Age and Ageing 1998; 27: 463-468
© 1998, British Geriatrics Society
Ownership and use of assistive devices
amongst older people in the community
NIA
I.
EDWARDS, DEE
A.
JONES
University Department of Geriatric Medicine, University of Wales College of Medicine, 3rd Floor. Academic Centre,
Llandough NHS Trust, Penlan Road, Penarth, South Glamorgan, CF64 2XX, UK
Address correspondence to : D. A. Jones. Fax: (+44) 1222 716091
Abstract
Aims: to determine the ownership and use of various assistive devices by older people living at home.
Method: a random sample of 1405 elderly people aged 65 years and over, in three health authorities, were asked
about ownership and use of a number of disability aids, spectacles and hearing aids.
Results: 74% of respondents owned one or more aid, 97% had spectacles and 16% a hearing aid. The most
commonly owned assistive devices were a non-slip bath mat (50%), a walking stick (24%) and a bath rail (21%).
Many severely disabled people, however, had no aids. For example, 75% had no stair rail, 68% had no lavatory rail
and 46% had no non-slip bath mat. Most of the equipment owned was used. Walking frames and wheelchairs were
used more by those over 75, as were all bathroom and lavatory appliances. Gender influenced the use of some aids,
with more women using their walking frames and bathroom rails than men.
Conclusion: our study confirms that ownership and use of aids varies with age, gender, living arrangements and
disability. Very disabled people need but do not own certain basic and relatively inexpensive appliances.
Community services currently aim to promote autonomy and independence in elderly people in the community.
This may be facilitated and enhanced by provision of appropriate equipment and increasing awareness of the value
of assistive devices among elderly people, informal carers and health- and social-care professionals. Knowledge of
who owns and uses various items of equipment may help improve strategic planning.
Keywords: assistive devices, disability, older people
Introduction
The number of people aged 65 years and over in the UK
is expected to rise from 8.4 million in 1985 to 9 million
by the year 2001 [1]. The greatest growth is to be found
amongst the 'oldest old' (i.e. those aged 85 years and
over), with a projected rise from 8 to 13% by the turn of
the century. Ninety-five percent of elderly people aged
65 years and over live at home and many of these will
eventually require help to continue living independently.
The International Classification of Impairment,
Disabilities and Handicaps [2] has influenced the way
in which impairments, disability and handicaps are
addressed and can help to identify community needs
[3].
Assistive devices can potentially compensate for
disability and lessen handicap and thus increase
independence and improve quality of life.
Over 25 years ago, the 1970 Chronically Sick and
Disabled Persons' Act made it a duty of local authorities
in the UK to ensure that disabled people had sufficient
practical assistance in their own homes. In 1971, the
Department of Health and Social Security called for "a
greater provision of simple personal aids and domestic
equipments as well as installation of appropriate
adaptations to the home" [4]. More recently, promotion
of an independent lifestyle at home and avoidance
of institutionalization of elderly people, were key
objectives of the 1990 Community Care Act [5].
The ownership and usage of assistive devices has
principally been investigated in disabled elderly people
living at home. Comparatively little research exists on
the ownership and use of assistive devices by 'normal'
random elderly populations. To date, the available
findings provide conflicting results: in their generalpractice-based sample, George and co-workers found
"many aids that the elderly had were faulty or not used"
[6], however, IIiffe et at. found most of their sample
used their equipment [7]. Previous study samples have
been either relatively small in size, general-practitionerbased or confined to disabled elderly people and hence
may not be representative.
463
N. I. Edwards, D. A. Jones
Table I. Ownership of assistive devices by age
No. (and %) of subjects, by age
Device
<75 years
>75 years
Walking stick
Two sticks
Walking frame
Wheelchair
Crutches
Lavatory rail
Raised lavatory seat
Commode
Bathroom rail
Non-slip bath mat
Bath seat
Bath board
Stair rail
Bed hoist
192 (24%)
21 (3%)
13 (2%)
16 (2%)
6 «1%)
73 (9%)
26 (3%)
49 (6%)
141 08%)
424 (53%)
45 (6%)
61 (8%)
10603%)
4 «1%)
227 (39%)
20 (3%)
38 (6%)
34 (6%)
6 (1%)
100 (17%)
47 (8%)
85 (15%)
191 (32%)
342 (57%)
81 04%)
98 (17%)
99 (17%)
70%)
p
<0.0001
NS
<0.0001
<0.0001
NS
<0.001
<0.001
<0.001
«WOOl
NS
<0.0001
<0.0001
NS
NS
NS, not significant: P > D.DS.
As part of a large study of health and well-being, we
interviewed a random sample of community-based
older people about their ownership and use of assistive
devices. Other findings from this study have been
published elsewhere [8). Our objectives were to (i)
establish the prevalence of assistive devices, spectacles, hearing aids and means of summoning help, (ii)
determine their usage and (iii) ascertain the relationship between ownership and age, gender, living
arrangements and disability.
Methods
A random sample of 500 people aged over 65 years was
selected from each of three Family Health Service
Authority registers in South Wales. Randomization was
achieved by means of an established Family Health
Service Authority randomizing computer program. The
total population of the three health authorities is
approximately 1.6 million. With reference to Webber
and Craig's review [9) on socio-economic classification
of local authority populations, the selected sample
reflected the general population of England and Wales.
Each person was interviewed in his or her home by a
trained, experienced fieldworker, using a structured
interview schedule. The interviewers introduced themselves, outlined the nature of the study and requested an
interview. They then asked about sociodemographic
factors including age, sex and living arrangements and
assessed functional and physical disability by means of
the Townsend scoring system [10). This assessment of
disability and dependence has often been used in larger
samples of older people living in their own homes. The
scoring system includes questions on the ability of an
464
older person to manage nine basic functions when alone.
These functions vary from cooking a meal to carrying
heavy shopping and the overall score ranges from 0 to
18. Four categories were identified from the scores: no
disability and some, moderate or severe disability.
Specific questions were asked about ownership and
use of mobility aids, bathroom and lavatory appliances,
stair rails and bed hoists (i.e. a hoist to assist in lifting a
person from the bed). A comprehensive list is shown
in Table 1. For the purposes of the questionnaire,
respondents were regarded as using their aids and
appliances regularly if they used them at least once a
fortnight. Respondents were also asked if their mobility
aids were used inside or outside. Finally, enquiries were
made about ownership of spectacles and hearing aids
and means of summoning assistance. This study did not
ask who had supplied the equipment as the results
would not have been valid: elderly people are often
unsure whether it was health or social services that
supplied their aids; moreover, in some areas the two
services have a shared budget for equipment.
Statistical analysis of the data was performed by the
x2 test, with a P value of <0.05 defined as significant.
Further analysis was performed by means of the
Mantel- Haenszel test for trend. Full details of the
methodology have been published previously [8].
Results
Of those subjects randomly selected, 1405 (95%) were
successfully interviewed, with similar numbers from
each district agreeing to participate. The respondents
included 559 men (40%), with 806 (57%) aged 65-74
years and 599 (43%) aged 75 years or over.
Use of assistive devices by older people
Table 2. Ownership of assistive devices by gender
No. (and %) of subjects, by gender
Device
Male
Female
P
Walking stick
Two sticks
Walking frame
Wheelchair
Crutches
Commode
Raised lavatory seat
Commode
Bathroom rail
Non-slip bath mat
Bath seat
Bath board
Stair rail
Bed hOist
196 (35%)
20 (4%)
31 (1 %)
10 (2%)
4 «1%)
31 (6%)
26 (5%)
31 (6%)
110 (20%)
295 (53%)
50 (9%)
56 (10%)
71 (13%)
6 «1%)
223 (27%)
21 (3%)
44 (5%)
40 (5%)
8 (1%)
7900%)
47 (6%)
7900%)
222 (26%)
471 (56%)
76 (9%)
10302%)
134 (16%)
5 «1%)
<0.0001
NS
<0.0001
<0.001
NS
<0.001
NS
<0.001
<0.0001
NS
NS
NS
NS
NS
NS, not significant: P > 0.05.
Ownership of assistive devices
We found no statistical difference in the ownership and
use of assistive devices between the populations of the
three health authorities studied. One thousand and
forty respondents (74%) owned at least one aid
(excluding spectacles and hearing aids). The most
commonly owned mobility aid was found to be a
walking stick: 419 subjects (30%) owned one and 41
(3%) owned two. The most commonly owned appliances were non-slip bath mats [owned by 766 subjects
(55%)] and bathroom rails [owned by 332 subjects
(24%)].
Ownership of one or more devices increased with
age: 1095 (67%) of those under 75 owned one or
more aids compared with 985 (83%) of those aged
75 years and over (P < 0.00(1). Of the mobility aids,
walking sticks, walking frames and wheelchairs were
Significantly more prevalent in the over-75 group
(Table 1). All lavatory and most bathroom appliances
were also significantly more prevalent in the older age
group (Table 1). Gender significantly affects ownership
of some aids: 1303 (76%) women owned one or more
assistive devices compared with 777 men (70%; P <
0.00(1). More men than women had walking sticks
and significantly more women than men had walking
frames, wheelchairs and commodes (Table 2). Bathroom rails were owned more often by women than
men, but no gender effect on ownership of other
appliances was observed.
Ownership of some mobility aids also varied with
living arrangements. An association between ownership of a wheelchair, walking frame or a commode and
living with others-compared with those living alone,
with their spouse or with their spouse and others-
was found. For example, of those with a wheelchair, 21
(12%) lived with others, eight (2%) lived alone, 19 (3%)
lived with a spouse and two (2%) lived with a spouse
and others (P < 0.0001). A similar situation was found
with ownership of walking frames and commodes. A
significant association between ownership of a bathroom rail and living alone was found [living alone 156
(32%) versus living with spouse 133 (21%) versus
living with spouse and others 13 (11%) versus living
with others 30 (17%) (P < 0.0001)]. No other relationships between living arrangements and ownership of
bathroom or lavatory appliances were found.
Ownership of all mobility aids and all lavatory
appliances, together with most bathroom appliances,
varied with the degree of disability of respondents
(Table 3). However, many severely disabled people
lacked assistive devices. Of the severely disabled
respondents, 68% had no lavatory rail, 80% had no
raised lavatory seat, 46% had no non-slip bath mat and
62% had no bathroom rails (Table 3).
Use of assistive devices
Most (64-92%) of the aids were used (Tables 4 and 5).
Use of mobility aids varied from 11 « 1% of the
population) for crutches to 313 (22%) for walking
sticks. Eleven people used a bed hoist while 707 (50%)
used a non-slip bath mat.
Use of mobility aids was commoner in those aged 75
years and over. For example, 30 (5%) of those aged 75
years and over used a walking frame compared with
seven (1%) aged under 75 years (P < 0.00(1). Similarly,
30 (5%) over 75 but only 15 (2%) under 75 used a
wheelchair (P < 0.001). The use of all bathroom and
lavatory appliances was commoner in the 75 and over
465
N. I. Edwards, D. A. Jones
Table 3. Ownership of assistive devices by disability
Number (and %) of subjects, by disability
None
Moderate
Severe
Device
n
No.
%
No.
%
No.
%
One stick
Two sticks
Crutches
Walking frame
Wheelchair
Commode
Rail in lavatory
Raised lavatory seat
Bathroom rail
Non-slip bath mat
Bath seat
Bath board
Bed hoist
Stair rail
1396
1403
1403
1405
1403
1377
1404
1404
1403
1401
1401
1402
1404
1404
38
1
1
1
0
9
22
5
45
172
13
12
2
25
10
<1
<1
<1
0
2
6
1
11
43
3
3
<1
6
51
11
2
3
6
13
51
6
<1
2
3
7
60 b
lOb
4b
2b
b
19
26 b
24
7
62
111
26
37
0
27
4
34
62
15
21
0
15
136
24
8
45
44
56
73
46
87
125
51
53
7
57
13
32b
20b
b
38
a
54
22b
23 b
a
3
25 b
ap < 0.001; b p < 0.000l.
group. However, use of a stair rail and bed hoist did not
vary with age. One hundred and eighty-five (59%) of
those who owned walking sticks and 31 (69%) of those
who owned wheelchairs only used them outdoors.
Conversely, 23 (62%) of those owning walking frames
only used them indoors.
Gender also influenced the use of some aids. More
women than men used their walking frames [32 (4%)
versus five (1%)] and bathroom rails [202 (24%) versus
98 (16%); P < 0.001].
A total of 1367 (97%) respondents owned spectacles and 224 (16%) owned a hearing aid. There were
no age or gender differences in ownership of
spectacles-however, ownership of a hearing aid was
significantly higher amongst those aged 75 and over
[113 (19%) versus 87 (11%); P < 0.0001] and
amongst men [100 (18%) versus 100 (12%); P<
0.05]. Most respondents [1108 (79%)] would use a
conventional telephone to summon assistance if
necessary, although 93 (7%) had no means of
summoning help (Table 6).
Discussion
Knowledge of patterns of ownership and use of
disability aids is important in view of the increasing
emphasis on care of older people in their own homes.
The size and randomization of our study, coupled with
a high response rate, leads us to conclude that our
findings are representative and therefore applicable to
the UK general population over the age of 65 years.
Previous studies have reported somewhat inconsistent
results, with the variation probably being a reflection
of sample size [6], limitation to one general practice [6]
or to disabled elderly people [11] or elderly people
over 75 years old [7].
Table 4. Ownership and use of mobility aids
No. (and %)a of subjects, by ownership/usage
% of owners who
Aid
n
Owns aid
Uses aid
Owns but does not use
do not use
One stick/umbrella
Two sticks
Crutches
Walking frame
Wheelchair
Ramps
1397
1404
1405
1401
419 (30%)
41 (3%)
12 «1%)
51 (4%)
313 (22%)
32 (2%)
11 «1%)
37 (3%)
106 (8%)
9 «1%)
1 «1%)
14 (1%)
25
22
8
27
10
22
"% of total population.
466
1403
50 (4%)
45 (3%)
5 «1%)
1404
9 «1%)
7 «1%)
2 «1%)
Use of assistive devices by older people
Table 5. Ownership and use of bathroom, lavatory and stair rail appliances
No. (and %)a of subjects, by ownership/usage
Aid
n
Owns aid
Uses aid
Owns but does not use
Commode
Rail in lavatory
Raised lavatory seat
Rail in bathroom
Non-slip bath mat
Bath seat
Bath board
Bed hoist
Stair rail
1404
1405
1405
1403
1402
1402
1404
1405
1404
138 (10%)
173 (12%)
73 (5%)
332 (24%)
766 (55%)
126 (9%)
159(11%)
11 «1%)
205 (15%)
96 (7%)
142 (10%)
56 (4%)
300 (21%)
707 (50%)
81 (6%)
115 (8%)
7 «1%)
187 (14%)
42 (3%)
31 (2%)
17 (1%)
32 (2%)
59 (5%)
45 (3%)
44 (3%)
4 «1%)
18 (1%)
% of owners who
do not use
30
18
23
10
8
36
28
36
9
"% of total population.
Our study revealed patterns of ownership and use of
mobility aids, bathroom and lavatory appliance similar
to those found by George et al. [6] in 1988 in a random
general-practitioner-based sample of 140 elderly people
aged 75 years and over. The only major difference
involved ownership of a walking stick: in both George
and co-workers' sample [6] and in Sonn and co-workers'
subsequent study of 595 elderly people in Sweden [12],
66% of respondents possessed a walking stick, while we
found a prevalence of 30%. We find the overall similarity
in the prevalence of individual devices surprising, since
the numbers of very elderly and disabled people
maintained in their own homes have increased, as has
the emphasiS on community-based care.
Increasing age and female gender influenced ownership of aids in our study and that of Sonn et al. [12]. In
addition, we found that ownership of a wheelchair,
walking frame and commode was significantly more
prevalent in those living with others. We postulate that
this may be due to an increased awareness of the
availability of various aids and appliances amongst
younger relatives with whom the person lives. It is
possible that an elderly person living alone or with an
Table 6. Means of summoning help available to 1401
respondents
Means
Telephone
Link to warden
Others
Portable alarm
To social services
To phone/police
Alarms linked to family/friends
Card for window
None
No. (and %) of
subjects
1108 (79)
100 (7)
46 (3)
25 (2)
7 (<1)
20 (1)
2
«1)
93 (7)
elderly spouse may be unaware of the diversity of
equipment available and whom to approach should the
need arise.
We were not surprised to find that ownership of all
assistive devices varied with increasing disability.
However, we were unable to find any comparative
data to determine the role of living arrangements and
disability upon ownership of aids within the normal
population. It is of concern, however, that many
severely disabled people lacked relatively basic and
low-cost aids and appliances. Although one cannot
always relate the need for equipment to the level of
disability (for example, very disabled people may have
alternative means of bathing and therefore not require
bath aids), we believe that relatively simple, inexpensive equipment would markedly contribute to promoting increased independence.
Almost one-tenth of the population studied had no
means of summoning assistance in an emergency; this
may also cause concern to those living alone or with an
elderly spouse.
In contrast to previous studies [13 - 15] of the use of
aids and appliances by elderly disabled people, we
found comparatively little wastage in terms of 'nonuse'. Our respondents appeared to use their mobility
aids more than those in some other studies: threequarters of those owning a walking frame used it, as
opposed to less than half in the sample studied by
George et al. [6] and only 6% in the sample studied by
Illife et ai. [7]. Similarly, our study revealed that threequarters of those owning a walking stick used it,
compared with two-thirds in the study of George et ai.
[6] and only one-third in the study of Illife et ai. [7].
Closer inspection of our results, however, reveal a
slightly different picture when applied to an average
district of250 000. For example, 1% of the over-65-yearolds not using their walking frames implies approximately 400 unused frames (1 % of 16% of 2500(0). This
would have cost implications if the aid were provided
by the public sector.
467
N. I. Edwards, D. A. Jones
The Community Care Act [5] promotes the philosophy
of independence and autonomy amongst elderly people.
With the emphasis on community-based support as
opposed to institutionalized care, any means by which
elderly people can maintain their self-sufficiency needs to
be embraced. The achievement of this goal can be
enhanced by the provision of appropriate aids and
appliances. Not only will these devices facilitate the
independence of individuals at home, but they may
contribute to reducing the strain upon informal carers,
social services and health-care professionals.
Knowledge of who owns and who uses equipment
and under what circumstances may also assist service
providers in planning future strategies. Our study
highlights that certain groups of elderly people own
and use assistive devices more than others-in
particular, women and those who are aged 75 years
and over or severely disabled. Perhaps these groups
would benefit the most from provision of appropriate
aids and should be targeted.
Assessment of the need for aids is usually made by
qualified health-care professionals such as the community occupational therapist. We suggest that a
heightened awareness of the availability, value and
importance of the various assistive devices needs to be
promoted-not only amongst informal carers and
health-care professionals but amongst elderly people
themselves. Furthermore, regular assessments could
also be made by a general practitioner or practice nurse
as part of their regular health checks of older people.
We suggest that provision of equipment should be
included in community care plans and that heightened
co-operation between health and social services needs
to be fostered.
Key points
•
•
•
•
Ownership of assistive devices varies with age,
gender, living arrangements and increasing disability.
Very disabled people need but do not own certain
very basic and relatively inexpensive appliances
A raised awareness of the value of assistive devices
needs to be encouraged amongst elderly people and
their carers.
The needs of elderly people with regard to
provision of equipment could be assessed as part
of the annual health check.
(computing) and C. Thomas (secretarial), our interviewers and the many people who agreed to be
interviewed.
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This study was funded under the King's Fund Major
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Received 29 May 1997; accepted 6 June 1997
468