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Updated Analyses of Trends in Use of Assistive Devices

Publication Date



Updated Analyses of Trends in Use of Assistive Devices

Executive Summary

Brenda Spillman

Urban Institute

January 7, 2013
REVISED January 20, 2014


Overview of 20-Year Trends (1984-2004) in Assistive Device Use in the Older Population

Assistive device use by Medicare beneficiaries age 65 or older with chronic disabilities more than doubled over the 20-year period from 1984 to 2004, based on estimates from five nationally representative cross-sections from the National-Long Term Care Survey. In 2004, one in four chronically disabled elders relied on assistive devices only (without help from others), nearly two in three used both devices and help, and only one in seven relied solely on help. Simple devices for mobility, bathing, and toileting--walkers, canes and crutches, tub of shower seats, and raised toilet seats--were most common and saw the largest increases. Among mobility devices, wheelchairs and scooters nearly doubled in prevalence, but use of walkers was twice as prevalent as wheelchairs and scooters and increased the most. Older persons using devices typically also had at least one accommodative feature in their homes (60 percent of persons relying solely on devices and 70 percent of those receiving help and using devices, compared with only 30 percent who relied solely on help).


Comparison of Earlier and More Recent Trends

The large increases in the rate of device use observed between 1984 and 1999 continued in 2004, but contrary to the earlier trend, between 1999 and 2004, the increase was driven by combined use of devices and help rather than sole use of devices.


  • Between 1984 and 1999, the proportion of chronically disabled community residents using assistive devices, with or without help, for all activities in which they had limitation doubled to nearly 30 percent; the proportion relying solely on help fell. Almost 1 million more elders were using equipment with at least one activity in 1999 than in 1984.

  • Most of the increase in device use was in independent use. Nearly one-quarter of elders with chronic disabilities managed all disabilities with only devices in 1999, and almost two-thirds used devices independently for at least one activity.


  • The upward trend in assistive device use continued at about the same pace between 1999 and 2004, so that the overall prevalence rose from 86 percent of community residents with chronic disabilities to 90 percent.

  • The combined effect of the increase in the older population with disabilities from 5.1 million to 5.7 million and the higher prevalence of device use was an increase of nearly 800,000 persons using devices for at least one activity, nearly as large as the increase of 1 million persons in the preceding 15 years.

  • Contrary to the earlier trend, the increase in device use reflects increased use of both help and devices for at least one activity; the prevalence of sole use of devices for all activities was 26 percent in 2004, essentially unchanged from 1999.


Device Use, Hours of Disability Assistance, and Unmet Need for Help

Exploratory cross-sectional multivariate analyses controlling for disability level and other characteristics found statistically significant associations of independent use of devices with fewer hours of help but not with higher rates of reported unmet need for help. Results were generally similar for all persons using both help and devices and among the subset who received help but managed at least one activity with only device use.

  • Each activity performed independently with devices is associated with six fewer hours of care per week for the full sample of persons using devices and help and nearly five fewer hours among those using only devices for at least one activity.

  • For the full sample, each activity performed independently with devices was associated with three fewer informal hours per week; although the magnitude was only slightly smaller for those using devices only for at least one activity, the difference is not statistically significant.

  • In both samples each activity performed solely with devices was associated with significantly fewer formal care hours.

  • Although the magnitudes were small, each activity managed with devices alone was associated with significantly lower rates of unmet need for both activities of daily living (ADLs) and instrumental activities of daily living in the full sample and a significantly lower rate of unmet need for ADLs within the subset using devices only for at least one activity.


Implications for Long-Term Care Services Use

  • The proportion of community-residing elders with chronic disabilities accommodating their functional limitations through use of both help and devices reached nearly two in three in 2004.

  • The group using both assistive devices and help had higher levels of disability than those managing disabilities with only devices or only help, making them an important target for potential policies to promote independent functioning and supporting informal caregivers.

  • The change in the driver of rising assistive device use from sole reliance on devices to use of both devices and help may be related to the increasing rate at which elders with severe chronic disabilities are receiving care in community settings.

  • Findings from cross-sectional multivariate analyses suggest the potential for assistive device use to reduce hours of paid and unpaid help without increasing unmet need for help, but more research is needed to confirm this potential.


Implications for Long-Term Care Policy

  • Although Medicare is a third party payer for many devices through its coverage for durable medical equipment (DME), coverage policies have not changed substantially over the 20-year period of rising device use, so the increases in device use cannot be attributed to deliberate policy efforts.

  • More aggressive marketing to an aging population, Medicare provider behavior, and other market factors related to the Medicare DME benefit may have contributed, however.

  • An implication of the study findings is that policy interventions designed to assist elders and their caregivers in identifying and acquiring appropriate devices might be able to increase independence, reduce hours of formal and informal care needed, and reduce informal caregiver burden, without increasing unmet need. Subsidiary findings suggest that home modifications may be an important part of such interventions.


The Full Report is also available from the DALTCP website ( or directly at