Improving the Measurement of Late-Life Disability in Population Surveys Beyond ADLs and IADLs: Summary of a Workshop (2009) / Chapter Skim
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5 Measuring Functioning and Disability in Context
5 Measuring Functioning and Disability in Context
Pages 69-84
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From page 69... ...
The utility of participation measures in population surveys INCORPORATING ASSISTIVE TECHNOLOGY AND HOME MODIFICATION MEASURES The objectives of Emily Agree's (Johns Hopkins Bloomberg School of Public Health) presentation were to discuss how accommodations, like the use of assistive technology or the use of home modifications, relate to individuals' functioning and to describe findings from a pilot study on assistive technology, fielded by Agree and colleagues in 2005, designed to develop survey questions on assistive technology and home environments.
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From page 70... ...
To expand on the concept a bit, if disability is an activity-specific gap between individual capacity and performance, technology expands the capacity of the individual and environmental modifications reduce barriers in the environment. Current Survey Measurement of Assistive Technology Use A review of six major national surveys -- (1)
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From page 71... ...
Assistive technology tends to be task specific by design, and so survey questions on assistive technology should be task specific; however, they need to be separate from questions about task difficulty. Such an approach would help people understand how effective assistive technology may be in reducing difficulty with tasks.
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From page 72... ...
Department of Health and Human Services, Agree and her colleagues conducted a nationwide pilot study to develop and test survey instruments on assistive technology use and the home environment for national surveys on health and aging. The goals of the pilot study were to design questions that are useful for people of all abilities, use positive language, and assess device use across environments and activities.
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From page 73... ...
Agree said she and her colleagues suggest refining ADL measures to ask about activities in a way that represents independent functioning. These items differ from those commonly found in national surveys in two ways.
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From page 74... ...
Thus, these data can be used to determine the potential need for targeting effective interventions. INCORPORATING QUESTIONS ON BEHAVIORAL ADAPTATIONS IN FUNCTIONAL LIMITATION MEASURES Carlos Weiss (Johns Hopkins University School of Medicine)
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From page 75... ...
Participation occurs on a continuum, from having difficulty doing tasks to restricted participation to dependence, and behavioral adaptations occur at many different levels along that continuum. However, it may make sense to first focus on understanding behavioral adaptation by studying it in the absence of dependence, and even in the absence of difficulty, to understand some of its salient features.
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From page 76... ...
A useful way to narrow the otherwise innumerable differences in the ways people participate in important social roles is to focus on behavioral adaptations that are responses to mild to moderate impairment, to ensure that the behavioral adaptations are occurring despite normal conditions and to ask whether they involve performing tasks or roles in a way that is not usual for that person. Consider walking as a prime example: one may sometimes walk more slowly.
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From page 77... ...
These different types of compensatory strategies would have different outcomes in terms of the amount of activity performed or time spent doing the activity. Weiss pointed out that the study of behavioral adaptation is already taking place under many different names in population surveys, such as subclinical disability, time use, avoidance, and life space.
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From page 78... ...
a more refined understanding of the reasons for changes, that is, why people change how they perform these activities, including personal and environmental factors; and (c) which of these behavioral adaptations are modifiable and therefore high-priority targets for intervention.
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From page 79... ...
However, ICF does not provide a measurement of participation, only a classification. The Craig Handicap Assessment and Reporting Technique (CHART)
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From page 80... ...
Participation measures can be used in population surveys to assess the participation gap between people with and without disabilities, trends over time, and the effects of environmental interventions. For example, participation measures developed in rehabilitation, such as CHART and CPI, have been used in Colorado, piggybacking on the Behavioral Risk Factors Surveillance System of the Centers for Disease Control and Prevention.
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From page 81... ...
It is a lengthy branching survey primarily focusing on activity limitations, but it also includes participation and quality of life. To conclude, participation measures should be used to determine the extent to which people with disabilities are fully participating in society.
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From page 82... ...
The difference between these participation measures and the more usual measures of activity limitations has to do with the fact that people value what they participate in differently. It is going to hinge on asking people how important each of these areas is to them so that each person has his or her own valuation scale.
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From page 83... ...
This area also was not addressed in the pilot study. It may be far too simplistic to say that environmental barriers impede participation and environmental facilitators enhance participation.
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