title: Reconsidering substitution in long-term care: when does assistive technology take the place of personal care?
abstract: OBJECTIVE
  Assistive technology (AT) may improve quality of life and reduce dependence for older persons with disabilities. In this article, we examine tradeoffs between the use of AT and reliance on personal care, with attention to factors that may influence those relationships.
  
  
  METHODS
  We jointly modeled hours of formal and informal care with use of AT in order to address the interdependence of these outcomes in ways not taken into account in previous studies. We analyzed a national sample of older persons with difficulty in activities of daily living drawn from Phase 2 of the 1994-1995 National Health Interview Survey (NHIS) Disability Supplement.
  
  
  RESULTS
  Our findings show that the use of AT was associated with reductions in informal care hours, especially for those who were unmarried, better educated, or had better cognitive abilities, but appeared to supplement formal care services for these groups. Individuals with cognitive impairment were less likely than others to substitute AT with either type of personal care.
  
  
  CONCLUSIONS
  These models raise the possibility that reductions of informal care hours may be accomplished with a combination of formal care and assistive devices, rather than from either alternative alone.
authors.affiliation: Department of Population and Family Health Sciences, 615 North Wolfe Street, Room E4646, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. eagree@jhsph.edu
authors.forename: Emily M
authors.initials: EM
authors.lastname: Agree
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Freedman
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Cornman
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Wolf
authors.forename: John E
authors.initials: JE
authors.lastname: Marcotte
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006704:Homemaker Services / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D012044:Regression Analysis; D012656:Self-Help Devices / Q000706:statistics & numerical data*; D014481:United States