The NLTCS is a nationally representative survey of persons aged 65 or older residing in the community or institutions conducted from 1982 through 2004, its final year.1 The survey was designed to identify those with chronic disabilities and to collect detailed data on their disability, service use, family support, and health and demographic characteristics. This study relies on cross-sectional samples of community residents reporting chronic disability from the five waves of the survey conducted in 1984, 1989, 1994, 1999, and 2004.
Disability items included are six personal care activities, or activities of daily living (ADLs), and eight independent living activities, or instrumental activities of daily living (IADLs). The ADLs are bathing, dressing, getting around inside, getting in and out of bed (transfer), toileting and eating. The included IADLs are shopping, managing money, meal preparation, laundry, light housework, taking medicines, getting around outdoors, and telephoning. The NLTCS disability measures allow measurement of use of help, use of disability-related devices ("special equipment"), reported need for help with ADLs, and inability to perform IADLs. Detail on types of devices used is collected for four ADLs (transfer, getting around indoors, bathing, and toileting) and for getting around outside, the one IADL for which disability-related device use is collected. For eating and dressing, information is limited to whether respondents used such items as special dishes or utensils, or special clothing or equipment.
For this study and the original study, the disability information is used to describe trends in use of assistive devices with and without help and trends in the types of devices used, among community-residing persons reporting at least one chronic disabilities (defined as having lasted 90 days or longer). Assignment of respondents to categories of using help only, assistive devices only, or a combination of the two is based on all disabilities reported, including disabilities that have not yet met the criterion for being chronic.
The distinction between rates based on this measure and the overall disability rates reported in Spillman (2004, 2011a) is two-fold. First, the aim is to look within the population with chronic disabilities to understand the mix of accommodations used. Second, whereas Spillman (2011a) used a hierarchical measure that identified persons with chronic help versus those using assistive devices without help for all disabilities, this analysis further discriminates the use of both assistive devices and help, within the population receiving help with chronic disabilities. Use of both devices and help is defined as any combination of performing some individual activities independently with devices or using both help and devices for individual activities.
In addition, disability characteristics, human and environmental support, and socioeconomic characteristics are examined for chronically disabled elders in 2004, grouped by whether they used only devices, only help, or both. Hours of care are examined for persons using help only or help and devices, and, among those using both help and devices, for persons using devices with help and persons performing some activities with only devices.