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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1 Introduction
1 Introduction
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, and so do disability and functional limitations, there has been a downward trend in the estimated prevalence of disability among the older population. The most commonly used measures for estimating trends in disability from population surveys have been ADLs and IADLs.
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In 1988 the Federal Interagency Forum on Aging Related Statistics appointed a committee to systematically examine the different estimates from the various surveys measuring ADLs. The committee found substantial differences in the prevalence of disabilities for the elderly population across the various national surveys.
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suggested that work was needed to reconcile different disability measures, such as chronic illness rates, functional limitations, ADLs, IADLs, uses of support services, and physical versus cognitive health; to craft new or revised survey questions to increase comparability across surveys; to test actual physical performance (e.g., climbing stairs) in addition to answering questions; and to develop measures that assess people's ability to live independently, considering objectively measured physical and cognitive abilities and assistance from devices and services that foster independent living even without improvements in underlying health.
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Another possibility is the use of easily collected biomarkers of chronic diseases that may track decline in functionality over the life course to supplement ADL and IADL measures that capture changes in functionality across thresholds. Another approach comes from the Patient-Reported Outcomes Measurement Information System (PROMIS)
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183–184) explain The field of disability research is in need of uniform concepts and a com mon language to guide scholarly discussion, to advance theoretical work on the disablement process, to facilitate future survey and epidemiological research, and to enhance understanding of disability on the part of profes sionals as well as the general public.
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defines disability as one's inability to engage in substantial gainful activity and this inability is by reason of any medically determinable physical or mental impairment directly tied to an underlying condition. The American Medical Association in 2001 defined disability as an alteration of an individual's capacity to meet personal, social, or occupational demands because of an impairment (Cocchiarella and Andersson, 2001)
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The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term that encompasses differing components, referred to as impairments, limitations in one's activity, and restrictions in one's ability to participate in social roles.
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The steering committee believed that a focused discussion among a wide range of disability researchers and survey methodologists could identify a framework for a long-term research agenda in this area for NIA and others in the field. To contribute to that framework, the committee commissioned a background paper Population Survey Measures of Functioning: Strengths and Weaknesses by Barbara Altman, which is included as Appendix A in this volume.
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INTRODUCTION comparisons, and Chapter 5 addresses the need to measure functioning and disability in context. The final chapter focuses discussion on the future in terms of suggesting research areas to advance the current efforts from the perspective of the participants attending the workshop.
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