Disability

Disability among older adults is now caused primarily by chronic disease (Ostir et al., 1999). In large studies of physical disability in the community setting, self-report has traditionally been employed to assess the degree of difficulty individuals face in self-maintenance and active involvement in the community (Ostir et al., 1999). The Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) scales are the two most commonly used measures to assess physical disability. ADL items cover basic mobility and activities required for community living (e.g., bathing, dressing, using the toilet, transferring from bed to chair, feeding, walking). Difficulty in performing ADLs can reflect serious health problems, and ADLs are the most frequently used indicators of the ability to live independently. IADLs are intended to identify individuals who are having difficulty performing important activities of living and who may be at risk for loss of independence. The items shown in Box 2-3 are activities that are frequently measured IADLs.

Information on the health and disability status of cancer survivors is available from the National Health Interview Survey (NHIS). However, only those residing in households and well enough to participate in the Survey are interviewed for important components of the Survey. Another limitation of the NHIS is that cancer cases are self-reported and not validated with medical records or cancer registry data. A strength of these data are that they provide estimates that are population based and nationally representative. Analyses of the 1998–2000 NHIS provide information on the prevalence of disability among those reporting a history of cancer (Hewitt et al., 2003). According to these national survey data, adults who

BOX 2-3
Instrumental Activities of Daily Living Items

  • Using the telephone

  • Driving a car or traveling alone on a bus or taxi

  • Shopping

  • Preparing meals

  • Doing light housework

  • Taking medicine

  • Handling money

  • Doing heavy housework

  • Walking up and down stairs

  • Walking half a mile without help



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