Abstract
Although researchers and clinicians tend to use subjective evaluations of functioning and objective assessments interchangeably, there may be important differences between how people view their own abilities and objective indicators. This study aims to examine the relation between self-reported evaluations of function and health and performance-based (PB) measures of functional ability and objective health indicators in a sample of the oldest old. The study is based on data from a sample of 349 individuals aged 80 and older from the OCTO-Twin Study. One member of each twin pair was randomly selected for this study. The result demonstrates that subjective evaluations of functional ability are significantly associated with objective measures of health and PB measures of function although considerable variance remained unexplained. The association of PB measures to the self-report evaluations differed by measure. PB measures had stronger associations with self-reported functioning than objective health indicators such as diseases and medications. PB balance was related to self-reported function in instrumental activities in daily life (IADL) and self-reported mobility, whereas PB upper body strength and flexibility was associated with all three self-reports of function but not to perceived health. The strength of these associations did not differ from one another suggesting that PB balance and upper body strength and flexibility have comparable effects on self-reports of daily life function. From a practical perspective, our findings confirm that self-reported ADL reflects objective measures of functioning, but probably also has subjective components that need further exploration. The result also indicates a need for multiple measures in evaluating functional ability in the oldest old.
Similar content being viewed by others
References
Ahacic K, Parker MG, Thorslund M (2003) Mobility limitations 1974–1991: period changes explaining improvement in the population. Soc Sci Med 57:2411–2422
Allen MS, Foster A, Berg K (2001) Receiving help at home: the interplay of human and technological assistance. J Gerontol B Sci Soc Sci 56:S374–S382
Arai Y, Zarit SH, Kumamoto K, Takeda A (2003) Are there inequities in the assessment of dementia under Japan’s LTC insurance system. Int J Geriatr Psych 4:346–352
Avlund K, Due P, Holstein BE, Sonn U, Laukkanen P (2002) Changes in household composition as determinant of changes in functional ability among old men and women. Aging Clin Exp Res 14:65–74
Avlund K, Vass M, Hendriksen C (2003) Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Age Ageing 32:579–584
Bardage C, Pluijm SMF, Pederson NL, Deeg DJH, Jylhä M, Noale M, Blumstein T, Otero Á (2005) Self-rated health among older adults: a cross-national comparison. Eur J Ageing 2:149–158
Béland F, Zunzunegui MV (1999) Predictors of functional status in older people at home. Age Ageing 28:153–159
Berg AI, Hassing LB, Nilsson SE, Johansson B (2009) “As long as I’m in good health”. The relationship between medical diagnoses and life satisfaction in the oldest-old. Aging Clin Exp Res 21:307–313
Braungart Fauth E, Zarit SH, Malmberg B, Johansson B (2007) Physical, cognitive, and psychosocial variables from the Disablement Process Model predict patterns of independence and the transition into disability for the oldest-old. Gerontologist 47:613–624
BURDIS (Burden of Disease Network Project) (2004) Disability in old age. Final report conclusions and recommendations. The Finnish Centre for Interdisciplanary, Gerontology University of Jyväskylä, Finland. Jyväskylä University Press
Burt DB, Zembar MJ, Niederehe G (1995) Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychol Bull 117:285–305
Cederlöf R, Lorich U (1978) The Swedish twin registry. In: Nance WE, Allen G, Parisi P (eds) Twin research: part b, biology and epidemiology. Alan R. Liss, New York
Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Am J Med 51:451–458
Davey A, Johansson L, Malmberg B, Sundström G (2006) Unequal but equitable: an analysis of variations in old-age care in Sweden. Eur J Ageing 3:34–40
Dening TR, Chi L-Y, Brayne C, Huppert FA, Paykel ES, O′Connor DW (1998) Changes in self-rated health, disability and contact with services in a very elderly cohort: a 6-year follow-up study. Age Ageing 27:23–33
Fauth ER, Zarit SH, Malmberg B (2008) Mediating relationships within the disablement process model: a cross-sectional study of the oldest-old. Eur J Ageing 5:161–179
Femia EE, Zarit SH, Johansson B (1997) Predicting change in activities of daily living: a longitudinal study of the oldest old in Sweden. J Gerontol B Psychol Sci Soc Sci 52:P294–P302
Femia EE, Zarit SH, Johansson B (2001) The disablement process in very late life: a study of the oldest-old in Sweden. J Gerontol B Psychol Sci Soc Sci 56:P12–P23
Fields J, Sobo D, Sanford J, Toll N, Wheatland R, Jette D (1999) The disablement model: the relationships between and among impairment, functional limitation and disability in the elderly population. Issues Aging 22:5–9
Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198
Fors S, Thorslund M, Parker MG (2006) Do actions speak louder than words? Self-assessed and performance-based measures of physical and visual function among old people. Eur J Ageing 3:15–21
Gayman M, Turner TR, Ming C (2008) Physical limitations and depressive symptoms: exploring the nature of the association. J Gerontol Psychol Sci Soc Sci 63B:P219–P228
Hallberg D, Lagergren M (2009) Moving in and out of public old age care among the very old in Sweden. Eur J Ageing 6:137–145
Hellström Y, Hallberg IR (2001) Perspective of elderly people receiving home help on health, care and quality of life. Health Soc Care Commun 9:61–71
Hogan DB (2000) Effects of age and disease on disability in the very elderly. Clin Geriatr 8:28–37
Iwarsson S (2005) A long-term perspective on person-environment fit and ADL dependence among older Swedish Adults. Gerontologist 45:327–336
Jagger C, Gillies C, Cambois E, Van Oyen H, Nusselder W, Robine JM (2010) The Global Activity Limitation Index measured function and disability similarly across European countries. J Clin Epidemiol 63:892–899
Jette AM, Assmann SF, Rooks D, Harris BA, Crawford S (1998) Interrelationships among disablement concepts. J Gerontol A Biol Med Sci 53:M395–M404
Johansson B, Allen-Burge R, Zarit SH (1997) Self-reports on memory functioning in a longitudinal study of the oldest old: relation to current prospective and retrospective performance. J. Gerontol B Psychol Sci Soc Sci 52:P139–P146
Kempen GIJ, Steverink N, Ormel J, Deeg DJH (1996) The assessment of ADL among frail elderly in an interview survey: self-report versus performance-based tests and determinants of discrepancies. J Gerontol B Psychol Sci Soc Sci 51:P254–P260
Kempen GIJ, Sullivan M, van Sonderen E, Ormel J (1999) Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact on depressive symptoms. J Gerontol B Psychol Sci Soc Sci 54:P380–P386
Kivett VR, Stevenson ML, Zwane CH (2000) Very-old rural adults: functional status and social support. J Appl Gerontol 19:58–77
Larsson K, Thorslund M, Kåreholt I (2006) Are public care and services for older people targeted according to need? Applying the Behavioural Model on longitudinal data of a Swedish urban older population. Eur J Ageing 3:22–33
Leinonen R, Heikkinen E, Jylhä M (1999) A path analysis model of self-rated health among older people. Aging Clin Exp Res 11:209–220
Leinonen R, Heikkinen E, Jylhä M (2002) Changes in health, functional performance and activity predict changes in self-rated health: a 10-year follow-up study in older people. Arch Gerontol Geriatr 35:79–92
Leitsch SA (2000) Perceived control and functional health in the lives of the oldest-old. Doctoral thesis. Human Development and Family Studies, Pennsylvania State University, State College
Lowenstein DA, Amigo E, Duara R, Guterman A, Hurwitz D, Berkowitz N, Wilkie F, Weinberg G, Black B, Gittleman B (1989) A new scale for the assessment of functional status in Alzheimers’s disease and related disorders. J Gerontol 44:P114–P121
Malmberg B, Berg S (2002) Further steps towards a resource model in aging. In: Malmberg B, Henning C (eds) Aspects on aging, old age care and local contexts. Programmet Åldrande och Äldreomsorg i ett Lokalt Sammanhang [Ageing and old age care in a local context] School of Health Sciences, Jönköping University
McCamish-Svensson C, Samuelsson G, Hagberg B, Svensson T, Dehlin O (1999) Social relationships and health predictors of life satisfaction in advanced old age: results from a Swedish longitudinal study. Int J Aging Hum Dev 48:301–324
Meinow B, Kåreholt I, Lagergren M (2005) According to need? Predicting the amount of municipal home help to elderly recipients in an urban area of Sweden. Health Soc Care Commun 13:366–377
Nilsson SE, Johansson B, Berg S, Karlsson D, McClearn GE (2002) A comparison of diagnosis capture from medical records, self-reports, and drug registrations: a study in individuals 80 years and older. Aging Clin Exp Res 14:178–184
Parker MG, Ahacic K, Thorslund M (2005) Health changes among Swedish oldest old: prevalence rates from 1992 and 2002 show increasing health problems. J Gerontol A Biol Med Sci 60:M1351–M1355
Penninx BWJH, Guralnik JM, Simonsick EM, Kasper JD, Ferrucci L, Fried LP (1998) Emotional vitality among disabled older women: the women’s health and aging study. J Am Geriatr Soc 46:807–815
Penninx BW, Leveille S, Ferrucci L, van Eijk JT, Guralnik JM et al (1999) Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. Am J Public Health 89:1346–1352
Puts MTE, Lips P, Deeg DJH (2005) Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. J Am Geriatr Soc 53:40–47
Radloff L (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Reynolds SL, Silverstein M (2003) Observing the onset of disability in older adults. Soc Sci Med 57:1875–1889
Roe B, Whattam M, Young H, Dimond M (2001) Elders’ needs and experiences of receiving formal and informal care for their activities of daily living. J Clin Nurs 10:389–397
Romberg MH (1953) Manual of nervous diseases of man. Sydenham Society, London
Romören TI, Blekeseaune M (2003) Trajectories of disability among the oldest old. J Aging Health 15:548–566
Rovine MJ, von Eye A, Wood P (1988) The effect of low covariate criterion correlations on the analysis-of-covariance. In: Wegmen E (eds) Computer science and statistics. Proceedings of the 20th symposium of the interface. American Statistical Association, Alexander VA. pp 355–357
Simmons SF, Johansson B, Zarit SH, Ljungquist B, Plomin R, McClearn GE (1997) Selection bias in samples of older twins. A comparison between octogenarian twins and singletons in Sweden. J Aging Health 9:553–567
Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC (1999) Risk factors for functional status decline in community-living elderly people: a systematic review. Soc Sci Med 48:445–469
Tabachnik BJ, Fidell LS (1996) Using multivariate statistics, 3rd edn. Harper-Collins, New York
Thomése F, Broese van Groenou M (2006) Adaptive strategies after health decline in later life: increasing the person-environment fit by adjusting the social and physical environment. Eur J Ageing 3:169–177
Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38:1–14
von Heideken Wågert P, Gustavsson JMC, Lundin-Olsson L, Kallin K, Nygren B, Lundman B, Norberg A, Gustafson Y (2006) Health status in the oldest. Age and sex differences in the Umeå 85+ study. Aging Clin Exp Res 18:116–126
von Strauss E, Fratiglioni L, Viitanen M, Forsell Y, Winblad B (2000) Morbidity and comorbidity in relation to functional status: a community-based study of the oldest old (90+ years). J Am Geriatr Soc 48:1462–1469
von Strauss E, Agüero-Torres H, Kåreholt I, Winblad B, Fratiglioni L (2003) Women are more disabled in basic activities of daily living than men only in very advanced ages: a study on disability, morbidity, and mortality from the Kungsholmen Project. J Clin Epidemiol 56:669–677
Willis SL (1996) Assessing everyday competence in the cognitively challenged elderly. In: Smyer M, Schaie KW, Kapp MB (eds) Older adults’ decision-making and the law. Springer, New York, pp 87–127
Acknowledgments
The National Institute on Aging (NIA:AG 08861) of the National Institutes of Health provided a grant for the OCTO Twin study.
Author information
Authors and Affiliations
Corresponding author
Additional information
Responsible editor: D.J.H. Deeg
Rights and permissions
About this article
Cite this article
Bravell, M.E., Zarit, S.H. & Johansson, B. Self-reported activities of daily living and performance-based functional ability: a study of congruence among the oldest old. Eur J Ageing 8, 199–209 (2011). https://doi.org/10.1007/s10433-011-0192-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-011-0192-6