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Activity Limitation Stages Empirically Derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult Community‐Dwelling Medicare Population
Author(s) -
Stineman Margaret G.,
Streim Joel E.,
Pan Qiang,
Kurichi Jibby E.,
SchüsslerFiorenza Rose Sophia Miryam,
Xie Dawei
Publication year - 2014
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2014.05.001
Subject(s) - activities of daily living , gerontology , medicine , physical therapy
Background Stages quantify severity like conventional measures but further specify the activities that people are still able to perform without difficulty. Objective To develop Activity Limitation Stages for defining and monitoring groups of adult community‐dwelling Medicare beneficiaries. Design Cross‐sectional. Setting Community. Participants There were 14,670 respondents to the 2006 Medicare Current Beneficiary Survey. Methods Stages were empirically derived for the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) by profiling the distribution of performance difficulties as reported by beneficiaries or their proxies. Stage prevalence estimates were determined, and associations with demographic and health variables were examined for all community‐dwelling Medicare beneficiaries. Main Outcome Measurements ADL and IADL stage prevalence. Results Stages (0‐IV) define 5 groups across the separate ADL and IADL domains according to hierarchically organized profiles of retained abilities and difficulties. For example, at ADL‐I, people are guaranteed to be able to eat, toilet, dress, and bathe/shower without difficulty, whereas they experience limitations getting in and out of bed or chairs and/or difficulties walking. In 2006, an estimated 6.0, 2.9, 2.2, and 0.5 million beneficiaries had mild (ADL‐I), moderate (ADL‐II), severe (ADL‐III), and complete (ADL‐IV) difficulties, respectively, with estimates for IADL stages even higher. ADL and IADL stages showed expected associations with age and health‐related concepts, supporting construct validity. Stages showed the strongest associations with conditions that impair cognition. Conclusions Stages as aggregate measures reveal the ADLs and IADLs that people are still able to do without difficulty, along with those activities in which they report having difficulty, consequently emphasizing how groups of people with difficulties can still participate in their own lives. Over the coming decades, stages applied to populations served by vertically integrated clinical practices could facilitate large‐scale planning, with the goal of maximizing personal autonomy among groups of community‐dwelling people with disabilities.