摘要：Objectives . This study examined whether use of equipment (technological assistance) to cope with disability was associated with use of fewer hours of help from another person (personal assistance). Methods . In a cross-sectional study of 2368 community dwellers older than 65 years with 1 or more limitations in basic activities of daily living (ADLs) from the 1994 National Long Term Care Survey, the relation between technological assistance and personal assistance was examined. Results . Among people with ADL limitations, multivariate models showed a strong and consistent relation between technological assistance and personal assistance, whereby use of equipment was associated with fewer hours of help. Conclusions . Among people with disability, use of assistive technology was associated with use of fewer hours of personal assistance. Personal assistance and technological assistance are the 2 basic modes of coping with limitations that interfere with the ability to complete activities of daily living (ADLs) and other tasks. Personal assistance refers to help that disabled persons receive from others, such as a spouse, child, friend, or paid caregiver. Help from another person does not enable people to function more independently, but it may reduce the difficulty experienced when attempting to perform a given task. Technological assistance refers to the use of equipment (wheelchairs, canes, walkers, raised toilet seats) to allow performance of daily activities. Equipment usually is provided to enable persons with difficulty performing their ADLs to function more independently than they would otherwise be able to do. From a theoretical perspective, both technological and personal assistance are contextual factors that act to modify the disablement process, reducing the severity of disability. 1, 2 Agree 3 and Smith 4 expanded this theoretical framework by elaborating methods for modifying disability, including reducing the task demands through environmental modification or technology, substituting another person to complete some or all of the task, and altering the performance of the given activity (e.g., going out less often, performing a bed bath instead of a tub bath). Agree and Freedman 5 suggested that the nature of the task, the characteristics of the person, the device, and the caregiver potentially influence the methods used to cope with disability. It is unknown to what extent various strategies may be interchangeable. For example, 1 potential outcome of reducing the task demands through use of technological assistance might be a decrease in the number of hours of personal assistance used for daily tasks. On the other hand, help from another person might be obtained to avoid using a piece of equipment, such as avoiding perceived stigma from a cane by leaning on the arm of a loved one. Clearly, technological assistance or personal assistance might be used for some tasks and not for others, technological assistance or personal assistance might be used only some of the time, and use of technological assistance or personal assistance for certain tasks might vary over time. However, regardless of whether a device is used to supplement or to substitute for personal assistance and of whether it is used some of the time or all of the time, the potential for appropriate equipment to reduce use of personal assistance is apparent. For example, common sense indicates that a hydraulic lift might reduce the time required to transfer a paralyzed patient from the bed to a chair; a raised toilet seat and grab bars might eliminate the need for help from another person when using the toilet; and use of a portable oxygen tank might enable independent mobility when otherwise exertional dyspnea might necessitate assistance from another person. Overall, use of technological assistance has increased at much higher rates than might be expected from the aging of the population alone. 6, 7 Whereas the US population increased by 19.1% from 1980 to 1994, the (age-adjusted) use of leg braces increased by 52.1%, canes by 37.0%, walkers by 70.1%, and wheelchairs by 82.6%. 8 Over the same period, use of home health services increased by more than 800%. 9 We urgently need to understand the respective merits of differing approaches to coping with disability. Although caregiving has been studied extensively, 10, 11 data on outcomes of any sort associated with the use of assistive technology are extremely limited. 4, 12 The goal of our study was to examine whether use of equipment to cope with disability was associated with use of fewer hours of help from another person. We chose to examine the effect of equipment use on hours of help rather than the reverse because of the potential humanitarian and financial benefits of reducing dependence on personal assistance (e.g., enabling persons without social support to maintain independence, reducing caregiver strain, lowering ongoing costs of care by reducing use of paid caregivers) and because of the relative paucity of data on the use of technological assistance as a coping strategy. We hypothesized that technological assistance might act as a buffer, reducing the number of hours of help used.
