Emily M. Agree

The influence of personal care and assistive devices on the measurement of disability

The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.

Incorporating assistive devices into community-based long-term care: an analysis of the potential for substitution and supplementation.

Objectives:This article examines the use of assistive devices as a part of the long-term care arrangements of community-dwelling older Americans. It examines the potential for assistive devices to substitute for and supplement personal care assistance. Methods:Data from the Phase 2 Disability Supplements to the 1994-1995 National Health Interview Surveys are used to compare the use of personal care and equipment among persons reporting difficulty with a given activity of daily living. Results:The capacity of equipment to substitute for or supplement personal care is highly task-specific and depends on the characteristics of the devices and the personal care providers. In general, those using simple devices are less likely to use informal care, whereas those using complex devices are more likely to use formal care services. Discussion:Technology has the potential to confer quality of life enhancements for older persons and their caregivers and cost savings for payers.

Community Aging in Place, Advancing Better Living for Elders:: A Bio-Behavioral-Environmental Intervention to Improve Function and Health-Related Quality of Life in Disabled Older Adults

To determine effect size and acceptability of a multicomponent behavior and home repair intervention for low‐income disabled older adults.

Factors Influencing the Use of Mobility Technology in Community-Based Long-Term Care

Objectives: This article adapts a framework commonly used to model personal long-term care services to examine factors influencing the use of mobility-related assistive devices, both in isolation and in combination with personal care. Methods: The authors analyze data from Phase 2 of the 1994-1995 National Health Interview Survey Disability Supplements to compare predictors of equipment use with those for personal care and rank the probabilities of using particular combinations according to health needs, access, and personal and family characteristics. Results: The authors find that underlying health needs are the dominant factor related to the type of care arrangement used. The typical person with a mobility-related disability is most likely to use equipment alone; only at younger ages or at greater levels of severity are other arrangements expected to dominate. Discussion: Research on the dynamic acquisition process, with attention to age and trajectories of disability severity, is needed to fully understand the integration of technology and personal care.

Validation of New Measures of Disability and Functioning in the National Health and Aging Trends Study

BACKGROUND Measurement gaps continue to hamper fuller understanding of late-life disability trends and dynamics. This article reports findings that validate the self-reported components of the disability protocol to be used in the new National Health and Aging Trends Study. The protocol was designed to redress existing measures by attending to environmental aspects of disability, capturing a broader range of capacity to perform tasks and including participation restriction items. METHODS We undertook an in-person validation study to determine the reliability, validity, and initial measurement properties of the National Health and Aging Trends Study self-reported disability protocol (n = 326). A random subset (n = 111) was readministered the protocol within 2-4 weeks. The interview and reinterview included new self-reported measures of physical capacity, activity limitations, and participation restrictions, as well as established performance and cognitive tests. We calculated percent agreement and kappa between interviews for all self-reported items and summary measures. We also assessed the construct validity of summary measures through correlations with demographic characteristics, frailty, memory, and performance-based mobility and confirmed whether activity limitations and participation restrictions were distinct domains. RESULTS New items and derived summary measures demonstrate robustness over a short time period, with kappas for retained/recommended items in the .60-.80 range. The summary measures correlate as expected with age, sex, residential status, and established performance-based constructs. Two factors, representing activity limitations and participation restrictions, were confirmed. CONCLUSIONS The National Health and Aging Trends Study protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed and preserving key conceptual distinctions.

Differences in disability among older women and men in Egypt and Tunisia

Research on child survival and health has indicated disparities between boys and girls in selected Middle Eastern countries. Health disparities in later life are understudied in this region. In this article, we examine differences between women and men in later-life activity limitation in Egypt and Tunisia. Difficulty executing physical tasks is more common for women than for men in both study sites, although differences are smaller after adjustment for underlying illness. Differences in the difficulty of executing physical tasks also are sensitive to environmental controls in variable ways across the study sites. The findings caution against the sole use of reported disability in comparative studies of gender and aging.

Intergenerational transfers of resources between older persons and extended kin in Taiwan and the Philippines

This study examines the extent to which older generations actively exchange resources with extended kin in Taiwan and the Philippines. It is critical to understand the position of older generations in the family, because population ageing and declines in family size spur concerns about the tenacity of family support. This research builds upon previous studies that have predominantly focused on parent–child relationships alone or on support received by older parents. Social-network measures are used to estimate overall levels of transfers of resources across generations, and the prevalence and patterns of pathways that link generations and types of kin. Our findings show that the availability of kin is similar in both settings but that transfer activity in the Philippines appears more broadly distributed across family relations, especially siblings, while in Taiwan transfers are more concentrated among lineal kin. These results confirm the importance and diversity of extended kin in systems of family support.

Behavioral Adaptation and Late-Life Disability: A New Spectrum for Assessing Public Health Impacts

OBJECTIVES To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations. METHODS We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n = 8077). For 7 mobility and self-care activities we identified 5 hierarchical stages--fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help--and explored disparities and associations with quality of life measures. RESULTS Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed. CONCLUSIONS Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life.

Gender and Disability Among Older Adults in North and South India: Differences Associated with Coresidence and Marriage

Women in most settings are morelikely than men to experience as well as reportpoor health and functional disabilities. Studies in the economically advanced countries(as in the US) have also shown an associationbetween gender, marital status and health anddisability. However, there is very littleinformation about gender differentials indisability among the elderly in developingcountries, especially those in South Asia. Also, little is known about the associationbetween gender, marital status, coresidencewith sons, and disability among older adults inthese countries.This study uses data from the National FamilyHealth Survey conducted in India in 1991–1992 toassess the gender disparities in functionalhealth among persons 55 years and older and tocompare the situation in the northern andsouthern parts of the country. Using logisticregression analysis, this study examines therelation between marital status, livingarrangements and functional status of olderadults in the states of Uttar Pradesh andHaryana in the north and Kerala and Tamil Naduin the south.The results confirm a female disadvantage inphysical impairments in the northern states,although these differences are not significantin the south. Marital status and coresidencewith sons is associated with impairments andthese associations show interestinginteractions.

A quality-of-life scale for assistive technology: results of a pilot study of aging and technology.

Background In an aging society, it is increasingly important to understand how assistive devices can be used by older people to maintain quality of life despite chronic disabilities. Assistive technology is a mainstay of physical therapist practice, but the potential for device use to affect psychosocial well-being is not yet understood at the population level. Objective The objective of this study was to develop a parsimonious indicator that can be used in population-based surveys to represent the effect of assistive technologies on quality of life for older people, separate from personal assistance. Design This study was a cross-sectional survey. Methods The methods used in this study were psychometric scale development and structural equation modeling. Results The results indicated that a parsimonious, valid, and reliable scale reflecting quality of life related to assistive device use can be created from 3 questions designed to measure improvements in safety, control, and participation due to technology. The findings also suggested that assistive technology may more effectively improve quality of life for people with greater levels of functional limitations. Limitations The data were derived from a cross-sectional survey conducted by telephone. The use of personal assistance, on average, was low; thus, the applicability to a population with more profound care needs has yet to be confirmed. Conclusions Determining the broader impact of assistive technology on quality of life with population-level measures may provide insight into how best to leverage technologies to prevent dependence in aging adults.