Assistive Device Use among the Elderly: Trends, Characteristics of Users, and Implications for Modeling

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Abstract

One of the most intriguing aspects of recent declines in old age disability is the concurrent increases in use of assistive devices among older persons with disability, particularly in use of devices for all disabilities without human assistance. This study updates information on trends in assistive device use and characteristics of device users; examines differences in the hours of care received by persons who do not use devices and those who use devices with and without help; and discusses implications for multivariate modeling of the relationship between device use and hours of help and other outcomes. Data are from the 1984 through 1999 rounds of the National Long Term Care Survey (NLTCS), which has been the key source of earlier information on trends in equipment use.

Introduction

One of the intriguing aspects of recent declines in elderly disability is the increased use of disability-related equipment, or assistive devices. Several studies using different data sources have found declines in the overall disability rate among older Americans, with larger decreases independent living activities, such as meal preparation and shopping, typically associated with lower levels of disability (Spillman 2004; Freedman, Martin, and Schoeni 2002; Schoeni, Freedman, and Wallace 2001; Waidmann and Liu 2000). One recent study also found consistent evidence across several national surveys of smaller declines in the mid to late 1990s in help with personal care activities, such as bathing and toileting that are associated with more severe disability (Freedman et al. 2004). Evidence of decline was not clear, however, when ADL disability was defined to include use of disability equipment as well as human help, because of the rising prevalence of equipment use. For only one activity, bathing, was an upward trend in the prevalence of equipment use associated with a downward trend in the prevalence of help (Freedman et al. 2004; Spillman 2004).

A number of factors argue for the need to better understand the upward trend in device use and its implications for the growing older population. Research provides evidence that assistive devices may substitute for human assistance under some circumstances, although the full scope and implications of such substitution is not yet known. Nevertheless, if equipment use reduces or removes the need for help from other persons, it may reduce the demands of disability care on both families and public programs and increase independence and quality of life for elders with disabilities. At least some evidence exists that use of assistive devices also may be associated with slower functional decline and lower health care utilization. Finally, better understanding of which activities and which types of equipment have experienced the largest increases may help identify where interventions to promote access to disability equipment may be most effective.

This study adds to understanding by updating information on trends in use of disability equipment and exploring how disability and other characteristics differ for equipment users and nonusers. Data are from the 1984 through 1999 rounds of the National Long-Term Care Survey (NLTCS), which has been a key source of earlier information on trends in equipment use (Manton, Corder, and Stallard 1993). We first examine several trends in the use of equipment over the period 1984 through 1999, including use of equipment with and without help, use of equipment for specific activities, and use of particular types of equipment. We then examine how disability, characteristics relating to the availability of potential caregivers and environmental accommodations, and socioeconomic characteristics differ for those using and not using equipment, and how hours of care vary by whether and how equipment is used. Finally, we discuss implications for of the findings for models relating to the role of assistive devices in managing disability.

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