Biomedical subjects

E M Agree

Publications and source records attributed to E M Agree.

5 recordsLinked to original sources

PubMed2000

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.

Activities of Daily Living↗

PubMed1999

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.

Activities of Daily Living↗

PubMed1999

Racial differences in skilled nursing care and home health use: the mediating effects of family structure and social class.

OBJECTIVES: This study investigates whether utilization of skilled nursing facility (SNF) care and Medicare home health differ by race. It then seeks to understand the extent to which family structure and social class explain any differences observed. METHODS: Linking measures from the 1989 National Long-Term Care Survey with Medicare claims data, we model SNF care and home health use as competing risks using a Cox proportional hazards model. Age at first use is the outcome measure, consistent with the analysis of long-term care use as a life-course transition. RESULTS: Blacks postpone both home health and SNF care until later ages than Whites, and both children and grandchildren play a part in deferring their use until even later ages. When formal assistance is needed, Blacks are more apt than Whites to use home health over SNF care. The race difference in SNF use is even greater than that previously reported for all types of nursing home use combined. Social class has little influence on the risk differential. DISCUSSION: Contrary to expectations, Black elders are not counterbalancing their lower rate of SNF use with a higher rate of home health use. This suggests that there are differences in need, preference, or access that are yet to be identified. Future research should consider the relationship between family structure and informal caregiving, variation in physician referral patterns by race, and the availability of long-term care in traditionally African American communities.

Black or African American↗

PubMed1990

Family, households, and care arrangements of frail older women: a structural analysis.

Previous research has examined determinants of the living arrangements and the informal-care arrangements of older women; research on care arrangements has often taken living arrangements as given. Here we consider each separately, then go on to analyze the simultaneous determinants of living and care arrangements. Factors influencing these outcomes can be categorized as indicators of opportunities, resources, needs, or preferences. Of particular interest is the extent to which kin availability--specifically, the existence of living children--constrains opportunities, the role of financial resources, and the consequences of needs as revealed by levels of physical and mental disability. Our analysis consists of multinomial-logit models estimated with data from the 1982 National Long-Term Care Survey. The results indicate the importance of kin availability, with striking differences in the living and care arrangements between childless and other older women. Among those with children, there are less striking but consistent differences according to the number and sex composition of living children. Finally, variables representing needs for care are generally the strongest predictors of all the outcomes analyzed.

Activities of Daily Living↗

PubMed1988

America's elderly.

The older population in the US has grown twice as fast as the rest of the population in the last 20 years. This growth is expected to accelerate early in the next century as the large baby boom cohorts move through middle age and become elderly. Today, about 1 in 8 Americans is 65 years of age or older. By 2030, 1 out of every 4 persons will be in older person. Substantial improvements in life expectancy at all ages, particularly at extreme old age, mean that not only will there be a greater proportion of elderly in the population, but the more will be the "oldest-old," over 85. By 2050, they will be more than 1/4 of the population. As people live longer, many are active and healthy well past retirement. However, many individuals living into their 80s have to cope with chronic disabilities affecting their capacity to perform day-to-day activities. Modern medicine has made great inroads against mortality from such illnesses as heart disease and stroke, but has not eliminated all the effects of these diseases. As the population ages, the issues of health care funding and availability, particularly long-term care, increase in importance. Contrary to widespread belief, the elderly are not abandoned by their families to nursing home care. The vast majority--95%--live in the community. Those needing assistance generally receive help from family and friends. This has created a tremendous demand for federal subsidies to support community-based long-term care services. 1/4 of the federal budget is now spent on the elderly--$270 billion in 1986. Medicaid and Medicare are among the government's success stories, but these programs are threatened by their very success. Economists estimate that government expenditures are 3 times greater for the elderly than for children, raising the issue of "intergenerational equity"--how to balance the amount of care society provides to those who have already contributed with what is provided to those who will contribute in the future. The view that the young and old simply compete for fixed resources is misleading. It ignores the interdependence among generations, and the burdens and benefits of intergenerational transfers at all stages of the life course.

Adult↗