Skip to main content
Log in

Self-reported activities of daily living and performance-based functional ability: a study of congruence among the oldest old

  • Original Contribution
  • Published:
European Journal of Ageing Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Béland F, Zunzunegui MV (1999) Predictors of functional status in older people at home. Age Ageing 28:153–159

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Hogan DB (2000) Effects of age and disease on disability in the very elderly. Clin Geriatr 8:28–37

    Google Scholar 

  • Iwarsson S (2005) A long-term perspective on person-environment fit and ADL dependence among older Swedish Adults. Gerontologist 45:327–336

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Jette AM, Assmann SF, Rooks D, Harris BA, Crawford S (1998) Interrelationships among disablement concepts. J Gerontol A Biol Med Sci 53:M395–M404

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • Kivett VR, Stevenson ML, Zwane CH (2000) Very-old rural adults: functional status and social support. J Appl Gerontol 19:58–77

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Radloff L (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  • Reynolds SL, Silverstein M (2003) Observing the onset of disability in older adults. Soc Sci Med 57:1875–1889

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Romberg MH (1953) Manual of nervous diseases of man. Sydenham Society, London

    Google Scholar 

  • Romören TI, Blekeseaune M (2003) Trajectories of disability among the oldest old. J Aging Health 15:548–566

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  Google Scholar 

  • Tabachnik BJ, Fidell LS (1996) Using multivariate statistics, 3rd edn. Harper-Collins, New York

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38:1–14

    Article  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to Marie Ernsth Bravell.

Additional information

Responsible editor: D.J.H. Deeg

Rights and permissions

Reprints 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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10433-011-0192-6

Keywords

Navigation