Updated Analyses of Trends in Use of Assistive Devices. Trends in Device Use

01/07/2013

  • The upward trend in assistive device use continued at about the same pace between 1999 and 2004, rising from 86 percent of community residents with chronic disabilities to 90 percent (Figure 1).

  • The combined effects of the increase in the number with disabilities from 5.1 million to 5.7 million and the increased prevalence of device use resulted in an increase of nearly 800,000 persons using devices for at least one activity, nearly as large as the increase of 1 million persons between 1984 and 1999.

  • Also as in the earlier years, use of help only with all disabilities continued to decline, falling from 14 percent to 10 percent.

  • Contrary to the earlier trend, however, the increase in device use was not driven by increasing sole use of devices for all activities, which was 26 percent in 2004 essentially unchanged from 1999; rather, the increase reflects increased use of both help and devices for at least one activity.

  • The proportion of those with chronic disabilities using a combination of help and devices with disabilities rose slowly, from 58 percent in 1984 to 64 percent, but the proportion receiving help with at least one activity but using devices only for at least one activity remained roughly constant at 40 percent throughout (not shown).

FIGURE 1. Trend in Assistive Device Use: Chronically Disabled Community Residents Age 65+
LINE CHART: Device use with any disability--1984 (72), 1989 (80), 1994 (83), 1999 (86), 2004 (90); Devices and help with any disability--1984 (36), 1989 (41), 1994 (43), 1999 (45), 2004 (50); Device use only with all disabilities--1984 (13), 1989 (18), 1994 (21), 1999 (25), 2004 (26); Help only with all disabilities--1984 (28), 1989 (20), 1994 (17), 1999 (14), 2004 (10).
NOTE: All trends statistically significant between 1984 and 2004.
** Indicates significant change between 1999 and 2004.

Trends for Individual Activities

The prevalence of all seven activities for which information on use of devices is collected as well as the prevalence of device use increased significantly within the community population with chronic disabilities between 1984 and 2004 (Table 1).

  • Between 1999 and 2004, however, results for both the prevalence of disabilities and devices are more mixed.

    • Disability in and of use of devices for bathing, getting around inside, and toileting increased between 1999 and 2004.
    • No significant change occurred in the prevalence of limitation in getting around outside, dressing, or eating disability, and device use increased only for getting around outside.
    • The prevalence of disability in transferring declined significantly, with no significant change in the prevalence of device use.
  TABLE 1. Trends in Use of Assistive Devices among Community Disabled Elderly, by Activity, 1984-2004  
    1984  
(%)
  1989  
(%)
  1994  
(%)
  1999  
(%)
  2004  
(%)
  Change  
99-04
  Change  
84-04
Getting around outside 72.3 76.2 76.1 80.9 81.4 0.5 9.1**
   Active or standby help only   22.2 22.1 22.3 26.0 23.1 -2.9** 0.9
   Any equipment use 50.1 54.1 53.7 55.0 58.3 3.4** 8.2**
      Equipment only 31.6 36.3 35.3 35.9 29.8 -6.1** -1.8
      Equipment and help 18.5 17.8 18.4 19.0 28.5 9.5** 10.0**
Bathing 52.6 58.6 60.9 64.8 68.9 4.1** 16.4**
   Active or standby help only 24.1 21.9 19.1 13.5 10.0 -3.5** -14.1**
   Any equipment use 28.5 36.7 41.9 51.3 59.0 7.7** 30.5**
      Equipment only 13.8 17.5 18.8 24.4 28.7 4.3** 14.9**
      Equipment and help 14.6 19.2 23.0 26.8 30.3 3.4** 15.6**
Getting around inside 48.3 54.2 55.6 56.8 59.6 2.8* 11.3**
   Active or standby help only 8.1 8.4 6.7 7.6 6.5 -1.1 -1.7**
   Any equipment use 40.1 45.8 48.9 49.2 53.1 3.9** 13.0**
      Equipment only 23.5 27.1 28.6 28.0 30.9 2.9** 7.3**
      Equipment and help 16.6 18.8 20.3 21.2 22.3 1.1 5.7**
Transfer 33.2 36.4 36.5 44.5 41.8 -2.7* 8.6**
   Active or standby help only 9.7 9.1 8.0 9.0 8.3 -0.7 -1.4*
   Any equipment use 23.5 27.3 28.5 35.5 33.5 -2.0 9.9**
      Equipment only 10.7 13.0 12.7 17.4 15.6 -1.8* 4.9**
      Equipment and help 12.9 14.4 15.7 18.1 17.9 -0.2 5.0**
Toileting 29.6 34.3 40.3 41.4 45.7 4.3** 16.0**
   Active or standby help only 10.0 4.8 7.5 7.8 7.6 -0.2 -2.3**
   Any equipment use 19.6 29.5 32.8 33.6 30.8 4.4** 18.4**
      Equipment only 9.7 14.1 19.1 18.3 23.0 4.7** 13.3**
      Equipment and help 10.0 15.4 13.7 15.3 15.1 -0.2 5.1**
Dressing 25.4 26.7 26.6 27.3 28.1 0.8 2.6**
   Active or standby help only 23.6 24.4 23.6 24.4 24.7 0.3 1.1
   Any equipment use 1.8 2.3 2.9 2.9 3.3 0.4 1.5**
      Equipment onlya 0.7 0.9 1.2 1.1 1.3 0.2 0.6**
      Equipment and help 1.2 1.4 1.7 1.8 2.1 0.2 0.9**
Eating 12.9 13.4 14.3 16.0 16.4 0.4 3.5**
   Active or standby help only 11.9 11.8 12.8 14.1 14.7 0.6 2.8**
   Any equipment use 1.0 1.6 1.5 1.9 1.6 -0.2 0.7**
      Equipment onlya 0.2 0.3 0.2 0.3 0.4 0.0 0.1
      Equipment and help 0.7 1.3 1.3 1.6 1.3 -0.3 0.5**
NOTE:
  1. Estimates do not meet a precision standard of relative standard error less than 30%.

**(*) Indicates that difference is significantly different from zero at the 5%(10%) level in a two-tailed test.

  • Use of only help or only devices also showed a mixed pattern between 1999 and 2004.

    • For bathing, use of only help continued to decline and sole use of devices continued to increase, but use of devices with help also increased.
    • For toileting, the reduction in sole use of help did not continue, but there was a significant increase in sole use of devices and no change in use of devices with help.
    • Getting around outside had the most dramatic change between 1999 and 2004, with reductions in use of only help and in use of only devices, absorbed by a nearly 10 percentage point increase in use of devices with help, so that overall prevalence did not change.2
  • The prevalence of device use among those with each of the disabilities generally rose over the period and is high--from a little more than 70 percent to nearly 90 percent in 2004 (Figure 2, solid lines)--with the exception of dressing and eating (not shown), for which device users represent less than 10 percent.

    • The prevalence of device use for each activity was roughly stable between 1994 and 2004 with the exception of bathing, for which device use rose by 15 percentage points in that decade after having increased by a similar amount between 1984 and 1994.
FIGURE 2. Device Use and Sole Device Use by Activity
(% of those with disability in each activity)
LINE CHART: Solid Lines: Getting Around Outside--1984 (69), 1994 (71), 1999 (68), 2004 (74); Bathing--1984 (54), 1994 (69), 1999 (80), 2004 (86); Getting around inside--1984 (83), 1994 (88), 1999 (87), 2004 (89); Transfer--1984 (69), 1994 (78), 1999 (80), 2004 (80); Toileting--1984 (66), 1994 (81), 1999 (81), 2004 (83). Dashed Lines: Outside, devices only--1984 (44), 1989 (48), 1994 (46), 1999 (44), 2004 (37); Bathing, devices only--1984 (26), 1994 (31), 1999 (39), 2004 (42); Inside, devices only--1984 (49), 1994 (51), 1999 (49), 2004 (52); Transfer, devices only--1984 (32), 1989 (36), 1994 (35), 1999 (39), 2004 (37); Toileting, devices only--1984 (32), 1994 (48), 1999 (44), 2004 (52).
  • The percent using only devices among those with each disability ranged from 37 percent to 52 percent in 2004 (Figure 2, dashed lines), with notable changes for toileting, bathing, and getting around outside, whereas sole use of devices for getting around inside and transfer were relatively stable.

    • For bathing, both the proportion using only devices and the proportion using devices with help rose, so that the 86 percent of those using devices for bathing were divided roughly equally between sole device use (42 percent) and device use with help (44 percent).
    • For toileting, only sole use of devices increased, after a dip between 1994 and 1999, with no change in use of devices with help; in 2004, 60 percent of the 83 percent with disability in toileting who used devices were using them independently.
    • Conversely, for getting around outside, both use of only help and use of only devices fell, while use of devices with help rose; by 2004, slightly more than half of those using devices to get around outside were using them independently, down from about two-thirds in the previous three survey waves.

Updated Trends in Types of Devices

The strong upward trend in use of devices of all types by elders with chronic disabilities continued in the 1999-2004 period.

  • The most common devices in all years are the major types of mobility aides (Figure 3), including canes, walkers, crutches, wheelchairs and scooters, which were used by 73 percent of elders with chronic disabilities.3

    • The increase in use of mobility devices between 1999 and 2004 was attributable to increased use of walkers, from 18 percent to 23 percent; no significant occurred in the use of canes or wheelchairs and scooters (not shown).
FIGURE 3. Trend in Mobility, Other Device Use
(% of community residents with chronic disabilities)
LINE CHART: Major mobility devices--1984 (57), 1994 (65), 2004 (73); Mobility, other devices--1984 (30), 1994 (44), 2004 (56); Other devices only--1984 (15), 1994 (18), 2004 (17); Mobility devices only--1984 (27), 1994 (21), 2004 (17).
NOTE: Major mobility devices are canes, walkers, crutches, wheelchairs, and scooters.
  • The proportions using only mobility devices continued to decline, and the proportion using only other devices was stable, as the proportion using multiple devices for mobility and other activities rose continued to increase rapidly--by about 2.5 percent per year over the last decade.

  • Aside from mobility devices, simple commonly available aides for bathing and toileting were the most common in 2004, as in the earlier years, and their prevalence continued to increase significantly between 1999 and 2004 (Figure 4).

    • Railings or grab bars most commonly used for bathing or toileting, were most prevalent in 2004 (47 percent), followed by bath or shower seats (44 percent), having increased by 4.5 percent and 5.5 percent per year, respectively, over the last decade.
    • Although less prevalent, use of raised toilet seats (25 percent in 2004) and hand-held showers (20 percent) continued to grow rapidly between 1999 and 2004, while use of rubber mats (23 percent in 2004) moderated somewhat.
FIGURE 4. Prevalence of Devices with Fastest Growth
(% of community residents with chronic disabilities)
LINE CHART: Railing/grab bars--1984 (21), 1994 (30), 2004 (47); Bath/shower seat--1984 (14), 1994 (26), 2004 (44); Rubber mat--1984 (6), 1994 (10), 2004 (23); Handheld shower--1984 (2), 1994 (8), 2004 (20); Raised toilet seat--1984 (6), 1994 (15), 2004 (25).

Updated Characteristics of Device Users and Nonusers

Disability Characteristics

Estimates for 2004 indicate a similar profile of disability by device use as in 1999 among community residents with chronic disabilities, with about three in five using both help and devices, and about one in four relying solely on devices (Table 2).

TABLE 2. Disability and Support Characteristics by Device Use or Nonuse, Community Residents with Age 65 or Older with Chronic Disabilities, 2004
  Devices Only for
  All Chronic Disabilitiesa  
  Both Devices & Help  
for Chronic Disabilitiesb
Help Only for
  All Chronic Disabilitiesc  
  Number     Percent     Number     Percent     Number     Percent  
All 1,513,680 100.0 3,572,393 100.0 659,379 100.0
Disability Characteristics
Physical limitationsd
   None or upper body only 293,218 19.4** 208,758 5.8** 141,364 21.4
   Lower body only 702,974 46.4** 966,233 27.0* 221,894 33.7**
   Both upper and lower body 517,489 34.2** 2,397,402 67.1** 296,121 44.9**
Cognitive impaired 84,017 5.6** 978,956 27.4** 228,394 34.6**
Disability level
   IADL only 254,430 16.8** 142,706 4.0** 400,167 60.7**
   1-2 ADLs 1,021,537 67.5** 1,142,289 32.0** 165,157 25.0**
   3-4 ADLs 235,698 15.6** 1,133,434 31.7** 29,590 4.5**
   5-6 ADLs 2,015 0.1**# 1,153,964 32.3** 64,465 9.8**
Duration of chronic disability
   Less than 1 year 186,167 12.3 357,702 10.0** 93,732 14.2
   1 year to 5 years 708,143 46.8 1,778,609 49.8 350,582 53.2*
   5 years or longer 619,370 40.9 1,436,082 40.2** 215,065 32.6**
Help/equipment with any ADL most of the time   923,589 61.0** 3,033,550 84.9** 71,755 10.9**
Unmet need for help/more help with any ADL 7,268 0.5**# 990,064 27.7** 113,938 17.3**
Unmet need for help with any IADL 409,494 27.1** 1,872,018 52.4 311,572 47.3**
Support Characteristics
Living arrangement
   Alone 812,715 53.7** 1,285,057 36.0** 159,756 24.2**
   With spouse 513,932 34.0 1,268,438 35.5** 288,208 43.7**
   With others 187,034 12.4** 1,018,898 28.5 211,415 32.1**
Residential type
   Private residence 1,224,996 80.9 2,801,366 78.4** 581,535 88.2**
   Community residential caree 84,259 5.6** 434,418 12.2** 34,118 5.2
   Other setting for older or disabled persons 204,425 13.5** 336,609 9.4* 43,726 6.6**
   Any home accommodative features presentf 925,850 61.2** 2,439,724 68.3** 180,705 27.4**
   Any home accommodative features desirablef 548,871 36.3** 1,670,536 46.8** 213,571 32.4
Education
   Less than high school 493,805 32.6** 1,546,205 43.3 307,389 46.6**
   High school graduate 472,049 31.2* 970,896 27.2 184,007 27.9
   Some college 547,826 36.2** 1,055,292 29.5 167,984 25.5**
Categorical income
   Less than $10,000 263,915 17.4** 905,449 25.3 151,148 22.9
   $10,000 - $20,000 570,487 37.7 1,308,197 36.6 216,862 32.9
   $20,000 - $30,000 314,761 20.8 682,561 19.1 152,751 23.2
   $30,000 or more 364,517 24.1** 676,186 18.9 138,618 21.0
NOTES: # estimate does not meet the precision criterion of standard error less than 30% of estimate. Significance assessed in two-tailed tests.
  1. **(*) denotes a significant difference between those using only devices and those using both help and devices at the 5%(10%) level.
  2. **(*) denotes a significant difference between those using both help and devices and those using only help at the 5%(10%) level.
  3. **(*) denotes a significant difference between those using only help and those using only devices at the 5%(10%) level.
  4. Somewhat/very difficult/unable to do an activity. Lower body: climbing stairs, walking across a room, bending, lifting and holding a 10-pound package. Upper body: reaching above head, combing/brushing hair, washing hair, and grasping and holding small objects. <3% had only upper body limitations.
  5. Assisted living, foster or family care, group home/community residential facility, or board and care services. (See Spillman and Black 2005.)
  6. Includes handrails or grab bars, ramps, elevators/chair lifts, extra wide doors or hallways, push bars on doors, and raised toilet seats.
  • Those using both devices and help continued to have a higher disability level than those relying solely on either devices or help.

    • Two in three of those using both devices and help had physical limitation in both upper and lower body activities, compared with about one in three of those using only devices and 45 percent of those relying solely on help.
    • About two-thirds also reported at least three ADLs, whereas a similar proportion of those using only devices had 1-2 ADLs, and 60 percent of those relying solely on help had disability only in IADLs.
  • The rate of cognitive impairment, which could not be examined in the 1999 data, was highest (35 percent) in the less severely disabled group using only help, and very low (less than 6 percent) in the group using devices only.

  • As in 1999, there were no striking differences across the groups in the duration of disability, although those receiving only help were less likely to have very long duration of 5 years or more.

  • Rates of unmet need were higher in 2004 than in 1999 for all groups, although, as in 1999, the group using only both help and devices was most likely and those relying only on devices least likely to report unmet need.

    • Unmet need for ADL help rose from about 21-28 percent among those using both help and devices and from about 11-17 percent among those using only help; unmet ADL need continued to be virtually nonexistent for those using only devices.
    • Unmet need for IADL help was reported by more than half of those using help and devices and nearly of those using only help, but also by more than a quarter of those using only devices.

Support Characteristics

Some notable changes in support environment and resources occurred between 1999 and 2004.

  • Those managing all disabilities with devices were still most likely to live alone and those using only help were still most likely to live with a spouse, although the proportion of this group living with persons other than a spouse increased from about one-quarter to nearly one-third.

  • Residential care became more common for all three groups, but increased most for those using both help and devices, from about 7 percent in 1999 to about 12 percent in 2004, a little more than twice the proportion for the other two groups.

  • Larger proportions of all three groups had accommodative features in their homes and identified features that would be desirable in 2004. Nearly 70 percent of those using help and devices, more than 60 percent of those using only devices had at least one accommodative home feature, compared with less than 30 percent of those using only help.

  • The level of education, which can be associated with greater adaptation to changing function, also rose across all three groups, but continued to be highest among those relying solely on devices and lowest among the group using only help.

  • As in 1999, those using only devices were least likely to have income below $10,000 and most likely to have income of $30,000 or more, although the differences across the groups were not striking.

TABLE 3. Mean Hours of Care in the Last Week for Device Users and Nonusers, 2004
  Devices and
  Personal Assistance  
Personal
  Assistance Only  
  Difference  
All 39 26 13**
Physical limitations
   None or upper body only 27 21 6
   Lower body only 23 30 -7
   Both upper and lower body 46 26 20**
Cognitive impaired 62 32 30**
Disability level
   IADL only 23 21 2
   1-2 ADLs 21 27 -6
   3-4 ADLs 26 27 -1
   5-6 ADLs 68 48 20*
Duration of chronic disability
   Less than 1 year 35 24# 11
   1 year to 5 years 39 26 13**
   5 years or longer 40 27 13**
Any ADLs with help/devices most of the time   41 30# 11
Help needed or more help needed with any ADL
   No 35 23 12**
   Yes 47 37 10
Help needed with any IADL for which no help received
   No 42 27 14**
   Yes 36 24 12**
NOTE: **(*) denotes that difference is significantly different from zero at the 5%(10%) level in a two-tailed test. # indicates that estimate does not meet the precision criterion of standard error less than 30% of estimate.

Hours, Device Use, and Independent Device Use

  • As in 1999, hours of care in the last week generally rose with level of disability for both groups, and were higher for the group using both help and devices than for the group using only help, consistent with their higher average level of disability (Table 3).

    • The largest differences--20 hours or more per week--are for those with both upper and lower body limitations, cognitive impairment and very high levels of ADL disability.

    • Interestingly, for both groups, those reporting unmet need for help or more help with at least one ADL were receiving more hours of help those reporting no need.

  • Within the group using both help and devices, those able to manage at least one disability with only devices received significantly fewer hours of care in the previous week (Figure 5).

FIGURE 5. Hours of Care in Last Week among Those Using Both Help and Devices
BAR CHART: No ADLs performed with devices only--All (55), 1-2 ADLs (25), 3-4 ADLs (40), 5-6 ADLs (73); 1+ ADLs performed with devices only--All (23), 1-2 ADLs (19), 3-4 ADLs (21), 5-6 ADLs (45).
NOTE: Difference in hours between those performing some activities with devices and those using devices with help statistically different at the 5% level in a two-tailed test.

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