Division of Geriatrics, Department of Medicine, University of California, San Francisco.
Division of Epidemiology and Biostatistics, Department of Medicine, University of California, San Francisco.
JAMA Intern Med. 2021 May 1;181(5):662-670. doi: 10.1001/jamainternmed.2021.0204.
Home modification through seemingly mundane equipment, such as grab bars and shower seats, mitigates injury, dependence, and reduced quality of life in older adults coping with increasing disability. However, whether these interventions are underused in the US is unclear.
To estimate how many older adults who need equipment to help with bathing and toileting do not have it, describe factors associated with not having equipment, and describe how many who did not initially have equipment acquired equipment over time.
This observational cohort study of participants 65 years or older used secondary data from the 2015 to 2019 waves of the US National Health and Aging Trends Study. Participants included community-dwelling older adults who would unequivocally benefit from equipment, defined as those with poor physical performance or substantial difficulty bathing, toileting, transferring, or walking. Respondents were representative of the US population 65 years and older. Data were collected from May 2015 to October 2019 and analyzed from August 1, 2019, to February 24, 2021.
Population characteristics (eg, age, sex, income, health conditions, and physical performance), environmental factors (eg, home ownership and living arrangement), and health behaviors (eg, prior knee and/or hip surgery).
Prevalence of any unmet need for equipment, defined as either needing bathing equipment (bath grab bars and shower seat) but having none or needing toileting equipment (toilet grab bars and raised toilet seat) but having none and the cumulative incidence of equipment acquisition during 4 years of follow-up.
A total of 2614 participants representing 12 million US individuals would benefit from equipment. The mean (SD) age was 80.5 (8.2) years, and 1619 individuals (62%) were women. Of these, an estimated 5 million individuals (42%; 95% CI, 39%-44%) had an unmet need. After adjustment for age, sex, and race/ethnicity, unmet need was associated with younger age (49% if aged 65-74 years, 37% if aged 75-84 years, and 29% if aged ≥85 years; P < .001), having fewer health conditions (55% if none vs 39% if ≥3; P = .002), non-White race/ethnicity (40% if White vs 51% if Black, 54% if Hispanic, and 55% if other; P < .001), no recent hospitalization (46% vs 37% if hospitalized; P = .001), and no prior knee and/or hip fracture or surgery (46% vs 35% if prior fracture or surgery; P < .001). After 4 years of follow-up, 35% of those with bathing equipment needs and 52% of those with toileting equipment needs never received equipment.
This cohort study suggests that in the US, 42% of older adults with impairments that would make bathing or toileting difficult lack equipment to assist. This situation is a missed opportunity to help 5 million individuals live independently and safely.
通过看似平凡的设备（如抓杆和淋浴座椅）进行家庭改造，可以减轻老年人因残疾而导致的伤害、依赖和生活质量下降。然而，在美国，这些干预措施是否未被充分利用尚不清楚。
估计有多少需要设备来帮助洗澡和如厕的老年人没有这些设备，描述与没有设备相关的因素，并描述最初没有设备的人在多长时间内获得了设备。
本研究使用了美国国家健康老龄化趋势研究 2015 年至 2019 年各波次的二次数据，对 65 岁及以上的参与者进行了观察性队列研究。参与者包括那些会从设备中获得明确受益的社区居住的老年人，这些设备定义为那些身体机能较差或洗澡、如厕、转移或行走有实质性困难的老年人。受访者代表了美国 65 岁及以上的人口。数据于 2015 年 5 月至 2019 年 10 月收集，并于 2019 年 8 月 1 日至 2021 年 2 月 24 日进行分析。
人口特征（如年龄、性别、收入、健康状况和身体机能）、环境因素（如房屋所有权和居住安排）以及健康行为（如先前的膝盖和/或髋关节手术）。
设备需求未得到满足的患病率，定义为需要洗澡设备（浴抓杆和淋浴座椅）但没有设备，或需要如厕设备（马桶抓杆和升高的马桶座椅）但没有设备，以及在 4 年随访期间设备获得的累积发生率。
共有 2614 名代表 1200 万美国民众的参与者将从设备中受益。平均（SD）年龄为 80.5（8.2）岁，1619 名参与者（62%）为女性。其中，估计有 500 万名参与者（42%；95%CI，39%-44%）存在未满足的需求。在调整年龄、性别和种族/民族后，未满足的需求与年龄较小相关（65-74 岁者为 49%，75-84 岁者为 37%，≥85 岁者为 29%；P < .001），健康状况较少（无健康状况者为 55%，≥3 种健康状况者为 39%；P = .002），非白种人（白种人 40%，黑人 51%，西班牙裔 54%，其他种族 55%；P < .001），近期无住院（住院者为 46%，无住院者为 37%；P = .001），以及无先前的膝盖和/或髋关节骨折或手术（有先前骨折或手术者为 46%，无先前骨折或手术者为 35%；P < .001）。在 4 年的随访后，35%有洗澡设备需求的人和 52%有如厕设备需求的人从未获得过设备。
本队列研究表明，在美国，有 42%的身体机能较差导致洗澡或如厕困难的老年人缺乏帮助他们的设备。这种情况是一个错失帮助 500 万人独立和安全生活的机会。
