Abstract
ObjectivesTo investigate the order in which 85 year olds develop difficulty in performing a wide range of daily activities covering basic personal care, household care and mobility.DesignCross-sectional analysis of baseline data from a cohort study.SettingNewcastle upon Tyne and North Tyneside, UK.ParticipantsIndividuals born in 1921, registered with participating general practices.MeasurementsDetailed health assessment including 17 activities of daily living related to basic personal care, household care and mobility. Questions were of the form ‘Can you …’ rather than ‘Do you…’ Principal Component Analysis (PCA) was used to confirm a single underlying dimension for the items and Mokken Scaling was used to determine a subsequent hierarchy. Validity of the hierarchical scale was assessed by its associations with known predictors of disability.Results839 people within the Newcastle 85+ study for whom complete information was available on self-reported Activities of Daily Living (ADL). PCA confirmed a single underlying dimension; Mokken scaling confirmed a hierarchic scale where ‘Cutting toenails’ was the first item with which participants had difficulty and ‘feeding’ the last. The ordering of loss differed between men and women. Difficulty with ‘shopping’ and ‘heavy housework’ were reported earlier by women whilst men reported ‘walking 400 yards’ earlier. Items formed clusters corresponding to strength, balance, lower and upper body involvement and domains specifically required for balance and upper/lower limb functional integrity.ConclusionThis comprehensive investigation of ordering of ability in activities in 85 year olds will inform researchers and practitioners assessing older people for onset of disability and subsequent care needs.
Highlights
Activities that are required to function independently in daily life, so called activities of daily living (ADLs), have long been seen as essential measures of disability in ageing studies and in clinical practice to assess care needs
839 people within the Newcastle 85+ study for whom complete information was available on self-reported Activities of Daily Living (ADL)
When Basic Activities of Daily Living (BADLs), for instance feeding, bathing, and toileting [1], are combined with Instrumental Activities of Daily Living (IADLs) which measure the ability to self-care within a household through activities such as shopping, cooking and doing housework [2], they better describe the spectrum of disability for a broader range of people [3]
Summary
Activities that are required to function independently in daily life, so called activities of daily living (ADLs), have long been seen as essential measures of disability in ageing studies and in clinical practice to assess care needs. The hierarchical structure to the order in which loss of ability in both BADL and IADL items occurs has been confirmed by crosssectional and longitudinal studies [3,4,5,6,7]. When both BADL and IADL items are considered together, difficulty with IADL items precedes difficulty with BADL items within the hierarchy [3]. The order of loss of ability to perform activities has been classified in terms of four domains with each domain containing multiple activities that are similar in terms of their need for specific functional integrity combinations of dexterity, balance, strength and upper or lower extremity involvement [5]. For example the first abilities lost require manual dexterity and the last upper rather than lower limb control
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