Advertisement

Rheumatology International

, Volume 35, Issue 9, pp 1581–1589 | Cite as

Hierarchical nature of activities of daily living in the Spanish Disability Survey

  • M. J. Forjaz
  • A. AyalaEmail author
  • A. Abellán
Original Article - Validation Studies

Abstract

Many studies have addressed the issue of dimensionality in activities of daily living (ADL) and its hierarchy, with contradictory results. This paper aims to study the unidimensional structure and the hierarchy of ADL in the Spanish Disability Survey. We analysed a sample of 8381 people aged 65 and over with at least one disability and receiving personal help with one of them. The following Rasch model properties were studied in 14 items enquiring about basic and instrumental ADL: fit to the model, reliability, unidimensionality, local independency between items and differential item functioning (DIF) by gender, age and proxy. The unidimensionality of the scale was confirmed. The final analysis of eight items showed a satisfactory fit, good reliability, local independency, unidimensionality and no DIF by age. The disability linear measure showed significant differences by gender and age. The obtained disability scale is a simple and reliable measure, and it suggests a hierarchical order of ADL and predicts a schedule of functional impairment in older adults. Rating the disability of older community-dwelling people has a predictive value that policy makers might find useful in service planning.

Keywords

ADL Disability Unidimensionality Rasch analysis Hierarchy 

Notes

Conflict of interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

References

  1. 1.
    Hoeymans N, Wouters ER, Feskens EJ et al (1997) Reproducibility of performance-based and self-reported measures of functional status. J Gerontol A Biol Sci Med Sci 52:M363–M368CrossRefPubMedGoogle Scholar
  2. 2.
    Kempen GI, Myers AM, Powell LE (1995) Hierarchical structure in ADL and IADL: analytical assumptions and applications for clinicians and researchers. J Clin Epidemiol 48:1299–1305CrossRefPubMedGoogle Scholar
  3. 3.
    Rivero T, Salvà A (2006) Envejecimiento y dependencia una mirada al panorama futuro de la población española / coord. by Rafael Puyol Antolín, Antonio Abellán García, pp 73–90Google Scholar
  4. 4.
    Bowling A (2004) Measuring health: a review of quality of life measurement scales. Open University in Press, Milton KeynesGoogle Scholar
  5. 5.
    Travis SS, McAuley W (1999) Simple counts of the number of basic ADL dependencies for long-term care research and practice. Health Serv Res 25:349Google Scholar
  6. 6.
    Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA J Am Med Assoc 185:914–919CrossRefGoogle Scholar
  7. 7.
    Kane RA, Kane RL, Carrillo E (1993) Evaluación de las necesidades en los ancianos: guía práctica sobre los instrumentos de medición. SG Editores, Barcelona, SpainGoogle Scholar
  8. 8.
    McDowell I (2006) Measuring health: a guide to rating scales and questionnaires. Oxford University Press, OxfordCrossRefGoogle Scholar
  9. 9.
    Fleishman JA, Spector WD, Altman BM (2002) Impact of differential item functioning on age and gender differences in functional disability. J Gerontol B Psychol Sci Soc Sci 57:S275–S284CrossRefPubMedGoogle Scholar
  10. 10.
    Spector WD, Katz S, Murphy JB, Fulton JP (1987) The hierarchical relationship between activities of daily living and instrumental activities of daily living. J Chronic Dis 40:481–489CrossRefPubMedGoogle Scholar
  11. 11.
    National Satatistics Institute (2010) Disabilities, Independence and Dependency Situations Survey 2008 (Methodology; in Spanish). http://www.ine.es/metodologia/t15/t1530418.pdf
  12. 12.
    LaPlante MP (2010) The classic measure of disability in activities of daily living is biased by age but an expanded IADL/ADL measure is not. J Gerontol B Psychol Sci Soc Sci 65:720–732. doi: 10.1093/geronb/gbp129 CrossRefPubMedGoogle Scholar
  13. 13.
    Breithaupt K, McDowell I (2001) Considerations for measuring functioning of the elderly: IRM dimensionality and scaling analysis. Health Serv Outcomes Res Methodol 2:37–50CrossRefGoogle Scholar
  14. 14.
    Spector WD, Fleishman JA (1998) Combining activities of daily living with instrumental activities of daily living to measure functional disability. J Gerontol B Psychol Sci Soc Sci 53:S46–S57CrossRefPubMedGoogle Scholar
  15. 15.
    Dunlop DD, Hughes SL, Manheim LM (1997) Disability in activities of daily living: patterns of change and a hierarchy of disability. Am J Public Health 87:378–383PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Ferrucci L, Guralnik JM, Cecchi F et al (1998) Constant hierarchic patterns of physical functioning across seven populations in five countries. Gerontol 38:286–294CrossRefGoogle Scholar
  17. 17.
    Oliva-Moreno J, Aranda-Reneo I, Vilaplana-Prieto C, González-Domínguez A, Hidalgo-Vega A (2013) Economic valuation of informal care in cerebrovascular accident survivors in Spain. BMC Health Serv Res 13:508. doi: 10.1186/1472-6963-13-508 PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Abellán A, Esparza C, Castejón P, Pérez J (2011) Epidemiology of disability and dependency in old age in Spain. Gac Sanit SESPAS 25(Suppl 2):5–11. doi: 10.1016/j.gaceta.2011.07.010 CrossRefGoogle Scholar
  19. 19.
    Maierhofer S, Almazán-Isla J, Alcalde-Cabero E, de Pedro-Cuesta J (2011) Prevalence and features of ICF-disability in Spain as captured by the 2008 National Disability Survey. BMC Public Health 11:897. doi: 10.1186/1471-2458-11-897 PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Ashbaugh MS, Benguria RD (1992) A sharp bound for the ratio of the first two eigenvalues of Dirichlet Laplacians and extensions. Ann Math 135:601–628CrossRefGoogle Scholar
  21. 21.
    Hoyle RH, Duvall JL (2004) Determining the number of factors in exploratory and confirmatory factor analysis. In: Kaplan D (ed) Handbook of quantitative methodology for the social sciences. Sage, Thousand Oaks, CA, pp 301–315Google Scholar
  22. 22.
    Rasch G (1960) Probabilistic models for some intelligence and attainment tests. Danish Institute for Educational Research, CopenhagenGoogle Scholar
  23. 23.
    Wright BD, Stone MH (1979) Best test design: Rasch measurement. MESA press, ChicagoGoogle Scholar
  24. 24.
    MacKnight C, Rockwood K (2000) Rasch analysis of the hierarchical assessment of balance and mobility (HABAM). J Clin Epidemiol 53:1242–1247CrossRefPubMedGoogle Scholar
  25. 25.
    Masters GN (1982) A Rasch model for partial credit scoring. Psychometrika 47:149–174CrossRefGoogle Scholar
  26. 26.
    Tennant A, Conaghan PG (2007) The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum 57:1358–1362. doi: 10.1002/art.23108 CrossRefPubMedGoogle Scholar
  27. 27.
    Tennant A, Pallant JF (2006) Unidimensionality matters!(A tale of two Smiths?). Rasch Meas Trans 20:1048–1051Google Scholar
  28. 28.
    Andrich D, Lyne A, Sheridan B, Luo G (2003) RUMM 2020. RUMM Laboratory, Perth, AustraliaGoogle Scholar
  29. 29.
    Baghaei P (2008) Local dependency in Rasch Measures. Rasch Meas Trans 21:1105–1106Google Scholar
  30. 30.
    Linacre JM (1994) Sample size and item calibration stability. Rasch Meas Trans 7:328Google Scholar
  31. 31.
    Linacre JM (2003) Rasch power analysis: size vs. significance: standardized chi square fit statistic. Rasch Meas Trans 17:918Google Scholar
  32. 32.
    Smith RM, Linacre JM, Smith EV (2003) Guidelines for manuscripts. J Appl Meas 4:198–204Google Scholar
  33. 33.
    Bjorner JB, Damsgaard MT, Watt T, Groenvold M (1998) Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol 51:1001–1011CrossRefPubMedGoogle Scholar
  34. 34.
    McHorney CA, Tarlov AR (1995) Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 4:293–307CrossRefPubMedGoogle Scholar
  35. 35.
    Andrich D, Sheridan B, Luo G (2009) RUMM 2030. RUMM Laboratory, Perth, AustraliaGoogle Scholar
  36. 36.
    Fieo RA, Austin EJ, Starr JM, Deary IJ (2011) Calibrating ADL-IADL scales to improve measurement accuracy and to extend the disability construct into the preclinical range: a systematic review. BMC Geriatr 11:42. doi: 10.1186/1471-2318-11-42 PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Fortinsky RH, Garcia RI, Joseph Sheehan T et al (2003) Measuring disability in Medicare home care patients: application of Rasch modeling to the outcome and assessment information set. Med Care 41:601–615. doi: 10.1097/01.MLR.0000062553.63745.7A PubMedGoogle Scholar
  38. 38.
    Kempen GI, Miedema I, Ormel J, Molenaar W (1996) The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties. Soc Sci Med 43:1601–1610CrossRefPubMedGoogle Scholar
  39. 39.
    Suurmeijer TP, Doeglas DM, Moum T et al (1994) The Groningen Activity Restriction Scale for measuring disability: its utility in international comparisons. Am J Public Health 84:1270–1273PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Jette AM, Haley SM, Coster WJ et al (2002) Late life function and disability instrument: I. Development and evaluation of the disability component. J Gerontol A Biol Sci Med Sci 57:M209–M216CrossRefPubMedGoogle Scholar
  41. 41.
    Haley SM, Jette AM, Coster WJ et al (2002) Late life function and disability instrument: II. Development and evaluation of the function component. J Gerontol A Biol Sci Med Sci 57:M217–M222CrossRefPubMedGoogle Scholar
  42. 42.
    Stineman MG, Ross RN, Maislin G (2005) Functional status measures for integrating medical and social care. Int J Integr Care 5:e07PubMedCentralPubMedGoogle Scholar
  43. 43.
    Rojo-Pérez F (2010) Población mayor, calidad de vida y familia: demanda y prestación de cuidados en el seno familiar. Imserso, MadridGoogle Scholar
  44. 44.
    Cabrero-García J, López-Pina JA (2008) Aggregated measures of functional disability in a nationally representative sample of disabled people: analysis of dimensionality according to gender and severity of disability. Qual Life Res 17:425–436. doi: 10.1007/s11136-008-9313-x CrossRefPubMedGoogle Scholar
  45. 45.
    Lazaridis EN, Rudberg MA, Furner SE, Cassel CK (1994) Do activities of daily living have a hierarchical structure? An analysis using the longitudinal study of aging. J Gerontol 49:M47–M51CrossRefPubMedGoogle Scholar
  46. 46.
    Puga MD, Abellán A (2004) El proceso de discapacidad: un análisis de la Encuesta sobre discapacidades, deficiencias y estado de salud. Fundación Pfizer, MadridGoogle Scholar
  47. 47.
    Verbrugge LM, Yang L-S, Juarez L (2004) Severity, timing, and structure of disability. Soz- Präventivmedizin 49:110–121CrossRefGoogle Scholar
  48. 48.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontol 9:179–186CrossRefGoogle Scholar
  49. 49.
    Hsieh C-L, Hoffmann T, Gustafsson L, Lee Y-C (2012) The diverse constructs use of activities of daily living measures in stroke randomized controlled trials in the years 2005–2009. J Rehabil Med 44:720–726. doi: 10.2340/16501977-1008 CrossRefPubMedGoogle Scholar
  50. 50.
    Saliba D, Orlando M, Wenger NS et al (2000) Identifying a short functional disability screen for older persons. J Gerontol A Biol Sci Med Sci 55:M750–M756CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.National School of Public HealthCarlos III Health Institute and REDISSECMadridSpain
  2. 2.Centre for Human and Social SciencesSpanish Scientific Research Council (CCHS, CSIC)MadridSpain

Personalised recommendations