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How Should Disability Be Measured in Older Adults? An Analysis from the Boston Rehabilitative Impairment Study of the Elderly
Author(s) -
Beauchamp Marla K.,
Bean Jonathan F.,
Ward Rachel E.,
Kurlinski Laura A.,
Latham Nancy K.,
Jette Alan M.
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13453
Subject(s) - medicine , odds , gerontology , metric (unit) , odds ratio , dimension (graph theory) , geriatrics , emergency department , logistic regression , psychiatry , operations management , mathematics , pure mathematics , economics
Objectives To determine and compare the predictive validity and responsiveness of the Late‐Life Function and Disability Instrument ( LLFDI ) frequency and limitation dimensions in assessing two critical dimensions of disability: frequency of and limitations in performance of major life roles. Design Secondary analysis of 2‐year follow‐up data from the Boston Rehabilitative Impairment Study of the Elderly. Setting Primary care. Participants Community‐dwelling older adults (≥65) (n = 430) at risk of mobility decline. Measurements The LLFDI frequency and limitation dimensions, self‐rated health, hospitalizations, and emergency department ( ED ) visits over 2 years. Responsiveness measures included effect size ( ES ) estimates and minimal detectable change ( MDC ) scores. Results The LLFDI frequency dimension predicted low self‐rated health (odds ratio ( OR ) = 0.51, P < .001), hospitalizations ( OR = 0.68, P < .001), and ED visits ( OR = 0.73, P = .003) over 2 years, whereas the limitation dimension did not. The absolute ES was 0.63 for the frequency dimension and 0.81 for the limitation dimension. The proportion of subjects with a decline greater than or equal to the MDC was 10.6% for the frequency dimension and 14.2% for the limitation dimension. For participants who improved greater than or equal to the MDC , the proportion was 1.7% for the frequency dimension and 15.3% for the limitation dimension. Conclusion Frequency of participation in major life roles was a better predictor of adverse outcomes than perceived limitations, although limitations appeared to be more responsive to meaningful change. These results can be used to guide the selection of the most appropriate metric for measuring disability in geriatric research.