Assistive devices for the elderly

Assistive technology is the umbrella term for assistive products together with the systems and services that deliver them. An assistive product is any product that maintains or improves functioning and independence — from a pair of spectacles to a powered wheelchair.

Assistive devices reduce activity and participation restriction, ranging from the simple and inexpensive to the technologically advanced, and help from carrying out ADLs to maintaining mobility and promoting continence.

Two cardinal cautions: “The provision of an aid is not always the best option for an impaired person, as it can foster dependence rather than independence”; and “Those in real need often do not avail themselves of even basic aids and appliances.” Both under-provision and over-provision are errors.

The golden rule of prescription: devices should be recommended only if they support improved participation in the activities identified as crucial to the elder and/or their family or support system. A device that does not serve a valued activity will be abandoned.

A prosthesis replaces a body part; an orthosis is applied to the external surface of the body to provide support, improve function, or restrict or promote movement. Their design, construction and fitting require particular skill and technological expertise; well-resourced centres include prosthetists and orthotists in the team.

Environmental adaptation is part of the same prescription: handrails and ramps, improved access to shower and toilet areas, additional lighting, grab bars, and removal of loose rugs and clutter. Early occupational therapy input, usually including a home visit, ensures that modifications are appropriate and timed to facilitate hospital discharge.

Vision — simple measures maximise residual vision: a magnifying device, large-print reading material, lighting intensifiers and reduction of glare. Aids must be combined with training (eccentric viewing, device use) or they fail.

Exclude any contraindicating medical or correctable problem (e.g. cerumen)

Greatest satisfaction if the loss is 55–80 dB; only partial help if the loss exceeds 80 dB

Less satisfaction when speech discrimination is poor

The aid is designed for face-to-face conversation — set realistic expectations

May need to be combined with lip reading

Loudness perception abnormalities (recruitment) may make the aid unacceptable

More severe loss requires a body-worn aid rather than behind-the-ear

Decide monaural versus binaural; assess the patient’s ability to handle the aid independently; assess motivation

Practical hearing aid points: hearing aids are most useful in one-to-one conversation and least useful in noisy group settings. The old adage that hearing aids do not help sensorineural loss is simply not true — modern digital aids can be tuned to specific frequencies rather than amplifying all frequencies. Binaural aids improve sound localisation and discrimination. Body-worn aids give the greatest amplification and have large controls; in-the-ear aids are cosmetically preferred but harder to manipulate. Patients are often initially resistant — patient and family counselling improves use and satisfaction. Middle-ear and cochlear implants are safe and effective options when hearing aids fail in severe loss.

Continence: absorbent pads and washable absorbent products, bedside commode and urinal to shorten the distance to the toilet, raised toilet seat and adequate night lighting. Continence advisors are the correct experts.

Wheelchair seating is a device issue, not a comfort issue. Wheelchairs were designed for transport, not prolonged sitting; sling-back seats give inadequate support. Poor back support, a chair too tall, heavy or wide, footrests set too high and the hammock effect cause pain and agitation — and hence unsafe transfers, falls and restraint use. Corrections: wedge cushion, wedge seat, lateral supports, and in hemiplegia an arm trough, elevated armrest, lateral arm support or half tray. Prolonged users need a formal seating evaluation by a physiotherapist or occupational therapist.

Falls-related devices — know the evidence limits. Hip protectors show uncertain benefit in nursing home residents and no clear benefit in community dwellers, but for high-risk older people willing to wear them, they may reduce fear of falling. An anti-slip shoe device reduces outdoor falls in icy conditions, and compression stockings plus tools to aid slow rising help in postural hypotension.

Advice on the suitability of aids is best left to occupational therapists or others with particular expertise: physiotherapists advise on mobility aids, speech therapists on communication aids, audiologists on hearing aids, and continence advisors on continence aids. These professionals also provide follow-up and ensure that aids are properly used and maintained and continue to serve their purpose.

The four provision steps are select → fit → use (train) → follow-up. Without all four, assistive products are often of no benefit, are abandoned, or may cause physical harm. This one line answers most exam questions on device failure.

Common causes of device abandonment: wrong device or wrong size; no training; cosmetic stigma; cost; the device not serving a valued activity; cognitive or dexterity failure (hearing aid batteries, walker brakes); lack of maintenance; and carer over-help that removes the reason to use it.

Device-related complications: falls from worn ferrules or wrong height; carpal tunnel syndrome, ulnar neuropathy and shoulder pain; axillary crutch palsy; pressure ulcers, contractures and functional incontinence from prolonged wheelchair use; skin damage from pads; otitis externa and cerumen impaction from hearing aid moulds; and learned dependence and deconditioning.

The over-help trap: if caregivers bathe and dress an older person who has independence goals, those goals will not be achieved — “helping” creates deconditioning, dependency, contractures and the other sequelae of immobility. A restorative philosophy must accompany every device.

The WHO ICOPE pathway builds assistive devices into intrinsic-capacity management: provide an assistive device to aid mobility; reading glasses and vision rehabilitation for irreversible low vision; hearing aids and auditory aids around the house (telephone, doorbells); home adaptation to prevent falls. Treating visual impairment enables maintaining family and social relationships, accessing information, moving safely and performing manual tasks.

Emerging technology: remote sensors and accelerometers for objective progress measurement, virtual reality platforms giving visual, auditory and tactile input, a robotic glove combined with VR attached to an arm orthosis that counterbalances arm weight after hemiparetic stroke, and walking assist devices with potential to augment recovery and assist ADLs including stair walking. Sensor-based gait analysis can indicate the most appropriate orthotic device to prescribe.

The global access gap The WHO–UNICEF Global Report on Assistive Technology (2022) found that more than 2.5 billion people need one or more assistive products, yet nearly one billion are denied access, with access as low as 3% of need in some low-income countries versus up to 90% in some high-income countries. An estimated 3.5 billion people will need assistive technology by 2050, driven by population ageing and rising non-communicable disease. Timely provision of assistive technology for older people improves independence and safety and enables them to live at home for as long as possible.

The Priority Assistive Products List and its ongoing update WHO introduced the Priority Assistive Product List (APL) in 2016, featuring 50 crucial products across mobility, vision, hearing, communication, cognition and self-care, followed by the Assistive Product Specifications (APS) in 2021 and the Training in Assistive Products (TAP) programme in 2022. The APL is modelled on the WHO Model List of Essential Medicines. On 6–7 May 2025 WHO convened the first in-person meeting of the Technical Advisory Group on Assistive Technology in Geneva — 24 independent experts from all six WHO regions — who assessed and prioritised 300 assistive products grouped by the six functional domains for an updated APL. Since 2016, 23 countries have adopted national lists based on the WHO model.

The workforce is the bottleneck — and the four provision steps Only about 1 in 10 people worldwide have access to appropriate assistive products, and workforce shortages are one of the biggest reasons. WHO states that trained personnel are essential for the proper assessment, fitting, user training and follow-up, and that without these four key steps assistive products are often of no benefit or abandoned, and may cause physical harm. WHO TAP covers the provision steps — select, fit, use, follow-up — for 25 basic products from the APL across cognition, communication, vision, hearing, continence and mobility, is open-access in 10 languages, and has been deployed in Tanzania, Ukraine, India, Iraq, Papua New Guinea and Romania.

Hearing aids and cognition — the ACHIEVE trial (Lancet 2023) ACHIEVE randomised 977 adults aged 70–84 with untreated mild-to-moderate hearing loss and without substantial cognitive impairment at four US sites to hearing intervention (audiological counselling plus hearing aids) or health education control, with 3-year change in global cognition as the primary endpoint. The result was negative in the total study population, but in the pre-specified subgroup of 238 participants drawn from the ARIC cardiovascular cohort — at increased risk of cognitive decline — hearing intervention slowed cognitive decline by 48% over three years. Hearing loss is present in 65% of adults over 60. Exam framing: hearing aids are not proven to prevent dementia in everyone, but are a reasonable intervention in the at-risk older adult — and remain unequivocally indicated for communication, mood and social participation.

Assistive devices alone do not prevent falls The 2023 Cochrane review found that assistive devices alone — eyeglasses, specialised footwear, bed alarm systems — and education alone do not reduce the rate of falls, whereas home fall-hazard assessment and modification reduces falls by 26% overall and 38% in high-risk older people. NICE NG249 (2025) found insufficient evidence on assistive technologies in community settings and issued a formal research recommendation.

Policy anchors and Indian provision WHA71.8 (2018) committed Member States to improving access to assistive technology; WHA76.6 (2023) calls for integrating rehabilitation into health systems within UHC and specifically commits to minimising the prohibitive costs of assistive technologies such as hearing aids, glasses, wheelchairs and prosthetics. WHO’s strategy uses the 4P framework — Policy, Products, Provision and Personnel. India: the ADIP Scheme (since 1981, revised with effect from 1 April 2024 and continued to 31 March 2026) provides durable, scientifically manufactured standard aids and appliances and funds corrective surgery where needed before a device is provided, with grants to ALIMCO, National Institutes, Composite Regional Centres, DDRCs, State corporations and NGOs. ALIMCO is the largest manufacturer of mobility and rehabilitation aids in South Asia; over seven years to 2020, ADIP spent about ₹10.8 billion and benefited 1.8 million people through 9460 camps, and ALIMCO is opening Pradhan Mantri Divyasha–Vayoshri Kendras (PMD-VK). Rashtriya Vayoshri Yojana supplies free walking sticks, elbow crutches, walkers, tripods/ quadpods, hearing aids, wheelchairs, artificial dentures and spectacles to BPL senior citizens with income ≤ ₹15,000/month, with doorstep delivery for those aged ≥80 years. DDRCs, now approved in every district, assess need, fit and repair assistive devices, and provide physiotherapy, occupational therapy and speech therapy.

Assistive technology = assistive products + the systems and services that deliver them.

WHO APL (2016): 50 priority products across six domains — mobility, vision, hearing, communication, cognition, self-care. Under revision; 300 products reviewed in May 2025.

The four provision steps: select, fit, use, follow-up. Miss one and the device is abandoned or harmful.

An aid can foster dependence rather than independence — but those in real need often never obtain even basic aids.

Prescribe a device only if it serves an activity the person and family value.

Prosthesis replaces a body part; orthosis supports, improves function, or restricts/promotes movement.

Hearing aid: best satisfaction at 55–80 dB loss; only partial help above 80 dB; poor discrimination predicts poor satisfaction.

Hearing aids work best one-to-one and worst in noisy groups.

Binaural aids improve sound localisation and discrimination.

ACHIEVE (2023): 48% slower cognitive decline with hearing aids in the at-risk subgroup only.

Vision aids: magnifier, lighting intensifiers without glare, tinted glasses, night light, large print — always with training.

Self-care classics: long-handled reacher, sock aid, dressing stick, built-up cutlery, raised toilet seat, shower chair, grab bars.

Assistive devices alone do not prevent falls.

WHO 4P framework: Policy, Products, Provision, Personnel.

India: ADIP (since 1981, revised 2024), ALIMCO, Rashtriya Vayoshri Yojana, PMD-VK and DDRCs.