Abstract
Self-assessments and performance-based tests are methods commonly used to assess physical function in health surveys of older people. It has been suggested that the choice of method could affect the results, particularly in certain groups. This study compares results attained using self-assessed and performance-based measures of upper and lower body function and vision. The influence of sex, age, education and cognitive status is explored. This is done by studying the prevalence rates of self-reported and observed limitations in function, the prevalence rates of discrepancies between measures and the prevalence rates as well as the odds ratios of discrepancies depending on sex, age, education and cognitive status. Data are from a nationally representative sample of the Swedish population aged 77 or above (n=492). The results show that discrepancies occur among a minority of the sample and with no distinctive bias toward either under- or overestimations of functional ability at the cross-sectional level. Cognitive impairment seemed to increase the risk of discrepancies. Women showed an increased tendency toward discrepancies between measures of upper body function. Age and education showed associations with some discrepancies but were not significant in the multiple regression models. In conclusion, there is a risk of systematic biases in the association between self-assessed and performance-based measures of function. At the cross-sectional level, however, these differences are small.
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Brach JS, VanSwearingen JM, Newman AB, Kriska AM (2002) Identifying early decline of physical function in community-dwelling older women: performance-based and self-report measures. Phys Ther 82(4):320–328
Cress ME, Schechtman KB, Mulrow CD, Fiatarone MA, Gerety MB, Buchner DM (1995) Relationship between physical performance and self-perceived physical function. J Am Geriatr Soc 43(2):93–101
Daltroy LH, Larson MG, Eaton HM, Phillips CB, Liang MH (1999) Discrepancies between self-reported and observed physical function in the elderly: the influence of response shift and other factors. Soc Sci Med 48(11):1549–1561
Elam JT, Graney MJ, Beaver T, el Derwi D, Applegate WB, Miller ST (1991) Comparison of subjective ratings of function with observed functional ability of frail older persons. Am J Public Health 81(9):1127–1130
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(3):189–198
FreedmanVA, Crimmins E, Schoeni RF, Spillman BC, Aykan H, Kramarow E, et al (2004) Resolving inconsistencies in trends in old-age disability: report from a technical working group. Demography 41(3):417–441
Gatz M, Fratiglioni L, Johansson B, Berg S, Mortimer JA, Reynolds CA, et al (2005) Complete ascertainment of dementia in the Swedish twin registry: the HARMONY study. Neurobiol Aging 26(4):439–447
Glass TA (1998) Conjugating the “tenses” of function: discordance among hypothetical, experimental and enacted function in older adults. Gerontologist 38(1):101–112
Guralnik JM, Branch LG, Cummings SR, Curb JD (1989) Physical performance measures in aging research. J Gerontol A Biol Sci Med Sci 44(5):M141–M146
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol A Biol Sci Med Sci 49(2):M85–M94
Hiller R, Krueger DE (1983) Validity of a survey question as a measure of visual acuity impairment. Am J Public Health 73(1):93–96
Hoeymans N, Feskens EJ, van den Bos GA, Kromhout D (1996) Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990–1993). J Clin Epidemiol 49(10):1103–1110
Hong TB, Zarit SH, Malmberg B (2004) The role of health congruence in functional status and depression. J Gerontol B Psychol Sci Soc Sci 59(4):P151–157
Iburg KM, Salomon JA, Tandon A, Murray CJL (2001) Cross-population comparability of self-reported and physician-assessed mobility levels: Evidence from the third National Health and Nutrition Examination Survey (No. 14). World Health Organization, Geneva
Kelly-Hayes M, Jette AM, Wolf PA, D’Agostino RB, Odell PM (1992) Functional limitations and disability among elders in the Framingham Study. Am J Public Health 82(6):841–845
Kempen GI, Steverink N, Ormel J, Deeg DJ (1996a) 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(5):P254–P260
Kempen GI, van Heuvelen MJ, van den Brink RH, Kooijman AC, Klein M, Houx PJ, et al (1996b). Factors affecting contrasting results between self-reported and performance-based levels of physical limitation. Age Ageing 25(6):458–464
Kivinen P, Sulkava R, Halonen P, Nissinen A (1998) Self-reported and performance-based functional status and associated factors among elderly men: the Finnish cohorts of the seven countries study. J Clin Epidemiol 51(12):1243–1252
Klein BE, Klein R, Jensen SC (2000) A short questionnaire on visual function of older adults to supplement ophthalmic examination. Am J Ophthalmol 130(3):350–352
Klein BE, Klein R, Lee KE, Cruickshanks KJ (1999) Associations of performance-based and self-reported measures of visual function. The beaver dam eye study. Ophthalmic Epidemiol 6(1):49–60
Lundberg O, Thorslund M (1996) Fieldwork and measurement considerations in surveys of the oldest old. Experience from the Swedish level of living surveys. Soc Indic Res 37:165–167
Melzer D, Lan TY, Tom BD, Deeg DJ, Guralnik JM (2004) Variation in thresholds for reporting mobility disability between national population subgroups and studies. J Gerontol A Biol Sci Med Sci 59(12):1295–1303
Merrill SS, Seeman TE, Kasl SV, Berkman LF (1997) Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci 52(1):M19–M26
Myers AM, Holliday PJ, Harvey KA, Hutchinson KS (1993) Functional performance measures: are they superior to self-assessments? J Gerontol A Biol Sci Med Sci 48(5):M196–M206
Nagi SZ (1991) Disability concepts revisited: implications for prevention. In: A. M. T. Pope, A.R. (ed), Disability in America: toward a national agenda for prevention. National Academy Press, Washington
Parker MG, Gatz M, Thorslund M (1996) Brief cognitive screening in a field survey of the oldest old. Aging (Milano) 8(5):354–359
Reuben DB, Seeman TE, Keeler E, Hayes RP, Bowman L, Sewall A, et al (2004) Refining the categorization of physical functional status: the added value of combining self-reported and performance-based measures. J Gerontol A Biol Sci Med Sci 59(10):1056–1061
Reuben DB, Siu AL, Kimpau S (1992) The predictive validity of self-report and performance-based measures of function and health. J Gerontol A Biol Sci Med Sci 47(4):M106–M110
Sayers SP, Jette AM, Haley SM, Heeren TC, Guralnik JM, Fielding RA (2004) Validation of the Late-Life Function and Disability Instrument. J Am Geriatr Soc 52(9):1554–1559
Thorslund M, Parker MG (2005) Förbättras eller försämras egentligen de äldres hälsa? En genomgång av aktuell svensk och internationell forskning. [Getting better or getting worse? Conflicting evidence and a possible resolution.]. Läkartidningen, (in press)
van den Brink CL, Tijhuis M, Kalmijn S, Klazinga NS, Nissinen A, Giampaoli S, et al (2003) Self-reported disability and its association with performance-based limitation in elderly men: a comparison of three European countries. J Am Geriatr Soc 51(6):782–788
Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38(1):1–14
WHO (2001) International classification of functioning, disability and health. World health Organization, Geneva
Wijlhuizen GJ, Ooijendijk W (1999) Measuring disability, the agreement between self evaluation and observation of performance. Disabil Rehabil 21(2):61–67
Acknowledgements
We are grateful for the financial support from the Swedish Council for Working Life and Social Research, grants 2003-0539 and 2002-0919 and from the Swedish Research Council, grant 2000-0893/28. The Karolinska Institute Ethics Committee approved the project.
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Fors, S., Thorslund, M. & Parker, M.G. 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 (2006). https://doi.org/10.1007/s10433-006-0021-5
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DOI: https://doi.org/10.1007/s10433-006-0021-5