title: Assistive devices in context: cross-sectional association between challenges in the home environment and use of assistive devices for mobility.
abstract: OBJECTIVE
  A primary goal for aging policy is to optimize independence in later life. We estimate the cross-sectional association between physical and social challenge in the home environment and use of assistive devices (AD) for mobility in the home, controlling for lower extremity physical performance (short physical performance battery [SPPB]) and other factors.
  
  
  METHODS
  Data are from the Women's Health and Aging Study I, a prospective study of the factors related to physical disability in a sample of moderately to severely disabled older women. We describe these associations in the baseline sample overall and also within subsets who do and do not have both a baseline and a 3-year follow-up observation.
  
  
  RESULTS
  On average, physical challenge in the home environment is inversely associated with level of AD use (p < .05) in the overall sample, independent of SPPB, living alone, and other factors. We do not find a significant (p < .05) association between social challenge and the level of AD use in the overall sample. Findings by follow-up responder status were similar (with minor variability).
  
  
  CONCLUSIONS
  Future cohorts who are better educated and more receptive to technology may confront challenges in the home environment that limit their ability to age in place. Our findings suggest that the physical challenges of the home are significantly related to AD use. Future analyses that explore the mechanisms of the home environment as a source of challenges to independent functioning could help in the design of future interventions for these cohorts as they age.
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York. Christopher_Seplaki@urmc.rochester.edu.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Seplaki
authors.affiliation: Department of Sociology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Agree
authors.affiliation: Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing.
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Weiss
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Szanton
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Karen
authors.initials: K
authors.lastname: Bandeen-Roche
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York.
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging / Q000502:physiology*; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D051346:Mobility Limitation; D011446:Prospective Studies; D012656:Self-Help Devices / Q000706:statistics & numerical data*; D016387:Women's Health
keywords: Aging in place; Function (physical mental); Technology