Recognition of the environment as having a direct impact on the experience of disability is an important conceptual and practical step on the road to improving participation and the quality of life of people with disabilities. The provision of affordable aids and equipment, support arrangements in educational and workplace settings, mainstream education, accessible public transport and personal assistance all act to facilitate opportunities for individuals to participate in the economic and social world. Furthermore, and just as importantly, they provide people with disabilities an added independence to explore these opportunities. Nonetheless, features of the environment may still act as barriers for different people in different circumstances.
The International Classification of Functioning, Disability and Health recognises environmental factors as one of three components defining functioning and disability (WHO 2001). Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives, and influence the experience of disability both at the body level (function and structure) and in terms of the activities they do and the areas of life in which they participate.
Aids and equipment are environmental factors with the potential to improve the life of people with disabilities through the attainment of greater independence and less reliance on personal assistance. Some research suggests that aids and equipment alone may be a more efficacious form of assistance than personal assistance in reducing difficulty associated with performing tasks of daily living. Nonetheless, the prescription of aids and equipment to people with disabilities is not always beneficial to the client, sometimes leading to the acquisition of an inappropriate aid and its eventual abandonment.
In Australia, a range of Commonwealth and state and territory based schemes provide cost free or low-cost aids to people with disabilities. These schemes, however, do not generally provide complete coverage in terms of scope, size and the types of aids and equipment provided, despite recent reviews to improve the quality and delivery of aids. This report describes the use of aids and equipment by people with disabilities in Australia, and other relevant environmental factors, such as support arrangements in educational and workplace settings, access to public transport, assistance with daily activities, and home modifications. A summary of the findings from analysis of the 1998 Survey of Disability, Ageing and Carers is given below.
Aids and equipment
- In 1998, 48% of people with a disability used some form of aid. Of this group, 40% were under the age of 65 years (Section 4.2).
- The use of aids and equipment was more likely in older age groups and for those with more severe core activity restrictions (Sections 4.3 and 4.4).
- Medical aids were the most frequently used aid for people aged 15–64 years, followed by mobility aids. The exception was children under 15 years, where self-care and communication aids were the second most used aid categories, after medical aids (Sections 4.3).
- The average number of aids used generally rose with increasing severity of core activity restriction. People with a mild core activity restriction used on average 1.2 aids compared to 1.5 for a moderate core activity restriction and 1.9 aids for a severe core activity restriction. People with a profound core activity restriction used an average of 3.5 aids (Section 4.4).
- People aged 0–64 and with physical/diverse or hearing impairments were more likely to be users of aids compared with people with an intellectual, psychiatric or vision and speech impairment (Section 4.5).
- People who needed assistance with core and other daily activities were more likely to use aids than those who did not need assistance. However, needing assistance with a core activity was not necessarily associated with a high use of aids specific to the core activity. Around 40% of people who needed assistance with self-care or mobility used self-care and mobility aids respectively. Only 8% of people needing assistance with communication used communication aids (Section 4.6).
- Almost half of people aged 0–64 years and reporting a need for assistance with self-care, mobility or communication received personal assistance only, suggesting that ‘low’ aid use is offset by receipt of personal assistance. Nonetheless, a high proportion of people still reported using neither personal nor aid or equipment assistance for core activities, in particular in relation to communication where the proportion having no personal or equipment assistance was 43% (Section 4.6).
- People with a primary carer were more likely to use aids. For people aged under 65 years and using aids and equipment, the primary carer was usually a spouse or partner, and to a lesser extent a parent; for people who did not use aids, a parent was the main primary carer. Aid and equipment users generally received shorter hours of primary care, albeit only slightly less so (Section 4.7).