1 Background

The population of elderly people is rising in every nation on earth. One in six individuals will be 60 or older by 2030. The population is ageing considerably more quickly than in the past. The number of persons in the globe who are 60 years or older will double by 2050. (2.1 billion). By 2050, it is anticipated that two-thirds of the world's population aged 60 and older will reside in low- and middle-income nations [1]. Population ageing was listed as one of the four global demographic “megatrends”—along with population growth, population ageing, international migration, and urbanization—with ongoing and long-lasting effects on sustainable development [2]. Older adults come to rely on their families due to the numerous health issues that come with ageing, including knee pain, impaired vision, hearing loss, and heart palpitations. Poor health, social isolation, physical and financial dependency, lack of sufficient income after retirement, loss of a spouse, and less structured time are all interconnected or dependent problems [3]. At the biological level, aging is caused by the build-up of numerous types of cellular and molecular damage over time. As a result, physical and mental abilities gradually deteriorate, and several complex health conditions known as geriatric syndromes appear as people age. This syndrome is often the result of various underlying issues, such as weakness, urine incontinence, falls, disorientation, and sores [1]. Several typical health issues among older people include common ailments that affect the elderly, including arthritis, hypertension, hearing loss, visual problems, diabetes, and varicose veins. These chronic conditions are more prevalent in women and tend to worsen as people age [4]. An older person’s quality of life and health status are more likely to decline rapidly. They are also more prone to fall if they cannot perform daily living activities, including cooking, eating, bathing, or climbing stairs.

Supportive tools used by elderly and people with disabilities to enhance their quality of life in terms of mobility, communication, and carrying out daily activities are called aids or assistive devices. According to the national trust [6], assistive devices are those that include self-help aids for use in daily activities like eating, showering, cooking, clothing, using the restroom, maintaining the home, etc. Some of these technologies are cutting-edge and digital, while others are simpler. Low technology is a technology that aims to be as easy as possible. Grab bars, grab rails, shower chairs, magnifying glasses, and automatic electrical gadgets such as kettles, automatic swing doors, and dressing sticks are included. Elderly people can use lever handles on doors and faucets, as well as walking sticks and pill organizers [7, 8]. Modified dining utensils, books, pencil holders, page-turners, dressing aids, and modified personal hygiene products are also examples. In contract, high technology refers to relatively recent technology that includes sophisticated features. Smart technologies, such as specialized Internet programs, may aid senior citizens in managing and understanding a range of medical issues [9]. Mobile phones can also help senior citizens increase their social support, cognitive function, and depression-reducing social interaction. In addition, the utilization of telecare and telehealth services in the management of chronic illnesses may reduce the need for hospitalization and allows for remote data exchange between a patient at home and healthcare professionals. Telecare also includes fall detection, personal alarm monitoring devices, and vibrating alarm clocks [10, 11].

By enabling the elderly and people with disabilities to carry out basic everyday tasks like bathing, climbing stairs, taking medications, and dressing, assistive and enabling technology improves their quality of life [12]. Increased mobility enhances physical, mental, and emotional health and quality of life. It also strengthens bones and muscles and may help persons with chronic illnesses avoid a quick decline in health [5]. The use of assistive technologies can help persons with disabilities or the elderly preserve their freedom, quality of life, and ability to pursue their vocations [13]. The concept of “active and successful aging”, which describes a state in which an elderly person can stay healthy and active, is one that assistive technologies promise and support [14]. However, not all older adults have access to the devices they need to improve their quality of life [15].

During later adulthood, ageing population face an increasing likelihood of developing limitations with daily activities, including their mobility activities and self-care. Among older adult community-dwellers, they experience at least of such limitation. Such limitation prevents older adults to stay connected with the society and their loved ones, thus, impacting the overall wellbeing of an older adults. Various research studies supported that the uses of assistive devices enable older adults to be less dependent towards others and promote inclusion and participation in the society. It helps ageing population to stay to live healthy and satisfying lives. Thus, the study was planned with an aim to assess the difficulties experienced by older adults when not using assistive devices and to study the relationship between age, sex, and problems experienced by older adults when not using assistive devices.

2 Methods

The present study was a descriptive and exploratory cross sectional study. Purposive Random Sampling technique was used to select the sample. The sample was selected from Lucknow, Uttar Pradesh, India. Out of the 110 wards of Lucknow city, 04 wards (Jankipuram, Shankar Purva, Keshari Khera, Sharda Nagar) were selected purposively and out of these Wards, 50 respondents each from Guddamba thana, Adil Nagar Kalyan Nagar, Kanwosi, South city were selectively from the selected wards respectively. The final sample comprised of 200 elderly people over the age of 60 years, including 110 males and 90 females. The study is based on primary data collected through a self-structured checklist based on the problems faced by them when they were not using assistive devices. The checklist was divided into different sections based on the difficulties experienced, such as mobility, vision, hearing, and communication problems. Each section asked participants to identify the problems they faced when they were not using assistive devices. Verbal consent was given by all the participants. Respondents were included if they were above 60 years and used any type of assistive devices. The elderly who has a chronic illness or are disabled/Clinical health-related problems were excluded from the final sample.

3 Tools and techniques

The questionnaire was divided into two sections, the first section collected information about socio-demographic characteristics of the respondent including age, qualification, occupation, income, marital status, etc. and the second part explored the difficulties experienced by elderly who used any type of assistive device when they were not using those devices.

3.1 Pretesting

To test the reliability and validity of the questionnaire and checklist, a pilot study was conducted separately among 30 older adults. Following the completion of the pilot research, the necessary revisions were made based on the respondents’ replies.

3.2 Statistical analysis

Frequency and percentage distribution were used to analyse the continuous and categorical variables. An Independent t-test was conducted to determine if there was a difference in self-reported difficulties between male and female respondents. ANOVA was used to compare difficulties experienced by the elderly across ages. A p < 0.01 value was considered highly significant. IBM Statistical Package for the Social Sciences (SPSS) 20.0 was used for statistical analysis.

4 Results

Table 1 represents the demographic distribution of respondents. Fifty-five percent of respondents were male and 45 percent were female. Data regarding age revealed that a significant proportion (41.5%) of the respondents were in the age group of 60 to 64 years, 24 percent respondents were found to belong to the age group of 65 to 69 years, while 20 percent respondents were in 70 years to 74 years of age and only 14 percent of the respondents were 75 years and above old. Data pertaining to the qualification of the elderly revealed that a significant proportion (40.5%) of the elderly were illiterate, and about 25.5 percent of the elderly were educated up to the secondary level, while 17 percent of them studied up to the primary level. However, 12 percent elderly were found to be graduates, and 5 percent had post-graduate degrees or above. Data further revealed that the majority (53.3%) of the illiterate respondents were found to be female and the majority of the higher-studied respondents were male.

Table 1 Distribution of respondents as per socio-demographic profile
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Further, data pertaining to the occupation of the elderly revealed that the majority (55%) of them were those elderly who were unemployed before they enter old age (not working), while 27 percent of the elderly were retired (those elderly who were employed in any services before entering old age) from services and 20 percent were in service, and only 8 percent were found to be self-employed. The data showed that the majority, 50 percent of respondents, reported that they did not have any source of income, so they were earning at all. Almost 19 percent elderly reported that their monthly income is Rs. 15,000–30,000, followed by 13 percent elderly whose monthly income was Rs. 5000–15,000, while 11 percent elderly reported that their monthly income was below Rs. 5000. However, 6 percent elderly have an income of Rs. 30,000–45,000 monthly.

Table 2 depicts the difficulties reported by respondents. We found that using communication devices, i.e., the computer, was the difficulty experienced by the majority (92%) of respondents, followed by unclear vision or presbyopia (91.5%). Seventy-seven percent responded that they faced difficulties using smartphones, followed by being unable to sit in squat to use the (Indian) toilet (64%). This type of toilet is used not by sitting but by squatting. Squat toilets come in a variety of forms, but at their core, they are all simply holes in the ground. Use of this style toilet was difficulty for older adults with severe arthritis or other mobility issues) [16]. A significant proportion of the respondents experienced mobility problems. Fifty-seven percent reported that they were unable to walk properly without any supportive assistive devices. Forty-four percent of respondents reported that they had difficulty hearing. Being unable to sit straight for a long time if not using any positioning devices, cushion chairs etc., was reported by thirty seven percent of respondents. We found that 53.5 percent reported of finding difficulty recalling remote memory, and 23.5 percent found difficulty in recalling a recent memory. Furthermore, it was also found that 11 percent of respondents were unable to open water tap (water faucet) at the bathroom for daily use, while 7 percent reported that they found difficulty in wearing clothes properly. Thus, the result indicated that the elderly who are not using any types of assistive devices were facing difficulties in their Daily Living Activities (ADL).

Table 2 Distribution of respondents based on difficulties experienced by elderly non-dependent on assistive devices (n = 200)
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Difficulties experienced by older adults when they were not using assistive devices by age is presented in Table 3. Older people faced more difficulties compared to the young old people. Those above 75 years old experienced more problems when not using assistive devices, followed by those 70–74 years, 65–69 years, and 60–64 years. All groups were statistically significant from each other (P < 0.05). Those over 75 years experienced more difficulties being able to walk properly without any mobility support, followed by those aged 70–74. Older adults ages 65–69 years experienced more difficulties walking than those 60–64 years. Similarly, those 75 years reported the most difficulty sitting straight for a long time, followed by those 70–74 years and those 65–69 years. The 60–64 year group faced little problem compared to other groups. The mean value of the group was (µ = 0.71 ± 0.46, 0.58 ± 0.49, 0.33 ± 0.47 and 0.16 ± 0.37) respectively. The older people who reported difficulty sitting for long periods of time reported they were suffering from spondylolisthesis or spinal problems that made it difficult for them to sit without support. Unclear vision was most often reported by those 75 years and older. They responded that they were facing age-related macular degeneration, near sighted or farsightedness, and presbyopia. People who were suffering from diseases like diabetes reported diabetes-related retinopathy and glaucoma. Similarly, nearly all respondents above 75 years (µ = 0.96 ± 0.18) reported hearing loss (Presbycusis), with rates decreasing by age. However, only persons above 70 years reported problems with dressing. Some seniors develop arthritis in their hand, experience symptoms from a stroke, a broken bone, back issues, or dementia and these can affect an elderly person's arms, arms, trunk or legs, making it difficult for them to perform fine motor tasks such as buttoning a shirt, buckling a belt or grabbing the ends of a sock and getting dressed or undressed etc. Difficulty recalling recent (short-term) and remote (long-term) memories was also more common with age with more people reporting difficulty with remote memories than recent memories at every age. As people grow older, they experience physiological changes that can cause impairment in brain function. Dementia is one of the most common diseases in the elderly, it can cause both short and long-term memory loss, especially in older adults. Alzheimer's disease, Lewy body dementia, Frontotemporal dementia, Vascular dementia are different types of dementia. Short-term memory loss can make it challenging to live alone without daily help for elderly.

Table 3 ANOVA of difficulties experienced by older adults when not using assistive devices by age group
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Further, only two groups of older adults, those aged above 75 years and 70–74 years, could not easily open the water tap at the bathroom for daily use. Similarly, older adults over 70 years reported the most difficulty using squat style (Indian) toilets.

After vison problems, difficulty using a smartphone and computer were those most highly endorsed items for all age groups with the vast majority of all respondents reporting difficulty in these areas.

The association between age and difficulty experienced by older adults when not using assistive devices was significant (χ2 = 186.986, p = 0.000**). This means that with increasing age older adults face more difficulty with activities and tasks of daily living.

The study was found that male and female respondents reported similar levels of difficulty doing these tasks. The t-test comparing the two groups was found to be non-significant (P = 0.445) at the level of 0.05 (Table 4).

Table 4 One-way independent t-test of difficulties experienced by older adults when not using assistive devices by gender
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Table 5 shows use of various assistive devices by respondents. The study found that 40 percent of elderly persons used walking sticks as mobility devices, while only 0.5 percent reported using a tricycle. Similarly, 41.5 percent reported using a special seat to sit, followed by cushions, and only 5 percent used a wedge seat to drive or sit for a long time. The majority, 77.5 percent, used eyeglasses, and 3.5 percent of the respondents used a magnifying lens to improve their sight. We found that 14 percent of older adults used of hearing aid, while only 8 percent of used headphones. No respondents reported using a hearing loop. Over a third of respondents reported using a commode seat in their daily living activities, while 9 percent used a shower seat/chair and toilet seat frame. Over 50 percent used a smart or simple cell phone and approximately 20 percent of the elderly reported using an extra loud phone and internet in the communication devices. Further, the study found that an equal proportion of respondents, 30 percent, were using dairies and calendar as cognitive devices, and only 8 percent used an alarm in their day-to-day lives.

Table 5 Distribution of assistive devices used
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Figure 1 represents the prevalence of assistive device use by elderly 60 years of age and older. The figure shows that 96 percent of the elderly used communication devices such as simple cell phone, video calls, internet, etc., followed by vision devices (81.5%). The majority, 75 percent, used positioning devices such as wedge seats, cushions, and special chairs, followed by cognitive devices 69.5% such as; dairies, calendars, and alarms, etc. Further, the data showed that 55 percent used devices to help with daily living (shower seat & shower chair, toilet seat frame, commode seat, bed rails, and dressing stick). Mobility devices like walking sticks, walker, wheelchair crutches, tricycle orthotic and prosthetics were also commonly used (50%). Over 20% of respondents used hearing devices such as hearing aids and headphones. The elderly who used assistive devices reported no problems or very few problems when using their device(s); they also reported better quality of life and improved well-being.

Fig. 1
figure 1

Represented general uses of assistive devices by elderly

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5 Discussion

The main focus of the analysis has been to confirm the difficulties faced by elderly assistive device users when they do not use those devices. It also presents the different assistive devices used by the elderly in their day to day lives.

Data reveals that elderly people experienced difficulty using communication devices, i.e., computers, and experienced vision difficulties, such as near and farsightedness when they were not using vision correction devices. The study is in line with the results of the study by McGregor and Chaparro who found that adults with low vision reported experiencing more difficulties with tasks related to stable acuity. Non-impaired older adults reported experiencing dynamic acuity and greater difficulty with illumination [17]. Further, another study reported that elderly persons frequently have trouble seeing adjacent things, which makes reading challenging. In order to make the necessary corrections and lessen the alarmingly high rates of blindness and visual impairment, access to the usage of eyeglasses and surgery is a crucial element in determining a person's quality of life [18]. Similarly, another study reported that the prevalence rate of non-refractive vision problems is significantly higher among older adults with a low to moderate household income, compared to the prevalence rate among older adults with a middle or higher household income [19]. Prior work has found that among older adults, sensory (vision and hearing) and cognitive impairments are very common and are linked to challenges in a number of areas, including social engagement, mood, communication, and functional competence [20].

Data further reveals that 64 percent of respondents experienced difficulty using the toilet; they reported that they had arthritis, sciatica, gout, and other bones or muscle-related problems, and more than half of the respondents reported\mobility problems. Another study showed that the percentage of people in residential care who have mobility issues (73.7%) was more than twice as high as the percentage of people who live independently [21]. In this way, older adults without assistance or mobility aids who find difficulty walking can also experience isolation, anxiety, and depression in this age [22]. However, other research has shown that older adults who used a cane or walker did not fret about falling more than those who did not use any devices [23]. Similar findings were made by Walsh et al. which revealed that elderly people had issues with mobility, cognitive functioning, and carrying out activities of daily life [21].

Hearing impairments are linked to poor self-rated health, problems with basic daily living activities (ADLs) including eating, bathing, and dressing as well as instrumental ADLs like using the phone and handling finances. They are also linked to memory problems, weakness, and falls [24]. The present study found that the elderly over 75 years of age were more likely to suffer from hearing difficulties than other age groups when they did not use assistive devices. The older adults in this study who had hearing problems also suffered from short-term and long-term memory problems. As reported in another study by Fisher et al. hearing loss and visual loss were both prevalent age-related problems [25]. Older persons who had hearing or visual loss, or both, were unable to recognise others or interact socially, especially in group settings [26].

The study showed that communication devices were used by the majority of the elderly. Vision, positioning, cognitive, daily living, and mobility devices were also used by the elderly. Other studies have also found that use of assistive devices by the elderly such as mobility devices, positioning devices and daily living devices were similarly prevalent [27].

6 Conclusion

The current study revealed that most elderly people faced problems when not using assistive devices in their day to day living. With increasing age, they faced problems related to mobility, vision, hearing, and using the toilet. Interestingly, this study did not find differences by gender with both men and women experiencing similar levels of difficulty when not using any types of supportive devices. Many older persons also face physical challenges when they do not use assistive devices. Utilizing an assistive device can increase the independent movement of the elderly, lessen disability, postpone functional decline, and minimize strain. The elderly people in this study used mobility devices, vision devices, communication devices, and daily living devices to enhance their quality of life, When not using these devices, they reported having problems with their mobility, near-sightedness and farsightedness, and hearing problems, that were causing them to be less socially connected.

7 Limitation of the study

The study was limited only to 200 residing in urban of Lucknow city. In this study, only a limited set of difficulties were studied and we assessed only the difficulties when not using an assistive device. In addition, health-related data, such as prevalence of hypertension, cardiac attack, dementia, diabetes, arthritis, etc., were not assessed in this study. Further, only common assistive devices that older adults may use their day-to-day life were asked about. Many of the advanced technology assistive devices are not included here.