The value of powered mobility scooters from the perspective of elderly spouses of the users – a qualitative study

Abstract

Purpose

To explore spouses’ experiences of the value of mobility scooters prescribed to their partner.

Material and Methods

A descriptive design with a qualitative approach was used. Thirteen spouses (11 females) aged 65–86 years participated. Semi-structured interviews were conducted when the spouse’s partner had had the mobility scooter for 4–6 months. The interviews were analysed using qualitative content analysis.

Results

The interviews showed primarily that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They reported that they could engage in activities of their own choice to a greater extent. The prescription of a mobility scooter to their partner had also yielded a sense of freedom related to shared activities. On the other hand, the spouses described some of the scooter’s limitations. Three categories emerged: a sense of freedom related to the spouse’s own activities, a sense of freedom related to shared activities and a somewhat restricted freedom.

Conclusion

Prescription of a powered mobility scooter was of value to the users’ spouses because it facilitated independent and shared activities and participation in the community. The value was mainly expressed as a sense of freedom when doing things on their own or together with their partner. Spouses are key persons in the rehabilitation of people with mobility restrictions. Their views on the assistive device may influence the rehabilitation process. Knowledge of spouses’ experiences is thus crucial, as this may influence the future rehabilitation outcome.

IMPLICATIONS FOR REHABILITATION

• A powered mobility scooter prescribed to one partner eases everyday life and increases activity and participation for the spouse, which in turn may further improve the quality of life for the scooter user.

• The spouses’ perspectives on their partners’ mobility scooter use could be helpful in developing the design of the mobility device and in the prescription process.

• A mobility scooter has an added value by giving a sense of freedom and freedom to choose for the spouse as well as the scooter user.

Keywords:

• Assistive technology
• powered mobility devices
• ICF
• aged
• mobility limitation

Introduction

Mobility devices are prescribed and used with the aim of maintaining, increasing and/or enabling activity and participation for people with different kinds of disability. One aspect of this, which is given less attention, is how the mobility device influences the everyday life of people close to the person using the device, that is, the spouse, child or other caregiver.

The prescription of mobility devices such as canes, walkers, wheelchairs and powered mobility devices (PMDs), which include powered wheelchairs and mobility scooters, increases with age and will probably become more common as the proportion of elderly people in society grows [1,2]. In Sweden, a mobility device is virtually free of charge and prescribed according to the specific needs of the person in question [3,4]. The prescription is made based on the assumption that the mobility device will have a positive effect on the user’s daily life, and research provides evidence of improved activity and participation in people who are prescribed such devices [5–7]. Assistive technology, such as PMDs, is a part of the environment [8]. As such, a PMD might also affect other people such as spouses and informal caregivers living with the user and sharing the same environment. Research concerning the significance of assistive technology to informal caregivers of those who use the technology is sparse [9–13]. The existing research shows that assistive technology can relieve the burden of caring and support for the informal caregiver [9,11,14]. However, it also shows that informal caregivers have both positive and negative experiences of this assistive technology [10,13], and they report some limitations of the technology per se [15]. In a systematic review [16], decreased need of supervision by the caregiver, reduced need of assistance with transportation, and no need to push users when going outside for a walk, were described as benefits of PMDs. One of the limitations of the studies in the review, as pointed out by the authors [16], was that many of the findings concerning the impact on informal caregivers were not first-hand reports by the caregiver but rather reported by the user of the device; furthermore, few of these studies concerned the use of PMDs. We have not found any study regarding spouses’ experiences in connection with the partner’s use of a mobility scooter. Therefore, the aim of this study was to explore spouses’ experiences of the value of mobility scooters prescribed to their partner.

Method

This study is part of a larger research project about the significance of mobility scooters, including a study on the effect from the user perspective [6] and a cost-effectiveness analysis [7], which have already been published. Ethical approval was gained from the Regional Research Ethics Committee in Uppsala, Sweden, approval no. 2011/134.

A descriptive design with a qualitative approach focussing on the experiences of the spouses was used for the present study.

The criteria for inclusion in the study were being the spouse of a person aged 65 or more who had been included in a previous study of powered mobility scooter users [6]. Eighteen spouses were invited to participate and five of them declined due to old age or their own illness. Thus, 13 spouses participated (11 women and two men) after providing informed consent. The participants were 65–86 years of age. Seven of the couples lived in cities, two in villages, and four in rural areas.

Semi-structured interviews (14) were conducted by the first author (CF). The interviews were carried out when the spouse’s partner had had the mobility scooter for approximately 4–6 months. Twelve of the interviews took place in the couple’s home and one in another place according to the spouse’s wishes.

The questions posed during the interview concerned (i) the significance of the mobility scooter for the spouse’s everyday activities, participation and quality of life, (ii) the significance of the mobility scooter for shared activity and participation (spouse and scooter user together) and (iii) the significance for the partner using a mobility scooter, from the perspective of the spouse.

The interviews were transcribed verbatim and analysed using qualitative content analysis [17]. They were read several times to get an overall sense of the content. The interview text was then divided into meaning units, that is, parts of the text, words or sentences that relate to the same meaning, guided by the aim of the study. The meaning units were condensed and labelled with codes. Next, the codes were compared according to similarities and differences and sorted into tentative categories. The tentative categories were further scrutinised, going back and forth between the interview text, the meaning units, codes and the tentative categories until the three final categories were established: a sense of freedom related to the spouse’s own activities, a sense of freedom related to shared activities and a somewhat restricted freedom. The authors discussed the meaning units, codes and categories throughout the analysis to achieve consensus over the results [17]. Quotes are used in the following section to illustrate the significance of the categories.

Results

The results from the interviews showed first and foremost that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They experienced a sense of freedom that had an impact on their own activities as well as on shared activities with their partner. The descriptions also portrayed a somewhat restricted freedom.

When the spouses described what value their partner’s use of a mobility scooter had for them, their stories took their point of departure from different experiences in the spouses’ everyday lives. Some of the spouses had experiences of rapid changes and others had seen slow changes in their partner’s health status over a period of time prior to the prescription of the mobility scooter. A pervading feature of their descriptions of the time before their partner received the scooter was that the difficulties the partner had in moving around, especially outdoors, meant that the spouse had to lend a helping hand whenever the partner had an errand to run or wished to go outside. These different experiences were reflected in their stories, resulting in the three categories described below.

A sense of freedom related to the spouse’s own activities

The prescription of a mobility scooter to their partner had meant a sense of freedom for the spouses to engage in their own activities.

…I can take my bike and go for a ride, perhaps visit a friend or … I can do something at home, I sort of feel more free…

Once they had chosen to do something on their own, they could continue with the activity without having to interrupt it because their partner needed help with something. For example, the partner could independently run an errand or go to an appointment. The spouses reported that they did not have to be on standby to the same extent as before, because their partner could manage alone by using the mobility scooter.

… I do not have to be on standby to drive X to…, … he can go by himself…, to me it is a great relief and that goes for X as well, he can do whatever he wants and does not have to wait for me to have the time to drive him if I am doing something special …

The spouses also reflected that, in addition to the feeling of freedom when carrying out their own activities, they no longer had to be concerned about what their partner did or could do during the day. They felt that the mobility scooter had given them both more freedom of choice.

Before their partner received the scooter, the spouses found it difficult to leave the home. They talked about feeling awkward leaving their partner at home, knowing that he or she was not able to go out alone. Knowing that their partner was dependent on them had restricted their own activities, until the mobility scooter made it possible for the partner to go outdoors alone; this changed how the spouses felt about their own activities outside of the home. Knowing that their partner also had the option of going out was a relief to them.

…I do not have to think that now X has to stay at home, I can go out with a clean conscience knowing that he can take the mobility scooter and go for a ride…, …I do not have to think of him all the time…

The mobility scooter had contributed to more shared responsibility for some activities, such as shopping. This too had made it easier for the spouses and gave them a sense of freedom concerning their own activities. This shared responsibility also meant that the partner took more initiative and a more active part in the everyday tasks, according to the spouses.

…X takes his own decisions, he can ask me if there is anything I want him to do as he is going out for a ride. It is he that decides, ‘is there anything I can do for you?’…, X has control of part of his life and that is a relief to me…

A sense of freedom related to shared activities

The spouses’ stories also revealed that the prescription of a mobility scooter to their partner had yielded a sense of freedom related to shared activities. The spouses explained that, before their partner had the scooter, they had to plan everything they wanted to do together very carefully. The car was often the only way to go beyond the home apart from short excursions in the manual wheelchair. The car was the easiest way to get from one place to another but it could be difficult to find a parking place near enough to the destination for the partner. In cases where the partner had used a manual wheelchair previously, the physical burden of lifting the wheelchair into and out of the car was large. Also, pushing the wheelchair when out walking was hard as it was heavy and the environment seldom modified for manual wheelchairs. The mobility scooter had become a less troublesome alternative, which the spouses appreciated. It had reduced the need for planning and decreased the physical burden on the spouse. It made it possible to spontaneously do things together with less effort.

Like yesterday X took the mobility scooter and I took my bike, we went to the lake and just went for a little ride. That is one example or …we can go together and do some shopping… that’s so much easier for me as the manual wheelchair was so heavy, it was tough, this is so much better…

The spouses’ stories revealed that they were now able to do things together again, activities that they had stopped doing.

In the summer we used to take the bike and barbeque, we went to different places and it was very nice, but we have not done that in a long time, it has been impossible but now we have been out to the park and even further. I take the bike and X takes the mobility scooter and we bring coffee so that is a difference.

The scooter had also made it possible to do things separately. The spouses were pleased that their partner could be more independent but also appreciated that they too were able to engage in activities of their own.

We can go into the city and then we split up …, … I might have some errands to run and X has some of his own to do and then we decide where to meet again … just like we did before… He has a life and I have a life, we are not so dependent on each other…

The spouses valued the opportunity to spend time on activities of their own or shared activities with their partner and found both independent and shared activities to be positive experiences. The mobility scooter had influenced the mood of the partner according to the spouses. They noted that their partner was “happier” or “in a better mood” since receiving it. If the partner was happier, that had an influence on the spouse as well.

X is in a better mood and thinks that life is nicer so it is nicer for me as well…, … I know that he does not sit there alone and bored but he is out …, …and it affects me too, I get rid of the responsibility that I really should not have but have anyway…

A somewhat restricted freedom

In the spouses’ stories, there are a few descriptions of the limitations of the mobility scooter. One of the descriptions concerns its size. It does not allow you to go wherever you want, and, if it is possible to enter into, for example, a shop or a pharmacy, the floor is usually cluttered with things that make it impossible to get around. The spouses pointed out that, for the same reason, going to the theatre or cinema could be very troublesome.

Even though the mobility scooter had brought positive changes into their lives, the spouses said that it did not solve all their problems. It was seen as a complement that made everyday life easier in some ways but in relation to life as a whole it was of less importance from the spouses’ point of view.

A wheelchair cannot solve that … it suits its purpose for her in certain situations, but life as such, as it changes … but that is life, you have to cope…

Discussion

In this study, the experience of having a mobility scooter is described from the spouses’ perspective. The results show first and foremost that the scooter had changed the spouses’ experience of everyday life. This is expressed as an increased sense of freedom but also a decreased physical effort concerning transportation. The results also show that a mobility scooter may have a great value for the spouses, particularly the opportunity to have more control over their own time and to increase the level of activity and participation for both partners.

The results of the present study also show that a mobility scooter prescribed to the partner might enable the spouse to engage in more activities of their own choice and get more involved in the community. This is in line with the results from studies on the scooter users’ perspective [6,7,18–21], showing that both partners benefit from a prescribed mobility scooter.

The spouses’ stories showed that the significance of a mobility scooter was primarily related to a change in how they experienced their everyday lives. The scooter made them feel less restricted in their own activities and those shared with their partner. They could engage in their own activities without having to be aware of their partner’s needs and what he or she was doing. The feeling of being on standby had diminished and the opportunities to focus on their own activities without interruption had increased. Frank et al. [19] reported that, from the users’ point of view, a powered wheelchair can increase caregivers’ freedom. The present study underlines this further, but in this case from the perspective of the spouses. Here, the spouses’ experiences were for the first time the main focus. However, in these interviews the spouses often began by talking about the value of the mobility scooter to their partner. This could indicate that the spouses had such positive experiences of the scooter that they wanted to put that forward. Alternatively, they may have associated the scooter so closely with their partner that their stories had to take that as a point of departure.

Mortensen et al. [16] found that the need to assist the partner, especially with transportation, had decreased. The same was also found in our study of the cost-effectiveness of mobility scooters [7], in which the scooter users (n = 45) significantly decreased their need of assistance with transportation from 3.6 h per week to 1 h per week. Further, Samuelsson and Wressle [22] showed a decrease in the use of assistance by on average 4 h per week. Both studies [16,22] reported results from the scooter user’s perspective. Demers et al. [14] and Frank et al. [19] also reported that the caregivers’ free time to participate in their own activities had increased, which to some extent is in line with the present study. However, the spouses in our study did not talk about this time in terms of minutes and hours, but rather of the feeling of being able to spend time on their own activities. This could be due to the fact that all except one participant in this study were retired and they might value their time differently. Regardless of this different view of time, as was also shown in the Hagberg et al. study [7], a mobility scooter saves a considerable amount of time for spouses. In this study, other values have been identified that are not usually captured in cost-effectiveness analyses, such as a sense of freedom and freedom to choose, for spouses as well as for users. Cost-benefit studies tend to focus on changes in resource utilisation and quality of life (mostly function, pain and mood). Thus, the present study adds a wider understanding of the value of a mobility scooter.

The interviews with the spouses revealed that the mobility scooter made it possible to resume previous shared activities as well as share new social activities, for example, to go for a ride or visit friends together without too much planning. Demers et al. [14] and Frank et al. [19] also found that the available time for shared activities increased when a PMD or other assistive technology was provided. Our study found that, in addition to being able to do things together more spontaneously, the physical effort of shared activities was reduced, as other studies [14,15] have also reported. The difference in the present study is that the spouses’ sense of freedom was associated more with the increased spontaneity than with the reduced physical effort. The value of the mobility scooter could also be seen in the fact that they had the opportunity to do things separately; the spouses expressed this as similar to their lives before their partner’s mobility problems. Life was less restricted and more normal now, and both partners felt happier. The partner with the mobility scooter could once again go out, which meant that their spouses could experience more freedom in their everyday lives. The spouses valued being able to socialise again and engaging in their preferred activities, which changed how they experienced their everyday life. This is consistent with reviews on engagement in activities [23] and social participation [18] in elderly people, which found that social relationships and participation are of significance for their health.

The spouses in our study spoke of the mobility scooter in positive terms. In earlier studies [13,16] it was found that using a PMD could be stigmatising, but the present study does not support this. This might be due to the fact that the partner had had the mobility scooter for less than four months. At that point, the spouse may not yet have experienced all its pros and cons. A second interview, or allowing a longer time to pass after the partner received the mobility scooter, might have shown such a result. Worries such as stigmatisation mentioned by spouses in other studies [16] were not seen in the present study. The worries the spouses in our study talked about had more to do with life in general, what their lives were like and how they would turn out eventually. From that point of view, the mobility scooter was only an accessory that made everyday life a bit easier. The study by Mortenson et al. [20] showed the same results: an assistive technology device eases the burden of the activity the device is designed for, but it does not ease the overall burden for the user or caregiver.

One negative aspect of the mobility scooter that was pointed out was its large size. This has an impact on access to different facilities outside of the home. How the couple’s premises were planned and equipped was also of importance. The spouses spoke about the design of the scooter as well as the accessibility of the environment, and about the interaction of the two sometimes enabling and sometimes preventing their participation in individual or social activities. This is also described from the users’ point of view in Torkia et al. [24], Pettersson et al. [25] and Widehammar et al. [26]. The abilities of the person, the environment where the device is used, the design of the device, as well as the activity in which the device is used, play a part in how active and involved a person can be in different arenas. This interaction between person, activity, technology and environment is of significance when using assistive technology to perform tasks [27–29] which is also described in the review by Mortenson et al. [16]. These results imply that the spouse’s perspective is important in the prescription process as well as in the rehabilitation process.

There are some considerations that need to be discussed when interpreting the results. The design of this study was descriptive and thirteen spouses participated. The available population of spouses depended on a previous study [6], which meant that the final study sample was limited and not evenly distributed, with 11 women and two men. This skewness can to some extent be explained by the fact that during the timeframe of this study, mobility scooters were prescribed to a higher degree to men than women [6]. A skewed distribution between women and men has been seen in other studies and needs further investigation [30,31]. For this study, the skewness affects the transferability of the results. Further studies are thus needed to specifically cover men’s experiences of mobility scooters prescribed to their wives.

One other matter that has to be considered is whether the stories related just to the mobility scooter or also to life in general. In some cases, the responses might have been more closely related to circumstances in everyday life than to the scooter per se. This might be a limitation of the results, but, since the scooter is part of everyday life, it needs to be considered as such. This view of a mobility scooter is in line with the results reported by Rudman et al. [15]. Therefore, we believe that the findings from this study are valid.

In conclusion, prescribing a mobility scooter to the partner with a disability was of value to the spouses concerning their own and shared activities and participation. This value was expressed primarily in terms of an experience of freedom when engaging in activities on their own or together with their partner. To our knowledge, this is the only study that has explored elderly spouses’ perspectives in relation to their partner’s use of a mobility scooter. It should be noted that mobility scooters are not directly comparable with powered wheelchairs, as they are suited to users with better balance who find it easier to transfer on and off the seat. Furthermore, they are less stigmatising than powered wheelchairs. For these reasons, studies of users of mobility scooters and powered wheelchairs should be treated separately. The results in this study are only valid for spouses of mobility scooter users. Further studies are thus needed to investigate the experiences of spouses of powered wheelchair users.

Acknowledgements

We acknowledge the support from University Healthcare Research Center, Region Örebro county, Örebro, Sweden, and from Sofia Tavemark, OT, MSc, clinical lecturer at Örebro University, Örebro, Sweden, who helped with finalising the manuscript.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

Funding was provided by the Swedish Institute of Assistive Technology and the Promobilia Foundation, Sweden.