dependence on personal care over time. Estimates show that in the 1990s nearly half of Americans aged 65 and older had home modifications or adaptations to reduce barriers. Results from the 2006 Health and Retirement Study (HRS) showed almost 70 percent of people aged 50 and older had a home modification. In general, both clinical and population-based studies suggest that the use of assistive technology and home modifications may improve functioning and quality of life, expand participation in activities, expand neighborhood mobility, and protect caregivers’ health.

Disability can be conceived as a gap between individuals’ capacities (physical, cognitive, and sensory ability) and their performance in daily activities and participation in social life. The ability of individuals to translate their intrinsic capacity into successful performance is affected by the context in which they perform each of these activities. What is required in order to do an activity depends on the specific task—getting out of bed, socializing with family and friends, or going to work. Each of these activity demands, in addition, has an activity-specific environmental context, which can incorporate barriers to accomplishing that activity as well as dimensions of the environment that actually facilitate conducting that activity.

The extent to which individuals can translate capacity into performance also depends on what they themselves can do to change the environment or to change the demands of the activity by adapting or accommodating, what has sometimes been termed compensation or using a compensatory strategy. Compensation includes the use of human help (both formal and informal care), changes in the way tasks are done (including the use of technology), and changes that are made to the home environment.

To expand on the concept a bit, if disability is an activity-specific gap between individual capacity and performance, technology expands the capacity of the individual and environmental modifications reduce barriers in the environment.

Current Survey Measurement of Assistive Technology Use

A review of six major national surveys—(1) HRS, (2) the National Health Interview Survey (NHIS), (3) the National Long-Term Care Survey (NLTCS), (4) the Medicare Current Beneficiary Survey, (5) the Medical Expenditure Panel Survey, and (6) the Survey of Income and Participation—shows that in the past few years there has been a proliferation in the number of surveys including questions about assistive technology. However, terminology varies across surveys (aids, special equipment, adaptive devices, medical devices or supplies, etc.), and so there has been little agreement in the data.

The level of detail on device use also varies across surveys. Questions may be asked globally about the use of devices for all activities or specific



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