Understanding challenges in the home environment and technology preferences for home assessments and modifications among older adults undergoing joint replacement surgery: A qualitative feasibility study
Event Type
Poster Presentation
TimeThursday, April 152:40pm - 2:42pm EDT
LocationDigital Health
DescriptionBackground: Most older adults prefer to age in place. However, the majority of homes are not designed to support the needs of older adults, especially those with chronic illnesses and mobility issues. Older adults undergoing joint replacement surgeries such as a total knee arthroplasty (TKA) or total hip arthroplasty (THA) will likely experience significant challenges navigating their home environment and performing daily activities. While several studies examine home environments for the safety of the generic aging population or those with cognitive impairments , it is paramount to identify environmental barriers and different types of modification strategies that can specifically support TKA/THA population and ensure comfortable and safe transition to their homes following surgery.

Modifications done prior to surgery could facilitate a safer transition to home from the hospital and prevent falls and injuries. There are several existing tools to assess home environments for older adults. In the past decade, there has been a shift from paper-based home assessment tools to technology-based tools. Most of these assessment tools involve the use of complex technology like virtual reality or robot-assisted photography that are designed to be used by occupational therapists. The acceptance and uptake of simple technology such as phone apps for conducting these assessments proactively by the older adults themselves has not been explored.

Purpose: The broader intent of this study is to develop a framework for a technology-based home assessment tool and to understand the feasibility of such tool prior to investing time and money in its actual development. A qualitative exploratory study was set up as a collaboration between Clemson University and Prisma Health-Upstate to -
(a) explore home environmental challenges experienced by older adults undergoing total hip and knee arthroplasty that could inform the development of a technology-based proactive home assessment tool for these adults
(b) understand the acceptance for a technology-based intervention to support home assessments among these older adults.

Methodology: Semi-structured interviews were conducted with 22 patient-care partner dyads before and after joint replacement surgery. Interviews focused on understanding patient and care partner perspectives around challenges anticipated pre-surgery and actual challenges faced with navigating their home environment post-surgery. In addition, the technology acceptance model was used as a basis to understand the perceived usefulness, intention to use technology-based home assessment tools as well as perceived barriers and facilitators to actual use of the tool for conducting proactive home assessments. The interviews were transcribed verbatim and analyzed in Atlas.ti using a combined approach of theory driven and open coding.

Home environment challenges. Modifications made by participants prior to surgery ranged from easy fixes like installing grab bars to the toilet and shower area, installing elevated toilet seats, removing rugs and reorganizing toiletries, clothes and cleaning supplies for ease of access to high-cost structural changes like remodeling critical spaces. Several patients underestimated the challenges they would face after surgery. Patients identified a range of challenges with their home environments specific to TKA/THA patients like the difficulty of lying in bed or getting in and out of bed or chair, bathroom showers and layout and placement of fixtures in the bathroom only post-surgery. Participants coped with these barriers through behavioral change, social support or environmental modifications.

Technology-based tool to support home assessments. Most patients and their care partners agreed on the importance of conducting proactive home assessments to address specific challenges prior to surgery. Most participants perceived the idea of a technology-based home assessment tool to be useful. Participants who were not comfortable with technology also expressed willingness to learn the use of an app from their family or friends. A comparison of responses between pre- and post-surgery interviews revealed that around 50% of the participants showed increased intentions of using an assessment tool after experiencing the challenges in their homes post-surgery. None of the participants reported reduced intentions of using the tool post-surgery. Study participants provided recommendations for key content and potential features to include in the tool as well as preferred formats like checklists, visuals and videos. Participants preferred the tool to be embedded within a healthcare portal to mitigate concerns about liability and privacy related to use of this tool.

Conclusions: Pre-surgery patient-initiated home assessment could be extremely helpful in educating patients and care partners about potential modification to their home to make their transitions post-surgery easier and safer. Technology based home assessment tools should be simple, intuitive, easy to use and should address considerations around privacy and sharing of information.