Introduction: Aging in place for older adults with cognitive impairments is a public health priority. Critical errors when performing instrumental activities of daily living (IADLs) can significantly compromise a person’s ability to live independently, yet little is known about these errors, the necessary assistance, or how occupational therapists (OTs) select assistive technologies for cognition (ATCs).
Objectives: This study aims to: (1) identify the critical errors older adults face in IADL tasks; (2) examine the assistance regarding cognitive support with verbal assistance or ATCs provided by OTs.
Methods: We conducted a mixed-methods study. First, we analyzed performance-based IADL assessments of 40 older adults (19 with cognitive impairment, 21 without) using the IADL Profile1 to identify errors and required assistance. Second, we held focus groups with 15 experienced geriatric OTs to discuss ATC decision-making.
Results: Among 40 participants, 28 (including 11 without a diagnosis) made at least one critical error, and 19 committed more than two. To support this, OTs mainly use a minimal cognitive verbal assistance approach with implicit OR explicit hints and reflection stimulations. However, when a tipping point is reached, OTs may shift to a maximal cognitive assistance approach. In using ATCs, their decision-making is guided by the client's abilities, the demands of the task, and the surrounding context.
Conclusion: Our findings highlight the importance of adjusting assistance levels to support autonomy. Tailored verbal assistance and ATCs enhance independence. This study inspires change in geriatric OT and drives innovation to improve safety, independence, and control over daily life.