Multiple sclerosis, aging and support service utilization

Journal of Rehabilitation,  Oct-Dec, 2007  by Michelle Putnam,  Fengyan Tang

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Results

Binary logistic regression analyses indicated associations between individual characteristics and assistive technology, personal assistance, and formal service utilization (Table 4). Within demographic variables, increasing age was related to assistive technology use and formal service use, but not to personal assistance use. This is demonstrated by odds ratios associated with age showing that a sixty-year old individual with MS was 2 1/2 times more likely than a forty-year old individual with MS to have used assistive technology or formal services. Additionally, respondents who lived with their own families compared to those who lived alone were over 3 times as likely to have used personal assistance and 70% less likely to have used formal services.

Health and functioning were significant disability variables related to service use. The strongest relationship was found between functional status and support service use, but as functional status was a count of difficulty with many different types of activities, interpretation of the magnitude of odds ratios (which were quite large) was somewhat restricted. However, in general it was clear from the analyses that the more activities of daily living individuals experienced difficulty with, the more likely they were to have used assistive technology, personal assistance, and formal services. The same pattern was evident for physical health and service use. As individuals rated their health as one category worse, the odds of having used assistive technology and personal assistance doubled. The odds of having used formal services increased by 80%.

Examinations of relationships between support service types and health insurance showed that respondents who used personal assistance were 5 times more likely to have used assistive technology and vice versa. Neither assistive technology nor personal assistance use was significantly related to formal service use. Type of health insurance held had no relationship to utilization of assistive technology, but the odds of using personal assistance were 90% less for holders of military health insurance than those without it. Individuals insured by Medicaid were more than 3 times as likely to use formal services as those not insured by the program.

Table 5 shows the results from logistic ordinal and multivariate regression models examining individual characteristics associated with level of service use. Regression results indicated that age was not significantly related to level of personal assistance use, but being older did predict use of more assistive technology devices. The likelihood of using personal assistance for a longer period of time increased for respondents with more education. Individuals who lived with others were likely to have used fewer assistive technology devices than individuals who lived alone.

Respondents with more functional difficulty and worse physical health were likely to have used greater levels of all services. Individuals who had difficulty performing ADL or IADL activities were more likely to have used more personal assistance hours per week, to have used personal assistance for a longer period of time, and to have used a greater number of assistive devices. For each level decrease in physical health, individuals were almost twice as likely to have used one category higher of personal assistance hours per week and more assistive devices. Conversely, lower levels of mental health were associated with fewer assistive technology devices used. Duration of MS was associated with duration of personal assistance service use, in that those who have had the disease longer have used these services longer.