Disparities in Mobility Device Use in Late-life

描述(由申请人提供)：技术在促进美国老年人独立方面发挥着越来越重要的作用。尽管有证据表明，少数群体在晚年经历了更多的残疾，但关于医疗保健中的种族差异的持续辩论并未明确承认技术是一种值得关注的护理类型。关于老年人使用移动设备的研究也没有明确关注种族差异。这项拟议的研究是对二次数据的社会行为分析，试图理清种族/民族、社会经济地位、健康和功能对美国老年人使用移动设备的影响。我们建议在安德森行为框架(Andersen&Newman 1973)的基础上进行扩展，该框架已被广泛用于急性和长期护理利用的研究，以指导我们对两个具体目标的调查：1)在使用、采用和放弃移动设备方面是否存在种族和民族差异；2)需要的种族和民族差异(例如健康、功能和环境障碍)和促成因素(例如收入、资产、保险和使用其他医疗服务)在多大程度上解释了这些差异。分析将主要基于NIA资助的健康和退休研究(MRS)的数据，该研究包含关于残疾、设备使用、健康、社会经济地位、个人护理使用和环境障碍的丰富数据。一系列回归模型将检验种族与移动设备的使用、采用和放弃之间的关系，以及控制需求和使能因素对种族-设备使用关系的影响。基于这些模型，我们应用一种直接标准化技术来量化观察到的设备使用种族差异的百分比，这些差异是由健康和经济准入因素中的种族差异解释的。拟议的研究将为今后与提高晚年功能衰退少数群体的独立性有关的干预工作奠定基础。通过检查设备的采用和废弃，这项研究还将提供对残疾过程中哪些方面的干预和政策可能最有效的洞察。

DESCRIPTION (provided by applicant): Technology is playing an increasingly important role in facilitating independence among older Americans. Despite evidence that minorities experience more disability throughout late life, the continuing debate on racial disparities in health care has not explicitly recognized technology as a type of care with which to be concerned. Research on the use of mobility devices among older adults has also not focused explicitly on racial disparities. The proposed research is a sociobehavioral analysis of secondary data that attempts to disentangle the effects of race/ethnicity, socioeconomic status, health, and functioning on the use of mobility devices by older Americans. We propose expanding upon the Andersen behavioral framework (Andersen & Newman 1973), which has been widely used in the study of acute and long-term care utilization, to guide our investigation of two specific aims: 1) whether there are racial and ethnic differences in the use, adoption and abandonment of mobility devices and 2) the extent to which racial and ethnic differences in need (e.g., health, functioning and environmental barriers) and enabling factors (e.g., income, assets, insurance, and use of other health services) account for the these differences. Analyses will be based primarily on data from the NIA-funded Health and Retirement Study (MRS) which contains rich data on disability, device use, health, socioeconomic status, the use of personal care and environmental barriers. A series of regression models will examine the relationship between race and the use, adoption and abandonment of mobility devices and the effects that controlling for need and enabling factors have on the race-device use relationship. Based on these models, we apply a direct standardization technique to quantify the percentage of the observed racial gap in device use explained by racial differences in health and economic access factors. The proposed research will lay the groundwork for future work on interventions related to enhancing independence for minorities experiencing functional decline in late-life. By examining both the adoption and abandonment of devices, this research will also provide insight into where in the disablement process interventions and policies might be most effective.