Establishing an Approach to Activity of Daily Living and Instrumental Activity of Daily Living Staging in the United States Adult Community-Dwelling Medicare Population

PM R, 2014 · DOI: 10.1016/j.pmrj.2014.05.001 · Published: November 1, 2014

Simple Explanation

This study focuses on developing a way to categorize and track the activity limitations of older adults living in their communities who are covered by Medicare. These categories, called Activity Limitation Stages, help to show what activities people can still do without difficulty. The stages are based on how people report difficulties with everyday tasks like bathing, dressing, and managing money. The researchers looked at a large survey of Medicare beneficiaries to create these stages and see how they relate to factors like age and health conditions. Ultimately, the goal is to use these stages to help healthcare systems better plan and provide support to older adults with disabilities, so they can maintain their independence and participate in their communities.

Study Duration

Not specified

Participants

14,670 respondents to the 2006 Medicare Current Beneficiary Survey.

Evidence Level

Cross-sectional study

Key Findings

1
The study defined five stages (0-IV) for both Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), reflecting different levels of retained abilities and difficulties.
2
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.
3
The stages reveal the specific ADLs and IADLs that people can still perform without difficulty, emphasizing their potential for continued participation in life despite their limitations.

Research Summary

The study aimed to develop Activity Limitation Stages for defining and monitoring groups of adult community-dwelling Medicare beneficiaries, using a cross-sectional design and data from the 2006 Medicare Current Beneficiary Survey. The stages were empirically derived for ADLs and IADLs, defining five groups based on hierarchically organized profiles of retained abilities and difficulties. These stages were then associated with demographic and health variables to assess construct validity. The study concluded that ADL and IADL stages can reveal activities people can still do without difficulty, emphasizing how individuals with difficulties can still participate in their own lives, potentially facilitating large-scale planning to maximize personal autonomy.

Practical Implications

Population Health Planning

Stages applied to populations could facilitate large-scale planning within vertically integrated clinical practices.

Maximizing Autonomy

The goal is to maximize personal autonomy among community-dwelling people with disabilities.

Targeted Support Services

Grouping populations by ADL and IADL stage helps identify subpopulations requiring similar types of supportive services and assistive technologies.

Study Limitations

1
The study focuses exclusively on community-dwelling Medicare beneficiaries, excluding those in long-term care facilities.
2
The reliance on patient-reported measures introduces potential bias if certain groups differ in their perception of what constitutes difficulty performing an activity.
3
The inclusion of information from proxy respondents could bias questions that relate to self-perception.

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