which include the cost of AT, lack of AT awareness/information, limited availability of providers, stigma, and lack of perceived need. However, it is unknown how gender inequalities among the multilevel factors that influence AT use could be reflected upon gender differences in the adoption and use of AT. The main objectives of the proposed study are to: 1) identify functional disabilities that can be mitigated by AT among community-living Hispanics, 65 years and older, with functional disabilities; 2) compare functional disability types (i.e., personal care activities, daily living activities, and functional mobility) between men and women; and 3) understand the multilevel factors (i.e., person, environment, technology, activities, access to and control over resources, bargaining positions, and gender norms) that result in barriers and facilitators to using AT. To meet these aims, this project interdisciplinary team of researchers will first collect and analyze data obtained from the administration of both the PROMIS Physical Function Short Form and a socio-demographic questionnaire to 250 older Hispanics; then, follow with the collection and analysis of individual qualitative interviews (assisted by AT videos) from a sub-sample of 24 participants. Participants will be purposively recruited from a low-income community in Puerto Rico because they are the most likely to experience barriers to accessing health care and AT services. The researchers have incorporated a community-based organization and their community advisory board to collaborate in the implementation and interpretation of the results of this study. The expected outcome is to improve the understanding of gender differences in different types of disabilities as well as the differences in the barriers and facilitators for using different types of AT. The results of this mixed method study will lay the foundation for the subsequent design and testing of a culturally-competent, gender-sensitive intervention aimed at increasing AT device use by older Hispanics, thereby enhancing their daily function, quality of life, and opportunities for ageing in place. This goal supports the NINR mission to prevent disabilities and advance the health and quality of life of underserved minority populations.
The proposed revised R21 research will contribute fundamental new knowledge about the factors that influence the adoption and use of assistive technologies (AT) among older Hispanics living in a low-income community to compensate for their disabilities in daily life activities and how these factors differ by gender. This new knowledge will serve to identify effective strategies that will be incorporated in a culturally-competent AT self-management intervention to promote the adoption and use of AT to increase older Hispanics function, quality of life, and opportunities for aging in place. This is directly aligned with the NINR mission to develop interventions to reduce disabilities among older people.