This research updates an earlier study conducted to better understand the upward trend in assistive device use by older persons with disabilities between 1984 and 1999 observed in estimates from the National Long-Term Care Survey (NLTCS) and the implications for policy (Spillman 2005). The context of the earlier study was a declining overall disability rate among older Americans over the 1984-1999 period. The trend was characterized by large decreases in help with independent living activities, such as meal preparation and shopping, associated with lower levels of disability, and smaller decreases in help with personal care activities, such as bathing and dressing, associated with more serious disability (Spillman 2004a, 2004b). Estimates from several national surveys over the period also indicated declines since the mid-1990s in help with personal care activities (Freedman et al. 2004).
Since the original study was undertaken, two key developments have occurred that support the need to revisit device use trends in the NLTCS. The first and most important is the completion of the final 2004 wave of the NLTCS and findings that the longstanding decline in help with disabilities did not continue between 1999 and 2004 (Spillman 2011), although the upward trend in assistive device use continued. Other work examining trends in difficulty and help with personal care and independent living activities across five national surveys confirmed the flattening of the trend in both difficulty and use of help and indicated that it had persisted through 2008 (Freedman et al. 2013).
A substantial body of evidence indicates the potential importance of assistive device use for policy. The evidence suggests that assistive devices may substitute for human assistance under some circumstances, although the full scope and implications of such substitution remains undetermined (see Spillman 2005 for a review of the literature). Nevertheless, if device use is able to reduce or defer the need for help from other persons, it may be able to reduce the demands of disability care on both families and public programs, increase independence and quality of life for elders with disabilities, and have other desirable outcomes.
Besides updating trends, this new research was undertaken, like the original study, to elucidate trends in device use and identify where interventions to promote access to devices may be most effective. The analysis has the following primary aims:
To update information on trends in use of disability devices, using data from the 1984 through 2004 rounds of the NLTCS.
To describe differences in characteristics of device users and nonusers.
To examine differences in the hours of care received by device nonusers and by persons using devices with and without help.
In addition, this update incorporates exploratory multivariate models to examine cross-sectional associations between patterns of assistive device use, hours of care, and reported unmet need for help among those using a combination of assistive devices and help.