Comparing Racial and Ethnic Differences in Social Determinants with Use of Assistive Devices for Elders with a Disability

Background and Purpose: Despite population trends indicating growth in diversity of US elderly, little is known regarding the cumulative impact of health disparities leading to disability for minority elderly populations. Increased access and use of assistive devices can attenuate the isolating effects of functional limitations, and support elders in successfully aging in place.

This study examines the racial and ethnic differences in assistive device use for a nationally-representative sample of White, Black, Hispanic and Asian elders with a disability. Because of differences in the cumulative impact of health disparities across the lifespan, it is hypothesized that the effect of social determinants on use of assistive devices would vary among White, Black, Hispanic, and Asian elders.

Methods: This study used data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS), collected annually by the Center for Disease Control and Prevention. Multivariate logistic regression analyses were conducted for elders 50 and over with a disability, to examine racial/ethnic differences in social determinants with use of assistive devices, such as wheelchairs, canes, a special bed, or a special telephone. Analysis was first conducted for the aggregate sample (n=91,574), and then separately for non-Hispanic Whites (n=73,413), Blacks (n=7,260), Hispanics (n=4,089) and Asians (n=6,812). Variables included gender, age, income, having a high school diploma, having insurance, having a personal doctor or health professional, poor health status, and exercise.

Results: Initial aggregate analysis revealed that Asian elders were almost 50% less likely to use assistive devices (OR=0.52, p<0.05), compared to their white counterparts with a disability. Elderly African Americans were 78% more likely than whites to use assistive devices (OR=1.78, p<0.01). Subgroup analyses revealed that having a high school diploma (OR=1.16, p<0.01) and a personal doctor or health professional (OR=1.54, p<0.001) increased assistive device use, but only for whites. Poorer health and older age increased assistive device use for all groups, but the effects were especially pronounced for Asians elders (Poorer Health: OR=5.10, p<0.00; 75 and over: OR=71.71, p<0.001). Hispanic elders with insurance were twice as likely to use assistive devices (OR=2.08, p<0.05), followed by Whites (OR=1.46, p<0.001), but the effect was not observed for any other group.

Conclusions and Implications: Results indicated racial and ethnic differences in the effect of social determinants on assistive device use for elders with a disability. Although black elders use more assistive devices, no associations were found with having insurance or a doctor for this group. Hispanic elders with insurance were twice as likely to use assistive devices, suggesting access is an important issue for this population. For Asian elders, being older and having poorer health were the only indicators for higher assistive device use, suggesting that this may be rooted in culturally-based ageism and attitudes toward disability. Future research should use longitudinal data to examine how health disparities accumulate across the lifespan in different ways for minority elders. Social work educators and practitioners must be sensitive to differences in how minority elders utilize services, and examine how interventions can be better framed to be culturally appropriate for different populations.