Millions of Older Adults Lack Home Equipment for Assistance With Bathing, Toileting

By Carolyn Crist

March 26, 2021

NEW YORK (Reuters Health) - About 5 million older adults in the U.S. who need assistance with daily activities such as bathing and toileting lack the grab bars, shower chairs and raised toilet seats that would improve their quality of life, according to geriatrics specialists.

Better clinical assessments could identify which adults may benefit from these low-cost home modifications, as well as prevent injuries and promote independence, they write in JAMA Internal Medicine.

"The reality is that aging frequently brings chronic and irreversible conditions like dementia or frailty, and the solution to that is not switching up medications but providing services and equipment to help older adults cope with aging once it gets difficult," said lead author Dr. Kenneth Lam of the University of California, San Francisco.

"As doctors, we underestimate the value and importance of equipment even though it is precisely a key part of the solution to the challenges of aging," he told Reuters Health by email.

Dr. Lam and colleagues analyzed data from the 2015-2019 U.S. National Health and Aging Trends Study, focusing on community-dwelling Medicare beneficiaries over age 65 who needed adaptive bathing or toileting equipment. They also examined how many people didn't receive equipment based on the annual follow-up interviews through 2019.

The research team found that more than 2,600 survey participants, which represents about 12 million older adults in the U.S., could benefit from assistive equipment. They tended to live in metropolitan areas, own their own home, have no prior knee or hip surgery and have no hospitalizations during the past year, yet they had poor physical performance scores that indicated a need for assistive equipment.

The researchers estimated that about 5 million adults had an unmet need for equipment, meaning they had a reduced capability to bathe or use the toilet independently but didn't have grab bars or seats that could help. Those who already used a walker indoors were most likely to have some equipment, though only 59% had both a bath seat and grab bars.

Compared with older ages, those between ages 65-74 were most likely to have an unmet need. In addition, those who had fewer health conditions, no recent hospitalizations and no prior knee or hip surgeries were less likely to have the equipment they needed. These groups may not be identified in typical clinical assessments although they need equipment, the authors wrote.

After four years of follow-up in the survey, 35% of those with bathing-equipment needs and 52% of those with toileting equipment needs never received equipment. In addition, Black and Hispanic respondents were more likely to have unmet needs.

"I hope this opens up more work investigating how we overcome some of the barriers to getting equipment," Dr. Lam said. "We talk a lot in medicine about quality measures - like making sure people get aspirin after they have a heart attack - and I hope we can start moving towards making sure people get the right referrals to get equipment when they come in with things like falls or difficulties living at home."

Future studies could uncover the barriers to accessing these home modifications, the authors write, such as cost or lack of knowledge about when and how to acquire equipment and install it. In addition, few doctors are specialized in identifying these unmet needs in their patients, discussing home environments and making recommendations.

"An important barrier to take-up could be stigma on the part of patients and consumers," said Dr. Brian McGarry of the University of Rochester, in New York. Dr. McGarry, who wasn't involved with this study, wrote an accompanying commentary on addressing the unmet need for assistive equipment through primary care.

Patients, primary-care doctors, physical therapists and mobility specialists should discuss aging-in-place recommendations, as well as specific products and installation, he said.

"We should be normalizing the use of adaptive equipment and accessible design features in homes," Dr. McGarry told Reuters Health by email. "Continued discussion about the benefits of equipment and its current underuse can help with that normalization."

SOURCE: JAMA Internal Medicine, online March 22, 2021.