Activities Of Daily Living Items Research Articles

Asking the right questions: the key to discovering what works in home care.

Discovering what works in home care begins with asking the right questions. Two principles from the evaluation research field are useful in understanding what results should be expected of home care: First, examination of program activities may be the key to discovering program objectives (Deutscher, 1977); second, evidence of immediate effects of programs is much more likely to be found than evidence of less proximate effects (Rossi, Freeman, & Lipsey, 1999). Therefore, to understand what home care is likely to accomplish, we should start by examining the specific tasks involved in home care and focus on immediately achievable program objectives. The core set of home care activities consists of personal assistance services intended to compensate for self-care limitations largely as reflected in activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Home care does for those with self-care limitations what they cannot do for themselves. More specifically, home care provides assistance with bathing, dressing, meal preparation, shopping, and so on for those who cannot perform these tasks independently. The immediate aim of personal assistance, therefore, is to assure that recipients have adequate solutions to challenges of daily living (Caro, 1981). I have come to use the term “quality of circumstances” to describe largely objective measures of the adequacy of solutions to problems of daily living. (I avoid the term “quality of life ” because it is typically conceived of as an entirely subjective construct.) Some examples of quality-of-circumstance content may be helpful. In the quality-of-circumstance framework, a highly favorable outcome for assistance with mobility is evidence that the recipient moves around in the living environment at will day and night with full access to all rooms in the residence and does so without experiencing injury. For those whose home care addresses inability to prepare meals, the quality-of-circumstance framework documents eating experiences from both a nutritional and enjoyment perspective. The nutritional aspect includes weight gain or loss, dietary balance, quantity of food available, and frequency of eating opportunities. Enjoyment of the eating experience includes the social context, satisfaction with the types and variety of food available, and satisfaction with the eating environment. For those who are unable to shop, the adequacy of assistance with shopping is measured by how fully the household is supplied with regularly needed items and how rapidly missing items are obtained. The quality-of-circumstance framework has content that corresponds to each ADL and IADL item.

Functional status and self-rated health in 2,262 nonagenarians: the Danish 1905 Cohort Survey.

To describe the functional capacity and self-rated health of a large cohort of nonagenarians. A cross-sectional survey of all Danes born in 1905 (92-93 years of age), carried out August to October 1998. Participants' homes. Two thousand two hundred and sixty-two nonagenarians, corresponding to a participation rate of 63% (of these, 20% participated by proxy). Activities of daily living (ADLs) and self-rated health were assessed by interview. Five items from Katz's ADLs (bathing, dressing, transfer, toileting, and eating) were used to construct a three-level five-item ADL scale (not disabled (no disabilities), moderately disabled (1-2 disabilities), severely disabled (3-5 disabilities)). From responses to a more extensive list of questions on ADLs (26 items), we identified scales of strength and agility by means of factor analysis. Furthermore, a 26-item ADL scale was made. Physical performance tests (chair stand, timed walk, lifting a 2.7 kg box, maximum grip-strength, and flexibility tests) were performed among nonproxy responders. According to the five-item ADL scale, 50% of the men and 41% of the women were categorized as not disabled, while 19% and 22%, respectively, were categorized as severely disabled. The five-item ADL scale correlated highly with the 26-item ADL scale (r = 0.83). The ADL scales showed moderate-to-good correlation with each other (r = 0.74-0.83), and with the physical performance tests (r = 0.31-0.58). Only 3.7% of the women and 6.3% of the men walked (normal pace) with a speed of at least 1 meter per second, which is the minimum walking speed required to cross signaled intersections in Denmark. A total of 56% considered their health to be excellent or good. Of the participants, 74% were always or almost always satisfied with their lives, even though only 45% reported that they "felt well enough to do what they wanted." The analyses showed that no single ADL item seemed to be of particular importance for how the participants rated their health. The Danish 1905 cohort survey is the largest and the only nationwide survey of a whole birth-cohort of nonagenarians. A total of 2,262 fairly nonselected nonagenarians participated. The level of both self-reported disability and functional limitations measured by physical performance tests among nonagenarians was high. Despite their lower mortality, women were more disabled than men and did not perform as well as men in the physical performance tests. Nevertheless, the majority of the participants considered their health to be good and were satisfied with their lives.

Effects of using consumer and expert ratings of an activities of daily living scale on predicting functional outcomes of postacute care

To test the effects of using preference weights for activities of daily living (ADL) outcome measures derived from different sources, data from a large study of the outcomes of postacute care (PAC study) were analyzed using two different weightings for the ADL measures. Both were developed using the same magnitude estimation technique; one from a panel of long-term care experts (the expert rating system); the other from a group of elderly Medicare beneficiaries (the consumer rating system). Neither group was directly involved in the PAC study. Although ADL scores generated by both rating systems were highly correlated prior to hospitalization and at hospital discharge, the consumer and expert rating systems generated significantly different functional outcomes measured by the change of ADL scores with a few exceptions. Compared to the consumer rating system, the expert rating system generated a greater change in functional outcomes at each of three follow-up time points after hospital discharge. This study suggests that the choice of weights for ADL items is important.

Considerations for Measuring Functioning of the Elderly: IRM Dimensionality and Scaling Analysis

Modern measurement methods were applied in this study to examine the properties of a measure of functioning of the elderly. Measures of functioning form an essential element in health services and outcomes research. Several implications for scale development and improved score precision are presented in this case study. This study examined the structure of responses to the Older Americans Resources and Services (OARS) Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales using item response model (IRM) analysis methods. The analysis illustrates the extension of IRM dimensionality and item analysis to health scales in general. Attention is given to the underlying theory and appropriate interpretation of these methods for health measurement. Data were taken from 1364 elderly Canadians participating in the caregiver component of the Canadian Study of Health and Aging (CSHA). The fit of a two-parameter logistic IRM was compared with a one-parameter (Rasch) model for these data. The dimensionality of responses to the scale was evaluated with an approximate χ2 test of residuals after fitting an IRM based on non-linear factor analysis. Results confirm that ADL and IADL item sets differ in the degree of disability they measure and are well represented as separate dimensions using a two-parameter IRM. Implications are drawn concerning the adequacy of the OARS disability measure for health surveys, while more general conclusions cover the precision of IRM based optimal scoring for functional disability measures.

Self-reported walking ability predicts functional mobility performance in frail older adults.

To determine how self-reported physical function relates to performance in each of three mobility domains: walking, stance maintenance, and rising from chairs. Cross-sectional analysis of older adults. University-based laboratory and community-based congregate housing facilities. Two hundred twenty-one older adults (mean age, 79.9 years; range, 60-102 years) without clinical evidence of dementia (mean Folstein Mini-Mental State score, 28; range, 24-30). We compared the responses of these older adults on a questionnaire battery used by the Established Populations for the Epidemiologic Study of the Elderly (EPESE) project, to performance on mobility tasks of graded difficulty. Responses to the EPESE battery included: (1) whether assistance was required to perform seven Katz activities of daily living (ADL) items, specifically with walking and transferring; (2) three Rosow-Breslau items, including the ability to walk up stairs and walk a half mile; and (3) five Nagi items, including difficulty stooping, reaching, and lifting objects. The performance measures included the ability to perform, and time taken to perform, tasks in three summary score domains: (1) walking ("Walking," seven tasks, including walking with an assistive device, turning, stair climbing, tandem walking); (2) stance maintenance ("Stance," six tasks, including unipedal, bipedal, tandem, and maximum lean); and (3) chair rise ("Chair Rise," six tasks, including rising from a variety of seat heights with and without the use of hands for assistance). A total score combines scores in each Walking, Stance, and Chair Rise domain. We also analyzed how cognitive/ behavioral factors such as depression and self-efficacy related to the residuals from the self-report and performance-based ANOVA models. Rosow-Breslau items have the strongest relationship with the three performance domains, Walking, Stance, and Chair Rise (eta-squared ranging from 0.21 to 0.44). These three performance domains are as strongly related to one Katz ADL item, walking (eta-squared ranging from 0.15 to 0.33) as all of the Katz ADL items combined (eta-squared ranging from 0.21 to 0.35). Tests of problem solving and psychomotor speed, the Trails A and Trails B tests, are significantly correlated with the residuals from the self-report and performance-based ANOVA models. Compared with the rest of the EPESE self-report items, self-report items related to walking (such as Katz walking and Rosow-Breslau items) are better predictors of functional mobility performance on tasks involving walking, stance maintenance, and rising from chairs. Compared with other self-report items, self-reported walking ability may be the best predictor of overall functional mobility.

在宅高齢者の日常生活動作能力評価に有効なADL項目の検討―加齢, 体力テスト, 項目相互間の関係から―

The purpose of this study was to propose useful ADLs (activities of daily living) and scales to estimate ADL ability on community older people from the viewpoints of aging, physical fitness level, and interrelationship among ADL. The survey constructing of 15 ADL items and physical fitness test of Ministry of Education, Science and Culture were carried out on 458 older people. Each ADL item was constructed with 3 level scales.As the results of this study, the following 12 ADLs were proposed as useful ADL items; in the locomotion domain, jumping across a ditch, walking, running, up and down stairs, and transfer; in the manipulation domain, taking bedding in and out, buttoning a shirt; in stability domain, standing in the bus or train, dressing while standing (trousers), standing on one foot with eyes open; in the posture-change domain, sitting up, standing up from the floor. These items were significantly related to age and physical fitness elements contributed largely to achievement of each ADL. Since significant high correlation was found between the index using 12 ADL items and that using 15 items, it is considered that the 12 items scale can account for the variance corresponded enough to that of 15 items scale, and that the new index is practical and simple.In further research, it will be required to examine validity of each ADL item and index by using more large sample, and to clarify the relation to various factors influenced to ADL ability level.

The proposal of the activities of daily living (ADL) index for institutionalized older adults

The purpose of this study was to propose the ADL index constructed with a unidimensional scale based on item difficulty for institutionalized older adults. Six hundreds and three subjects (159 males and 444 females) were divided into the following four groups based on assisting devices for movement: G1 did not use assisting devices for movement; G2 used a stick or a walker; G3 used a wheelchair; G4 could not move. As the results of examinations from the points of the approximation of proportions, non-answer rates and agreement rates of each item according to 74 ADL items representing 9 ADL domains, the 27 ADL items were selected as utility items. The reliability and unidimensionality of the ADL index consisting of 27 items were considered to be high. As the results of examining the difficulty of items and ADL ability characteristics of each group, the ADL concerning movement and other lower limb activity in G1 and G2, and concerning changes of posture and manual activity in G3 and G4 were considered to reflect the individual differences of ADL ability, respectively. The numbers of ADL items which should first be assessed in each group were as follows: 20 items in G1; 21 items in G2; 21 items in G3; 11 items in G4.

The Behavioral Dyscontrol Scale and Functional Status Among Elderly Medical and Surgical Rehabilitation Patients

This research was conducted in a sample of 150 older adults (mean age = 78.0) who were inpatients receiving rehabilitation services for a variety of medical and postsurgical conditions. The purpose of the study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the ability to use intentions to guide purposeful activity, would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression (Geriatric Depression Scale), and general mental status (Mini Mental State Exam [MMSE]). Functional status was assessed by rehabilitaion nurses' ratings of patients on 11 individual Activities of Daily Living (ADL) items and the Barthel Index. The hypothesis, tested by means of multiple regression analysis, was supported by the results. The BDS was the independent variable most strongly associated with all 11 ADL items and the Barthel Index. The MMSE contributed significantly to none of the models. Other covariates made minimal contributions to the variance shared with functional ability. Consistent with prior results in other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.

Identifying a short functional disability screen for older persons.

Disability in instrumental activities of daily living (IADLs) or activities of daily living (ADLs) is an indicator of health risk. The inclusion of these items in population screens may be limited by variation in item performance across gender and age groups. Further, identification of shortened lists may encourage inclusion of these items in screens. We applied item response theory (IRT) methods to assess the responses of 9865 community-dwelling elders in the 1993 Medicare Current Beneficiary Survey to 11 IADL/ADL items. Items were classified as "receive help/not receive help" for the overall population and stratified by age and gender. We assessed the same IADL/ADL items using responses classified as "difficulty/no difficulty." After eliminating items that performed poorly, we performed all-subsets analyses to identify abbreviated sets of items that would select the highest proportion of persons with IADL/ADL disability. Responses classified in receive help format showed consistency by gender and age group. Changing the response classification to difficulty/no difficulty influenced the reported order and relationship of IADL/ADL items. Receipt of help for any one of five items--shopping, doing light housework, walking, bathing, or managing finances--identified 93% of individuals receiving help with any IADL/ADL. A slightly different set of five items--walking, shopping, transferring, doing light housework, or bathing--identified 91% of persons reporting difficulty with any IADL or ADL. The relationship of IADL and ADL items to the underlying construct of disability was similar for men and women. The relationship was also similar for oldest-old and younger-old individuals. This study also identified abbreviated lists of disability items that can be used to efficiently screen community-dwelling elders for the presence of IADL/ADL disability.

Fear of falling in patients with stroke: a reliability study.

To examine the scaling properties and test-retest reliability of an expanded version of the Falls Efficacy Scale (FES) and to compare group differences in the scores. The expanded version focuses on more basic, primary activities of daily living (ADL), which makes the scale more suitable for subjects with moderate to low functional ability, e.g. patients with stroke. A test-retest reliability study with one group convenience sample. Two day-care units: a rehabilitation unit and a geriatric rehabilitation unit. A volunteer sample of 30 patients (mean age 65 years, SD 11 years) who had sustained stroke between 5 and 84 months prior to the investigation. A 13-activity questionnaire (the Swedish modification of the Falls Efficacy Scale (FES(S)) comprising the 10 activities of the original FES and three additional activities was used. Falls efficacy was rated on a 10-point visual analogue scale for each activity on two occasions, 5-22 (mean 10, Md 7) days apart. The overall test-retest reliability of the FES(S) was high (intraclass correlation coefficient (ICC) = 0.97). The ICC for the personal ADL (items 1-6) scores was 0.93 and for the instrumental ADL (items 8-13) 0.97. ICC for the individual items ranged from 0.76 to 0.97. On the basis of these preliminary findings, the FES(S) appears to have acceptable test-retest reliability. The test may be a reasonable addition for assessing stroke patients with balance disturbances and risk for falls.

Predictors of functional status in older people living at home.

to describe changes in functional status of community-dwelling Spanish elderly people, followed for 2 years, and to identify socio-demographic and health characteristics that predict functional change. we have analysed data from the first two waves of the longitudinal study, Ageing in Leganés, from a representative sample of community-dwelling people aged 65 and over (n=1273). Functional status was categorized according to a hierarchical scale as: completely functional, with functional limitations, with instrumental activities of daily living (IADL) disability, with activities of daily living (ADL) disability or deceased. Multinomial logistic regression was used to estimate the predictive value of selected 1993 socio-demographic and health status variables on 1995 functional status. prevalence of disability based on dependency in any of seven ADL items was 15.5%. Half of the respondents were disabled in at least one of 10 IADLs. Some improved functionally, others deteriorated. Men were more likely to recover function while women were more likely to enter and to remain in the IADL state. Socioeconomic factors were associated to baseline functional status and to functional status change on bivariate analysis. Number of chronic diseases, presence of cognitive problems and depressive symptoms predicted transitions, even after controlling for baseline functional status. although estimates of prevalence of disability among people over 65 are higher in Spain than in other European and North American countries, the pattern of functional changes, both in the direction of improvement and decline, seems to be similar.

Multidimensionality in Instrumental and Basic Activities of Daily Living

Although the use of self-reported ADL (activity of daily living) scales has a long history, the Katz-based assumptions of unidimensionality and hierarchy are increasingly found lacking, and ADLs alone are found to underestimate dysfunction and disability. Data from nearly 8900 elderly respondents in the community sample of the 1991 Canadian Study of Health and Aging were used to examine the measurement properties of a modified version of the Older Americans Research Survey (OARS) ADL and IADL items combined. A multidimensional factor structure was revealed, with three levels of functional ability possessing internal consistency. We conclude that assumptions regarding ADL/IADL unidimensionality and hierarchy are not always valid, and that ADL and IADL items should be considered in combination to capture a greater range of functional disability prevalence. We also suggest that expectations of precise measurement of functional dependence by (I)ADL scales should perhaps be relaxed to the goal of simply differentiating broad levels of self-reported functioning (such as basic, intermediate, and complex), within which some tasks are roughly equivalent. Because these scales are widely used as screening tools and in shaping policy, we suggest that employing a more empirically grounded measurement standard has the potential to reduce bias due to item complexity and task specificity, facilitate standardization, and more reliably predict outcomes.

Gender differences in correlates of disablement among the elderly in Egypt

The purpose of this paper is to examine gender-specific models to determine whether different combinations of correlates are associated with male and female disablement, using a sample of non-institutionalized elderly persons in Egypt. Because women and men have different work, family, and household roles, as well as different health risks, it is reasonable to assume that there may be differing correlates for disablement for elderly males and females. The dichotomous dependent variable indicates problems, or the inability, in performing at least one of six activities of daily living (ADL). Of interest is the association of health, economic, and family variables, controlling for age. Logistic regression models are estimated for the total, male, and female samples. The results indicate that for males, having to stop working due to illness and having an unattended medical need are associated with higher odds for disablement as compared with females. Additionally, illiteracy increases the odds for male disablement, yet it has no effect on female disablement. Having experienced an injury in the past year is associated with disability for females, as is spending a lifetime in a rural setting and currently living in a fair to poor residence. Also for the females, increased number of living children significantly increases the odds for functional disability. Separate male and female models were estimated for each of the six ADL items. The trends indicated that the model covariates were more useful in modeling female disabilities in personal care activities, rather than problems with eating and mobility. The health variables were significantly associated with most of the specific ADL problems for the males.

An Inventory to Assess Activities of Daily Living for Clinical Trials in Alzheimerʼs Disease

We developed a set of informant-based items describing performance of activities of daily living (ADL) by patients with Alzheimer's disease (AD) to identify which ADL are useful for assessment of patients in clinical trials. Evaluation of ADL is an important outcome measure in AD clinical trials. For clinical trial measurement, ADL should have broad applicability, good test-retest reliability, scaling to cover a range of performance, and sensitive to detect change in disease progression. A total of 45 ADL items developed from literature review and clinical experience were administered to informants of 242 AD patients and 64 elderly controls as part of the multicenter Alzheimer's Disease Cooperative Study Instrument protocol. Half of the subjects were re-evaluated at 1 and 2 months and all at 6 and 12 months. Controls performed virtually all ADL items optimally at baseline and at 12 months. Among subjects with AD, 27 of the 45 ADL were widely applicable, i.e., performed at baseline or premorbidly by >90% of subjects; showed good test-retest reliability between baseline and 1 and 2 months; correlated with MMSE scores of AD patients cross-sectionally; and showed a decline in performance from baseline to 12 months in at least 20% of AD patients. ADL could be identified that capture change in functional ability in patients across the entire range of the MMSE. The remaining 18 ADL included several that may be useful for trials that target specific populations, e.g., women with AD. Because change on specific items depends on baseline MMSE, ADL evaluation should include items relevant to the severity of dementia of patients enrolled in a clinical trial …

Severity of neurological disorders in elderly residents of a farming town in Kyushu, Japan; prevalence of disability in activities of daily living.

Activities of daily living (ADL) were evaluated in 421 elderly people, aged 60-95, who resided in 27 randomly selected communities in the town of Mifune, Japan. The disability of ADL increased with age, and was particularly rapid after age 80. Most of the elderly were independent; the prevalence of dependent elderly ranged from 0.7% (in feeding) to 9.5% (in working). The prevalence of dependent elderly increased markedly after age 80 in all ADL items, especially those related to behavior such as ambulation, stair climbing, transfers, and working (i.e., employment, housekeeping, etc.). These results emphasize the importance of community health care of the elderly for preventing and treating neurological disorders which comprised the main cause of disabilities of behavioral ADL.

Reported activities of daily living: agreement between elderly subjects with and without dementia and their caregivers.

to determine how accurately information on disability provided by a caregiver (proxy respondent) reflected the opinion of subjects themselves, and if this agreement varied by severity of dementia or relationship of the caregiver to the subject. the study was based on data from the Canadian Study of Health and Aging, a multicentre study of dementia and health of Canadians age 65 and over. Eight hundred study subjects and their caregivers were independently interviewed regarding the subjects' activities of daily living (ADL). the percentage of subjects who were independent for individual ADL items and the agreement in these reports between subjects and caregivers were investigated using three-level kappa statistics. index subjects with caregivers other than spouses or offspring required more assistance with ADL. The reported percentage of independence decreased with increasing severity of dementia. There was more agreement between self- and proxy-reported level of independence for physical ADL than for instrumental ADL items. Agreement decreased with increasing severity of dementia. Few statistically significant differences were noted between level of agreement and caregiver relationship. satisfactory levels of agreement on ADL between cognitively normal subjects and their caregivers indicate that proxy respondents are a reasonable source of information on ADL when data collection from the subjects themselves is not feasible. Since agreement decreases as the severity of dementia increases, caregiver reports may be preferred for elderly patients even with mild dementia in order to facilitate longitudinal assessment of ADL ratings as the dementia progresses.

Dimensionality and hierarchical structure of disability measurement

Since the D-code of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in its full form has proven to be impractical, an instrument based on a selection of 28 items is used to measure disability in Dutch patients undergoing rehabilitation. The items are categorized into 5 domains of physical, activities of daily living (ADL), social, psychological, and communicative activity. Measurement is made on a 4-point scale ranging from 0 (not disabled) to 3 (severely disabled). As a result of the ordinal character of the rating, statistical and mathematical manipulations of the scores are complicated. The aim of this study was to obtain more insight in the dimensionality and hierarchical structure of the items, to overcome problems in comparing disability between items, between patients, and within patients between different moments in time. Mokken scale analysis of the disability scores from 1,967 rehabilitation inpatients showed that the 28 items constitute hierarchical scales. However, categorization of the items into the 5 original domains was not replicated. Five other scales or dimensions were investigated, measuring the level of extended ADL, extended psychological, fine motoric, work/leisure, and hearing/ seeing activity, respectively. The number of items per dimension ranges from 14 in the extended ADL dimension to 2 each in the work/leisure and hearing/seeing dimensions. Although each disability item may be of importance in clinical case management, a reduced set of extended ADL items suffices to describe the disability level in this dimension for epidemiological research purposes. The other dimensions need further specification to provide reliable and sensitive measuring of disability.

ADL dependence and medical conditions in Chinese older persons: a population-based survey in Shanghai, China.

To describe the prevalence of activities of daily living (ADL) dependence and medical conditions and the relationship between illnesses and ADL performance in the older population of Shanghai, China. Probability sample survey of community residents. The Jing An district of Shanghai, China. The interviews were carried out at the homes of the older persons. There were 3763 noninstitutionalized elders screened, 3745 of whom completed the interview. The dependent variables were the five basic ADL items: eating, dressing, transferring, toileting, and bathing. The independent variables were dementia and 19 self-reported medical conditions, along with age, gender and education level. Of those in Shanghai aged 65 and older, 8.28% (6.52% of males, 9.17% of females) were functionally dependent in one or more ADLs. The most prevalent self-reported illness was cardiovascular disease, including hypertension (29.12%) and heart disease (26.65%). ADL performance was associated with dementia and a number of medical conditions in univariate analysis. The best predictors of functional dependence in both age groups (65-74 years; 75 years and older), based on the multiple logistic regression analysis and after controlling for age, gender, and education, were stroke, dementia, Parkinson's disease, diabetes, and emphysema. The authors have successfully applied five ADL items selected and culturally adapted from Older Americans Resources and Services to the study of older Chinese. A consistent and reliable estimate of functional dependence among older persons is obtained. The prevalence of dementia and many self-reported illness, as well as the ADL status by medical condition, are reported. The findings reveal certain patterns of relationship between illness conditions and ADL performance.

Life satisfaction and its related factors among institutionalized patients at a Hansen's disease sanatorium

We conducted a questionnaire survey on life styles and health status for 293 patients with Hansen's disease. They were admitted to the wards for disabled and physically able patients of Ohshima Seishoen, in Kagawa prefecture, in 1991. This institution is one of Japan's national leprosy sanitarians. We measured patients' life satisfaction with the Delighted-Terrible Scale. In this report, the distribution of life satisfaction and its associated factors were examined for 210(71.7%) respondents. Factors examined were length of treatment, physical health, and social aspects of life at the sanatorium. The major findings were as follows; 1. The patients aged under 60 had lower proportions of being satisfied with life than those aged 60 or older. The proportions of life satisfaction of the 40-59 age group were 17% for men and 22% for women, while for the 60 or older age groups were 33-44% for men and 41-45% for women. The proportions of life satisfaction in the 60 or older age groups were lower than those of community dwelling elderly persons. 2. We examined factors associated with life satisfaction for the respondents aged 60 or older. Dependence on activities of daily living (ADL) was associated with life satisfaction in some ADL items. Care and aid provided by the staff of the sanatorium may modify the relationship between ADL impairment and life satisfaction. For social aspects of life at the sanatorium, both having networks with family members and having resources other than family were associated with life satisfaction. Going out and positively spending their daily lives were associated with life satisfaction, too. These associations were significant for men. Similar patterns of association were observed for women, but were insignificant. This finding suggests that it is important for the health and medical care staff to pay attention to the social aspects of the life of elderly patients with Hansen's disease.

A postal version of the Barthel Index

The Barthel Index is the best known and most popular activities of daily living (ADL) scale. Many studies have confirmed its validity and it has been validated for many different methods of administration. These include direct observation, interview of patient carer or nurse and telephone. The aim of this study was to devise and test the reliability of a self-completed postal version of the Barthel Index for use in surveys and outcome studies. The items were changed into multiple choice questions, taking into account the published guidelines and knowledge of common areas of confusion when administering the Barthel by interview. The test retest reliability over two weeks of the resulting questionnaire was evaluated using a consecutive series of 21 patients from a stroke register, who had responded without prompting to a postal survey six months after stroke. All the items had κ statistics indicating at least moderate reliability, the toilet and mobility items being the worst. The mean difference in total scores was -0.5 out of 20, standard deviation 2.1. The 95% limits of agreement were -4.6 to 3.6, corresponding to a change in dependence of up to two ADL items. This study demonstrates that the postal self-report questionnaire version of the Barthel is reliable and practical. Further studies are needed to establish its validity in comparison with interview administration.