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OBJECTIVE. Dressing is an important activity of daiiy liying, yet many oider adults haye difficuity due to
impairments. The purpose of this study was to expiore the use of assistive devices for dressing by oider persons with impairments, and to iook at ditterences among fraii eiders with no dressing difficuity, upperextremity-oniy dressing difficulty, lower-extremity-oniy dressing difficuity, and both upper- and iower-extremity dressing difficuity.
M E T H O D . We conducted in-home interviews and functionai assessments with 1,101 eideriy persons with
actiyities of daiiy iiving and/or instrumentai actiyities of daiiy iivihg limitations in Western New Yori< and
Northern Fiorida, Participants were assigned to one of four groups based on Functionai Independence
Measure item scores for upper-extremity dressing and iower-extremity dressing. Descriptive statistics were
used to report resuits,
RESULTS. Compared to women, there were reiativeiy more men with iower-extremity dressing difficuity than
with upper-extremity dressing ditficuity. The group with both upper- and iower-extremity dressing ditficulty
reported the highest ievei ot pain and scored iowest on aii measures ot tunctionai status and mental status. The
most commoniy used dressing devices were associated with iower-exiremity dressing.
CONCLUSION. There are ditterences in gender, heaith status, functionai status, and mental status among
eideriy persons grouped by upper- or lower-extremity dressing difficuity. Resuits suggest that therapists should
consider such differences as gender and type of difficuity (upper- or lower-extremity dressing) in both therapeutic approaches and recommendations tor assistive devices. Pain is another important consideration, but it
can often be reduced during dressing by using assistive devices.
Mann, W. C, Kimble, C, Justiss, M. D., Casson, E., Tomita, M., & Wu, S. S. (2005). Problems with dressing in the trail
elderly. American Journal of Occupational Therapy. 59, 398-408.
398
n 1996, tbere were 33.9 million people in tbe United States more tban 65 years
of age (Administration on Aging, 1996), and by 2020, tbis group will increase to
53.2 million (Sigel, 1996). Tbe "oldest-old" elderly persons, tbose more tban 85
years of age, are tbe fastest growing segment of tbe population, and tbis will accelerate witb tbe baby boom generation now reacbing 65 years of age (Sigel, 1996).
In 2000, 35% of elderly persons reported limitations in activity (Centers for
Disease Control and Prevention, 2003). Sixteen percent of persons more tban 85
years of age bave difficulty witb dressing and 11% require belp (Hobbs & Damon,
1996). Assistive devices are available tbat can be used for dressing; bowever, we
know relatively little about tbe use of assistive devices for dressing by elderly persons witb functional limitations. We do know tbat overall, assistive device use bas
been increasing wbereas use of personal assistance is declining (Mantn, Corder,
& Stallard, 1993). We also know tbat people who use assistive devices report less
unmet need relative to tbeir personal care (Agree & Freedman, 2003). Tbe purpose of tbis study was to explore tbe use of assistive devices for dressing by homebased elderly persons with functional limitations.
Literature Review
Ability to complete activities of daily living (ADL) independently can affect one's
sense of well-being. Krach, DeVaney, DeTurk, and Zink (1996) examined six
Number 4
formed by others, (2) perception of lack of need, (3) equipment failure or loss, and (4) equipment too "cumbersome"
(Gitlin et al., 1993). In a related study, Githn, Scbemmm,
and Landsberg (1996) found tbat o 642 devices provided
to 86 rebabilitation in-patients, 50 percent were used frequently to always in the fitst 3 months following discharge.
These studies illustrate the importance of assistive devices
for dressing, but do not specifically examine differences in
upper- and lower-extremity dressing difficulties, as in the
present study.
Other studies have also addressed use of assistive
devices for dressing, de Klerk, Huijsman, and McDonnell
(1997) identified variables related to the use of assistive
devices in a study of 498 single, independent-living elderly
persons (mean age 81 years). Aids for ADL (such as buttonbooks, raised beds) were used by 73.5% of tbe sample.
Tbe most frequently used dressing aid was the long-handled shoehorn with 10% of subjects using this device.
Women and those living in small or sheltered housing used
more assistive devices. Elderly persons who received home
care used more devices than those not receiving home care.
The investigators postulated that caregivers provide informal training and stimulate their care recipients to use more
assistive devices. No significant relationship was found
between educational level and the use of assistive devices.
Subjects witb bigber income used fewer devices than those
with lower incomes. Use and number of assistive devices
used for basic ADL activities wete positively correlated with
having chronic illness (de Klerk et al.).
The importance of dressing devices was also identified
in a study of hospital patients' concetns, petceptions, and
beliefs regarding assistive devices (Gitlin, Luborsky, &
Schemm, 1998), with a sample of 103 stroke patients who
wete receiving rehabilitation. Devices were categorized as
addressing mobility, dressing, feeding, seating, and bathing.
Mobility devices generated the most comments, followed
by dressing devices. Dressing devices received a proportionately larger number of positive comments compared to tbe
other device types. User satisfaction and dissatisfaction were
studied in more detail in the present study.
The use of "technical aids," including assistive devices
for dressing, was studied in a sample of 57 subjects more
than 74 years of age who reportedly had difficulties performing ADL (Parker o Thorslund, 1991). Four hundred
twenty-two technical aids (7.4 per person) were found in
the subjects' homes, of which 75% were being used. Aids
for personal hygiene (raised toilet seats, bathtub bencbes,
and dtessing aids) composed 20% of the aids. Subjects wbo
reported diBculties in dressing, eating, and transfers were
the least likely to have aids for these limitations. When
dressing, subjects relied on personal assistance, adapted the
399
Methods
Sample
This report is based on the Rehabilitation Engineering
Research Center (RERC) on Aging Consumer Assessments
Study (CAS), a longitudinal study of the coping strategies
of elderly persons with disabilities. From 1991 to 2001, 26
senior service agencies and hospital rehabilitation programs
referred individuals they currently served, or in the case of
hospital rehabilitation programs, individuals discharged
home, to the CAS. A comparison of the sample with the
Federal Interagency Forum on Aging-Related Statistics
(2000) demonstrated that the resemblance of the subjects
to the national population of elderly persons was very close
for race and living status. However, compared to the statistics of the U.S. Census Bureau (2000), the subjects were
older and a larger proportion of them were women. This
sample further closely resembled the approximately 20 percent of the elderly population who has difficulty with at
least one ADL or instrumental activities of daily living
(IADL) (Administration on Aging, 2004).
The CAS was initiated in Western New York (WNY)
where 790 elderly persons were interviewed. In the final
two years, the CAS was replicated with 311 study subjects
in Northern Florida (NFl). For the present report, we combined initial interviews of the NFl and WNY samples and
grouped study participants based on Functional
Independence Measure(tm) (FIM(tm)) dressing scores.
We grouped study participants based on the two FIM
dressing item scores (upper-extremity dressing and lowerextremity dressing items). FIM item scores range from 1
through 7 and each score is defined; for example 7 =
"Complete Independence," 3 = "Moderate Assistance," and
1 = "Complete Dependence." Croups were defined as follows: (1) NDDNo Dressing DifficulryFIM lower- and
upper-dressing item scores equal to 7 ( = 295); (2)
UEODDUpper-Extremity-Only Dressing Difficulty
lower-extremity FIM item score equals 7 but upper-extremity FIM item score less than 7 {n = 23); (3) LEODD
Lower-Extremity-Only Dressing
Difficultyupperextremity FIM item score equals 7 but lower-extremity
FIM item score less than 7 ( = 118); (4) BLUEDDBoth
Lower- and Upper-Extremity Dressing Difficultyboth
upper-extremity and lower-extremity FIM item scores
below 7 {n = 665).
Demographic information for study participants is presented in Table 1, broken down by group assignment. The
following information is for the entire sample {N = 1 JOl).
Participants ranged from 60 to 106 years of age, with a
mean age of 75.3 years (8.3). Eight hundred one of these
study parricipants (72.8%) were female, and 80.2% were
tulv/Atiai/Kt
", Number 4
Table 1. Demographic Information for Elderly Persons With Problems DressingNew York and Florida Population Year 1
NDD
UEODD
(n = 295)
% or x(SD)
(/7=23)
% or x(SD)
75.8
77.4
229 (77.9%)
65 (22.1%)
20 (87.0%)
3 (13.0%)
85 (72.0%)
33 (28.0%)
467 (70.2%)
197 (29.7%)
801 (72.8%)
298 (27.2%)
Race (A/=1,096)
Black
White
Hispanic
Asian
Other
41
249
2
1
1
6 (26.1%)
17 (73.9%)
23 (19.5%)
94 (79.7%)
132 (20.0%)
523 (79.1%)
3 (0.5%)
(0.5%)
202 (18.4%)
883 (80.6%)
5 (0.5%)
2 (0.2%)
4 (0.4%)
60 (20.5%)
110 (37.5%)
65 (22.2%)
29 (9.9%)
21 (7.2%)
8 (2.7%)
7
6
6
4
(30.4%)
(26.1%)
(26.1%)
(17.4%)
34
36
28
12
8
(28.8%)
(30.5%)
(23.7%)
(10.2%)
(6.8%)
169 (25.5%)
253 (38.0%)
143 (21.5%)
54 (8.1%)
24 (3.6%)
13 (2.0%)
270 (24.6%)
405 (36.9%)
242 (22.0%)
99 (9.0%)
53 (4.8%)
21 (1.9%)
90 (30.6%)
150 (51.0%)
32 (10.9%)
19 (6.5%)
3 (1.0%)
5
12
4
2
(21.7%)
(52.2%)
(17.4%)
( 8.7%)
34 (28.8%)
58 (49.2%)
12 (10.2%)
10 (8.5%)
3 (2.5%)
216 (32.5%)
315 (47.4%)
66 (9.9%)
57 (8.6%)
11 (1.7%)
345 (31.4%)
535 (48.7%)
114 (10.4%)
88 (8.0%)
17 (1.5%)
170 (57.8%)
124 (42.2%)
15 (65.2%)
8 (34.8%)
66 (55.9%)
52 (44.1%)
338 (50.8%)
324 (48.7%)
589 (53.7%)
508 (46.3%)
155 (52.7%)
124 (42.2%)
15 (5.1%)
15 (65.2%)
8 (34.8%)
65 (55.1%)
48 (40.7%)
5 (4.2%)
359 (54.0%)
247 (37.1%)
59 (8.9%)
594 (54.1%)
427 (38.8%)
79 (7.2%)
111 (42.5%)
80 (30.7%)
30 (11.5%)
24 (9.2%)
16 (6.1%)
10 (50.0%)
8 (40.0%)
48 (46.2%)
36 (34.6%)
10 (9.6%)
4 (3.8%)
6 (5.8%)
287 (48.2%)
176 (29.5%)
65 (10.9%)
32 (5.4%)
36 (6.0%)
456 (46.5%)
300 (30.6%)
105 (10.7%)
61 (6.2%)
59 (6.0%)
(8.3)
(13.9%)
(84.7%)
(0.7%)
(0.3%)
(0.3%)
(7.2)
LEODD
BLUEDD
Ail Participants
% or x(SD)
(n=665)
%orx(SD)
/V=1,101
% or x(SD)
75.3
75.2
74.4
(8.2)
(8.5)
1 (0.8%)
3
1 (5.0%)
1 (5.0%)
(8.3)
Wofe. BLEDD = hoth iower- and upper-extremity dressing difficuity; LEODD = lower-extremity-only dressing difficuity; NDD = no dressing ditticuity; UEODD =
upper-extremity-only dressing difficuity.
*p<.05
Instruments
The CAS uses a battery of instruments to measure multiple
dimensions including instruments developed by other
investigators, and instruments developed to meet the
unique requirements of this study. The Consumer
401
Table
2.
and Mental
Health
Number of MD visits past 6 montiis
Number of sick days pasf 6 monfhs* (N = 1,081 )
None
Less than a week
1 week-1 month
1 month-3 monfhs
4 months-6 months
UEODD
LEODD
BLUEDD
(/7 = 295)
% or x(SD)
(n = 23)
% orx(SD)
(n=118)
% or x(SD)
(/7 = 665)
% or x(SD)
5.3
5.0
(6.1)
5.8
70
14
17
15
2
(59.3%)
(11.9%)
(14.4%)
(12.7%)
(1.7%)
333
109
84
71
57
(50.9%)
(16.7%)
(12.8%)
(10.9%)
(8.7%)
2.6
4.2
5.8
(6.8)
(2.8)
(2.8)
2.7
5.5
6.3
(9.1)
(3.9)
(3.0)
5.7
(5.5)
170
36
35
36
9
(59.4%)
(12.6%)
(12.2%)
(12.6%)
(3.1%)
(3.6)
10 (43.5%)
7 (30.4%)
1 (4.3%)
5 (21.7%)
1.4
5.0
7.2
(3.5)
(3.2)
(3.3)
(6.0)
2.4
5.7
6.2
(7.1)
(3.7)
(3.5)
44
130
67
47
6
(15.0%)
(44.2%)
(22.8%)
(16.0%)
(2.0%)
5 (21.7%)
10 (43.5%)
8 (34.8%)
20
56
29
13
(16.9%)
(47.5%)
(24.6%)
(11.0%)
77
297
172
105
13
(11.6%)
(44.7%)
(25.9%)
(15.8%)
(2.0%)
59
107
72
44
9
(20.3%)
(36.8%)
(24.7%)
(15.1%)
(3.1%)
5 (21.7%)
11 (47.8%)
4 (17.4%)
2 (8.7%)
1 (4.3%)
22 (18.6%)
57 (48.3%)
28 (23.7%)
11 (9.3%)
129
263
172
105
13
(19.4%)
(39.6%)
(25.9%)
(13.7%)
(1.4%)
12.2 ( 4 . 9 )
15.5
(7.8)
Functional Status
FIMTotai (18-126)***
FIM Motor***
FiiVl Cognition***
IADL-OARS(0-14)***
SiP (0-100)***
118 (5.4)
84.6 (4.4)
33.4 (2.7)
11.1 (2.7)
16.5 (11.4)
27.4
33.1
11.1
2.2
3.2
(3.4)
(4.7)
(9.1)
(0.9)
(0.9)
15.1
(6.7)
13.8
(4.9)
114.4 (6.7)
81.0 (5.4)
33.4 (2.0)
10.7 (2.6)
24.1 (10.9)
115.4 (4.7)
81.8 (4.4)
33.9 (1.5)
11.1 (2.6)
22.5 (12.2)
99.0 (21.5)
69.0 (16.5)
30.2 (7.5)
7.8 (4.1)
32.4 (14.9)
27.9 (2.3)
32.8 (4.9)
14.1 (12.0)
2.3 (1.0)
3.2 (1.1)
28.3 (2.5)
33.2 (4.9)
11.4 (10.3)
2.3 (1.0)
3.0 (0.9)
25.5 (6.8)
31.6 (5.2)
13.6 (10.8)
2.4 (0.9)
2.8 (1.0)
Note. BLUEDD = both lower- and upper-extremify dressing ditticuity; LEODD = lower-exfremity-only dressing difficuify; NDD = no dressing difficulty; UEODD =
upper-extremify-oniy dressing difficuity.
*Significance < .05, **Significance < .01, ***Signiticance < .001
NDD
(n = 295)
UEODD
(/7=23)
LEODD
(n=^^8)
BLUEDD
(/i = 665)
Cardiovascular Disease
203 (68.8%)
21 (91.3%)
93 (78.8%)
515 (77.4%)
Arthritis
193 (65.4%)
19 (82.6%)
91 (77.1%)
477 (71.7%)
91 (30.8%)
10 (43.5%)
42 (35.6%)
201 (30.2%)
145 (49.1%)
12 (52.2%)
56 (47.5%)
310 (46.6%)
Hearing impairment
252 (85.4%)
7 (30.4%)
31 (26.3%)
169 (25.4%)
77 (28.0%)
5 (21.7%)
29 (24.6%)
196 (29.5%)
Respiratory Disorders
68 (23.1%)
4 (17.4%)
24 (20.3%)
141 (21.2%)
61 (20.7%)
8 (34.8%)
26 (22.0%)
129 (19.4%)
Diabetes
52 (17.6%)
8 (34.8%)
24 (20.3%)
153 (23.0%)
Cerebrovascuiar accident
29
4 (17.4%)
12 (10.2%)
149 (22^4%)
(9.8%)
Note. BLUEDD = both iower- and upper-extremity dressing difficulty; LEODD = iower-extremity-only dressing difficulty; NDD = no dressing difficuify; UEODD =
upper-extremity-oniy dressing difficulty.
402
Number 4
ming together the scores on the 7 items from the IADL section of the OARS (Fillenbaum, 1988). The 7 items ask
whether or not the study participant can use the telephone,
get to places out of walking distance, go shopping, prepare
meals, do housework, take medicine, and handle money.
Responses are scored: 2 = without help, 1 = some help, 0 =
completely unable or no answer. The IADL score can range
from 14, totally independent, to 0, totally dependent.
Reliability on the IADL section of the OARS was found to
be high (Fillenbaum & Smyer, 1981).
The SIPPhysical Dysfunction Section, was used to
determine percent of physical disability for study participants (Gilson, Gilson, & Bergner, 1975). Three sections of
the SIP (Body Care and Movement, Mobility, and
Ambulation) bave a total of 45 separate items tbat are used
to calculate the percent of physical disability score.
Testretest reliability of tbe SIP is reported as high (Bergner,
Bobbitt, & Carter, 1981).
The FIM was developed as an instrument to determine
the severity of disability (Center for Functional Assessment
Research, 1990). The FIM consists of 18 items, each with a
maximum score of 7, and a minimum score of 1. Thus, tbe
highest possible total score is 126, and the lowest, 18. Each
level of scoring (1 through 7) is defined; for example, 7 =
"Complete Independence," 3 = "Moderate Assistance." Tbe
FIM measures the following areas: Self-Care, Sphincter
Control, Transfers, Locomotion, Communication, and
Social Cognition. The FIM has been found to be reliable
DliVlENSiON
DEVELOPED BY
1.0ARS
2. RERO-Aging Demographic Survey
1. *Duke university
2. **RERC-Aging
Health Status
Physical Heaith
Pain
OARS
Functionai Status index-iVlodified
Duke University
A. Jette
impairment Status
Vision and Hearing
Cognition
iVlotor
OARS
Mini-Mentai Status Examination
Sickness impact Protiie
Duke university
iVi. Foistein, S. Folstein, R iVIcHugh
B. Giison et ai.
Functional Status
instrumentai Activities of Daiiy Living
Functionai independence
OARS
FiM
Duke University
C. Granger
Psychosociai Status
Depression
Seit-Esteem
L. Radioft
R. Rosenberg
Assistive Technoiogy
RERC-Aging
Home Environment
RERO-Aging
Demographic intormation
The Ame"/-
'The
403
Data Collection
For the CAS, nurse or occupational therapist interviewers
collected all data in face-to-face interviews in study participants' homes. Interview time averaged about 2.5 hours.
Appointments were scheduled at times convenient for study
participants to ensure that they would be rested, comfortable, and not feel rushed.
Statistical Analysis
We compared the four dressing groups on demographic
variables, health status, functional status, psychosocial status, and mental status using the Kruskal-Wallis tests
(Hollander &C Wolfe, 1999). To correct for multiple comparisons, we calculated permutation-adjusted p values for
each hypothesis. With this approach we measured the significance of each difference by comparing the observed
study restilt with those results derived from randomly
assigning 1,101 study participants to the four dressing
groups, taking the correlation structure between the
hypotheses into account (Westfall & Young, 1993).' We
chose the Fisher's combining function because it is the most
sensitive among different types of combinations oip values
according to Birnbaum (1954).
We adopted nonparametric methods with permutation-based/> values because they are more robust, adjust for
testing multiple outcomes, and have valid type-I error control even for unequal group sizes. However, for each dependent variable, we did not perform multiple pair-wise comparisons among the 4 dressing groups as one group was
significantly smaller than the other 3 groups {n = 23), and
thus limit our conclusions to differences among the 4
groups, rather than specific differences between any one
group and otbers. We report the descriptive findings for
each of the 4 groups to guide others in future research.
Results
Research Question 1
What are the differences among the four dressing difficulty groups in demographic characteristics, health status.
'Algorithm 4.1 in Westfall and Young was modified using Fishet's combining fijnction for^ values. Fitst, the individual unadjusted/) values/>,
- Pi- - PK ^re evaluated for the 7i'hypotheses based on the nonparametric tests. Then we randomly permuted the patients for B times
and calculated the corresponding/; values/)*,/)';, . . . , / ) * , for the b"'' permutation. Using the Fisher's combining fianction h(x^, x,, . . . , x ) =
- 2 2 - ^ 1 log(x ), the /) value for the combining statistic is estimated as
A,, = Yf^.JWp'',,
is the indicator function. Finally, the adjusted/) value fot the ;''' hypothesis is given \yy pf = n^ax p^^. The Westfall and Young's original algorithm corresponds to the Tippett combining function for tests, h{x , x,,
. . . , X, ) = min(.V|, X,, . . . , x^).
Number 4
# Ovi/ned
#Used
# Satisfied
127
83
58
24
18
15
15
14
14
10
6
3
2
2
2
1
1
1
1
97
42
45
15
18
13
13
13
7
10
115
68
55
20
17
14
13
13
12
9
6
3
2
2
1
1
1
1
1
CJl
3
1
2
2
1
1
1
1
*Sfudy participant modifications of household items used for dressing inciuded a broom handie with a nail as a dressing stick, a bent coat hanger for a
sfocking aid, and piiers used as a zipper puli.
Discussion
This is the largest in-depth study of home-based elderly persons with dressing difficulties. We looked closely at three
groups of elderly persons with either or both lower- or
upper-extremity dressing difficulty, and a fourth group of
elderly persons who had difficulty with at least one other
ADL, but who had no difficult)? with dressing. We discuss
the results relative to demographic variables, health status,
fianctional status, psychosocial and mental status, and
device use and satisfaction.
Demograpiiics
Researcii Question 2
What types of dressing devices are most commonly used?
Table 5 lists the number of devices owned and used,
and the number with which study participants were satisfied. Shoe horns were the most common device, followed
by sock aides, dressing sticks, button aides. Velero shoes,
and adapted clothing.
Researcii Question 3
What are the reasons for dissatisfaction or non-use of dressing devices?
The largest percentage of responses for not satisfied ot
non-use related to a perception that the device was not
needed (65.1% of all responses). This was followed by "does
not work well" (16.3%) and "too difficult to use" (12.8%).
The AmericaiLJui
nl n-f
Orrutt/ltinn/iJ
Frequency
Percent of Responses
56
14
11
2
2
1
65.1%
16.3%
12.8%
2.3%
2.3%
1.2% ^m
older men may have difficulty with lower-extremity dressing, therapists should make certain to address lowerextremity dressing in their assessments of older men.
Heaitti Status
We found an overall high number of medications taken,
which is a reflection of the participants in the sample: older
persons with ADL and IADL difficulties. Even those study
participants who were not having difficulty with dressing
(and were taking a somewhat higher number of medications) were baving difficulty with at least one other ADL or
IADL. The results for health status differences among the
four study groups were somewhat surprising. We did not
expect participants in the NDD group to use more medications than the other groups. All groups were taking more
than four medications, but tbe NDD group participants
were taking one and one-half more medications, on average, than the LEODD group participants. However, the
NDD group participants did have fewer sick days in the
past 6 months, and reported the lowest level of pain. The
group participants with BLUEDD reported the highest
level of pain, which could be a major factor in the difficulties they were having with dressing tasks. Review of medications to determine use of pain relievers, and referral to the
family physician to address the pain issue could be an
important role for a therapist working with patients with
dressing difficulty and pain.
Functionai Status
As expected, study group participants with BLUEDD also
scored lowest on other measures of functional status,
including the IADL scale and the SIP Difficulty with completing dressing tasks is highly correlated with other ADL
and IADL. Measurement of dressing represents 2 of 18
items on the FIM. Therefore, it is not surprising that dressing difficulty status for our study participants should be
correlated with the total FIM score. For therapists, these
results suggest that if someone is having difficulty with
dressing, they are likely to be having difficulty with one or
more other ADL or IADL.
Psyciiosociai and Mentai Status
Study participants in the group with BLUEDD scored
lower than participants in the other groups on the MMSE.
Study participants with significant cognitive impairment
typically require assistance with dressing. We know from a
previous CAS analysis of study participants with cognitive
impairment but no other impairments, that the amount of
human assistance required with dressing is related to
MMSE score (Mann, 2001). In a study of the use of bebavioral approacbes to improve ADL performance witb nurs406
Limitations
Although the total sample size was large (A'^= 1,101), one
group, the UEODD group, was disproportionately small,
with only 23 subjects. Although we can generalize regarding differences on study variables among all four groups, we
have been careful to state tbat the differences among specific groups are limited to our study participants, and these
differences can not be generalized.
Reievance to Occupationai Therapy
Dressing is an important activity of daily living. In assessing
older adults' ADL performance, occupational therapists
should consider all aspects of both upper- and lowerextremity dressing. Many older persons adopt alternative
approaches to dressing, such as wearing slippers instead of
shoes, because they cannot don socks and shoes. This can in
turn lead to a decrease in their mobility, sucb as not leaving
the house. Yet, there are assistive devices and special clothing, including shoes and socks, that can make dressing easier. Therapists can recommend approaches, such as sitting
down while dressing, and assistive devices to make virtually
all dressing tasks easier. Therapists can review the range of
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