Thursday, June 13, 2013
Challenges for Disability Populations
The population I have chosen for this discussion is older adults with early signs of dementia. Older adults are a vulnerable population in the best of circumstances. Health issues compromise their ability to continue to function autonomously in some cases. Cognition declines with age and some older adults become dependent to an extent on family members (Remley & Herlihy, 2010). This decline can have a tremendous affect on an individual's self esteem (Remley & Herlihy, 2010).
One challenge for this population is short-term memory (Prabhavalkar & Chintamaneni, 2010). Implementing any health education campaign must make use of the individuals' capacity to remember the information being taught. Duhaney and Duhaney (2000) made some interesting points about technology that might be appropriate for the older adult population. For example, if the goal was to help the individual take a new medication that was going to help them, timing devices with voice prompts could be implemented to remind the individual that it is time to take medication or that it is time to eat lunch.
When the goal is to help or guide older adults, it is important to validate and support the idea that they can continue to be valued mmbers of society (Pruchno, 2001). Feeling that they can contribute affects their level of self-esteem and self-efficacy, both of which have a significant effect on longevity, illness, and disease (McGuire et al., 2008). Perhaps the most intriguing element of implementing technology for individuals with disabilities is how it can enhance self-image (Duhaney & Duhaney, 2000). In older adults, this may be especially salient because this population suffers a psychologically excruciating loss of cognition, which can cause embarrassment and a decrease in self-efficacy and self-esteem (McGuire, Klein, & Chen, 2008).
Another challenge to implementing a health behavior in this population is their lack of health literacy and lack of motivation to introduce a new routine. Rollnick, Miller, and Butler (2008) found that when the goal is to initiate change in an individual, the initial motivation must be encouraged, but also it is critical to engage the individual in a commitment to change. The commitment to change provokes a change in the individual's perception of self-efficacy (Irby, Kaplan, Garner-Edwards, Kolbash & Skelton, 2010), which could have a significant effect on an older adult's overall ability and desire to instigate a behavior change.
Computer programs might be advantageous for this population because of the iterative nature of specially designed computer programs. For example, if my goal is to teach an older adult to not only take her medication, but to understand how important it is to take it, the daily use of a computer program could teach the individual why she must remember to take her meds. The program could slowly and iteratively work toward increasing health literacy and contribute specific information about the individual's chronic diseases and what kinds of symptoms to watch for. It could help her remember to take her medication and increase her understanding of why she must take it. The program could include some light-hearted and entertaining interactivity and would be engaging for an older adult, but ultimately would help to instigate behavior change. Of course, this could only work in a population of older adults who had computer access, or in an assisted living establishment that had computers for residents' use.
Duhaney, L. M. G., & Duhaney, D. C. (2000). Assistive technology: Meeting the needs of learners with disabilities. International Journal of Instructional Media, 27(4), 393–401.
Irby, M., Kaplan, S., Garner-Edwards, D., Kolbash, S., & Skelton, J. A. (2010). Motivational interviewing in a family-based pediatric obesity program: A case study. Families, Systems, & Health, 28(3), 236-246. doi:10.1037/a0020101
McGuire, S. L., Klein, D. A., & Chen, S. (2008). Ageism revisited: A study measuring ageism in East Tennessee, USA. Nursing & Health Sciences, 10(1), 11-16. doi: 10.1111/j.1442-2018.2007.00336.x
Prabhavalkar, K. S., & Chintamaneni, M. (2010). Diagnosis and treatment of mild cognitive impairment: A review. Journal of Pharmacy Research, 3(2), 388–392.
Pruchno, R. (2001). The Complex Nature of Ageism: What Is It? Who Does It? Who Perceives It? The Gerontologist, 41(5), 576-577. doi: 10.1093/geront/41.5.576
Purdie, N., & McCrindle, A. (2002). SELF-REGULATION, SELF-EFFICACY AND HEALTH BEHAVIOR CHANGE IN OLDER ADULTS. Educational Gerontology, 28(5), 379-400. doi:10.1080/03601270290081353
Remley, T. P., Jr., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill/Pearson Education.
Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care. New York, NY: Guilford Press.