Abstract
BackgroundDifficulties with performance of functional activities may result from cognitive and/or physical impairments. To date, there has not been a clear delineation of the physical and cognitive demands of activities of daily living. ObjectivesTo quantify the relative physical and cognitive demands required to complete typical functional activities in older adults. DesignExpert panel survey. SettingWeb-based platform. ParticipantsEleven experts from 8 academic medical centers and 300 community-dwelling elderly adults age 70 and older scheduled for elective noncardiac surgery from 2 academic medical centers. MethodsSum scores of expert ratings were calculated and then validated against objective data collected from a prospective longitudinal study. Main Outcome MeasurementsCorrelation between expert ratings and objective neuropsychologic tests (memory, language, complex attention) and physical measures (gait speed and grip strength) for performance-based tasks. ResultsManaging money, self-administering medications, using the telephone, and preparing meals were rated as requiring significantly more cognitive demand, whereas walking and transferring, moderately strenuous activities, and climbing stairs were assessed as more physically demanding. Largely cognitive activities correlated with objective neuropsychologic performance (r = 0.13-0.23, P < .05) and largely physical activities correlated with physical performance (r = 0.15-0.46, P < .05). ConclusionsQuantifying the degree of cognitive and/or physical demand for completing a specific task adds an additional dimension to standard measures of functional assessment. This additional information may significantly influence decisions about rehabilitation, postacute care needs, treatment plans, and caregiver education.
Highlights
Accurate and objective assessment of functional capacities is important in both clinical and research settings
Cognitive activities correlated with objective neuropsychological performance (r=0.13–0.23, p
Quantifying the degree of cognitive and/or physical demand for completing a specific task adds an additional dimension to standard measures of functional assessment
Summary
Accurate and objective assessment of functional capacities is important in both clinical and research settings. Functional status is often measured through assessment of activities of daily living (ADLs). ADLs can be divided into two types: basic (BADLs), which comprise self-care tasks such as bathing, toileting, dressing, and grooming, and instrumental (IADLs), which include tasks that facilitate autonomy and independent living, such as handling finances, administering medications, shopping, and managing transportation.[3,4,5] While BADLs are often thought to reflect more rudimentary, primarily physical, aspects of functioning and IADLs the more demanding cognitive aspects[6,7,8] there is considerable overlap, as the ability to complete an activity can require highly divergent skills. There has not been a clear delineation of the physical and cognitive demands of activities of daily living
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