The proposed study will examine how states' long-term care policy and local communities' societal and health resource factors as well as individuals' attributes are associated with use of compensation for activities of daily living (ADL's) among non-institutionalized adults aged 70 and older in the United States. Personal assistance (formal and informal helpers) and equipment assistance are the two major strategies used to compensate for activity limitations that are, commonly experienced by older adults. Previous studies on use of compensation have almost exclusively examined individual-level determinants, paying little attention to macro-level community factors. Our overarching hypothesis is that states' commitment to community-based home care and local communities' societal and health-care factors, in addition to older adults' predisposing, enabling and needs factors, influence (1) use of informal and formal personal assistance among those with activity limitations, (2) use of personal equipment assistance among those with mobility difficulties, and (3) unmet need for assistance with daily activities. Using a multi-level analysis framework, we will link individual-level survey data from the Assets and Health Dynamics among the Oldest Old (AHEAD) survey, Wave I, with state-and local community- level data from multiple sources including the Census, the Area Resource File, federal and state governmental: statistics and other appropriate data. The geocoded place of residence available only in the restricted AHEAD dat will provide a unique opportunity to analyze linked macro- level and individual-level data. Our findings on factors related to multiple compensation strategies will be useful for predicting use in the future and developing long-term care policy. Furthermore, substantive and methodological knowledge to be obtained from this study will provide a basis for future studies to examine linkages between macro-level and micro-level phenomena in the study of aging and health.
NIH ExPorter
NIH ExPorter