Biomedical Engineering Reference
In-Depth Information
or older and used assistive devices (Statistics Canada 2008). A survey of adult consumers of
California independent living centers found that devise use increases with age (Kaye et al.
2008). Despite the use of these devices, unmet need appears to be a problem. According to
PALS, one-quarter of Canadians with disabilities under the age of 15 had none of the AT
they required, and 30% needed additional equipment. Of those 15 years and older, 10% had
none of the AT they required and 29% needed additional equipment (Statistics Canada 2008).
Agree et al. (2005) found that 72% of older people with activities of daily living (ADL) limita-
tions who used AT also relied on informal care, whereas 54% of non-AT users did. Similarly,
26% of AT users and 12% percent of nonusers relied on formal care. Further analysis indi-
cated that AT use substituted for personal care only for individuals who were unmarried
and those with more high school education. In contrast, individuals with cognitive impair-
ments were less likely to substitute AT for informal or formal personal assistance.
Informal caregiving is extremely common and may have detrimental consequences
for the care provider. In the United States, more than 50 million informal caregivers, like
Jean, Susan, and Harold, assist individuals who are ill or disabled (Houser and Gibson
2008). Informal caregivers of older adults are frequently either spouses or adult children
(Department of Health and Human Services 1998), whereas caregivers for children are
usually their parents. Because the number of older adults, aged 65 and older, will double
in Canada in the next 20 years (Statistics Canada 2005), informal caregivers will likely
experience increased demands. To maintain the quality of life of those they help, care-
givers may experience a great deal of stress that can lead to their physical or emotional
burnout (Egbert et al. 2008). The potential for burnout poses a challenge to our health-
care system because informal caregivers provide their unfunded assistance 4 times more
frequently than formal caregivers (Agree et al. 2004). The replacement value of informal
caregiver's unpaid contributions has been estimated at $350 billion annually in the United
States and $25 billion annually in Canada (Houser and Gibson 2008; Hollander et al. 2009).
This value excludes loss of economic productivity associated with time spent providing
care and emotional and physical burden. The cost of informal caregiving to employers
has been estimated at $33.6 billion annually in the United States (Metlife Mature Market
Institute, National Alliance for Caregiving 2006). A meta-analysis found that caregivers
have significantly higher stress and depression and significantly lower subjective well-
being, self-efficacy, and physical health than noncaregivers (Pinquart and Sörensen 2003).
A principal reason for providing AT is that it reduces dependency on human assistance
and decreases caregiver burden. However, despite the use of AT, activities and social par-
ticipation are likely to remain restricted to some extent, especially for persons with moder-
ate and severe levels of impairments (Fuhrer et al. 2006). There are three main patterns of
assistance: (1) the use of AT alone, (2) AT combined with human assistance, and (3) human
assistance alone. Harold and Lisa use the third pattern of assistance with Charlie because
they carry him places rather than using AT. Bob uses the first pattern of assistance when
ambulating with his cane. Bob and Jean use the second pattern of assistance for shopping
because Bob uses his cane to get to the car so he can drive his wife to the store, but he does
not buy things himself. Indeed, considerable data exist indicating that both AT and human
assistance are used by users to enhance their participation (Allen et al. 2001; Taylor and
Hoenig 2004; Agree et al. 2005; Østensjø et al. 2005).
5.2.2 Caregivers of Assistance Users
To appreciate the impact of AT on participation, one must understand how provision
of AT may affect the human help that is provided. Recognition of the essential role of
