Psychometric Properties of the PAT: An Assessment Tool for ADL Performance of Older People Living in Residential Homes

Abstract

Background: As the world population ages, the number of people with diminished performance on the Activities of Daily Living (ADL) increases. A reliable and valid measure needs to be developed to determine the effects of interventions focused at increasing self-care abilities. We developed the Performance ADL Test (PAT) for this purpose. Objective: The aim of this study was to investigate the reliability and validity of the PAT in older people living in residential homes. Methods: The PAT contains 16 test items, covering the entire range of Basic ADL and Instrumental ADL performance in elderly people. For this assessment, 40 older people (mean age of 85 ± 7.5 years) participated. All 40 subjects lived in residential institutions in the Netherlands, were able to walk at least 10 m, could understand instructions spoken in Dutch, and had no cognitive impairment. During the first test session, subjects completed the PAT, the Groningen Activity Restriction Scale (GARS), and performance-based physical fitness tests. Two weeks later, subjects were retested on the PAT. Results: Factor analysis revealed three subscales: Organization of Performance, Gross Motor Function, and Fine Motor Function. Internal consistency (Cronbach’s α) of all scales and subscales ranged from 0.731 to 0.881. Test-retest reliability (intraclass correlation) ranged from 0.316 to 0.950. Paired sample t-tests revealed no significant differences between subject performance obtained during the two test periods. Pearson’s correlations between the PAT and the GARS ranged from 0.490 to 0.831, and between the PAT and the fitness tests from 0.317 to 0.781. Conclusion: Although the number of participants was limited (n = 40), the PAT seems to be a useful instrument for assessing ADL performance in older people living in residential homes. In general, internal consistency, test-retest reliability, and validity were satisfactory.

Measuring physical capacity and performance in older people

“…progressively more challenging ADLs and have the quality of performance scored by an assessor [50]. Some of the most commonly used instruments measuring ADLs are the Katz Index of Activities of Daily Living (Katz ADL) [51], Functional Independence Measure (FIM) [52] and Barthel Index [53].…”

Clinical Utility of Select Neuropsychological Assessment Battery Tests in Predicting Functional Abilities in Dementia

“…Recent guidelines proposed by Marson (2015) suggest that as an alternative to self-or informant-reported questionnaires, clinicians should use interval-scaled, direct performance measures that can tap into cognitively challenging functional tasks that are affected early in the disease process. Consequently, there has been emergence of research examining various performance-based measures of ADLs, such as the Direct Assessment of Functional Status, The University of California, San Diego Performance-Based Skills Assessment, and the Financial Capacity Instrument (Binegar et al, 2009;Chisholm et al, 2014;Cullum et al, 2001;Diehl et al, 2005;Farina et al, 2010;Foster, 2014;Goldberg et al, 2010;Heaton et al, 2004;Loewenstein et al, 1989;McDougall et al, 2009;Patterson et al, 2001;Sadek et al, 2011;Triebel et al, 2009;Weening-Dijksterhuis et al, 2010). These tools can accurately distinguish clinically normal elderly from MCI, but are time intensive.…”

“…Recent diagnostic guidelines encourage the use of performance-based tasks that are sensitive to cognitively complex ADLs in order to detect preclinical AD changes in functioning (Marson, 2015). Although several performance-based measures have been developed that can accurately distinguish clinically normal elderly from MCI, they are typically time intensive (most requiring >30 min) (Binegar, Hynan, Lacritz, Weiner, & Cullum, 2009;Chisholm, Toto, Raina, Holm, & Rogers, 2014;Cullum et al, 2001;Diehl et al, 2005;Farina et al, 2010;Foster, 2014;Goldberg et al, 2010;Heaton et al, 2004;Loewenstein et al, 1989;McDougall, Becker, Vaughan, Acee, & Delville, 2009;Patterson, Goldman, McKibbin, Hughs, & Jeste, 2001;Sadek, Stricker, Adair, & Haaland, 2011;Triebel et al, 2009;Weening-Dijksterhuis, Kamsma, & Van Heuvelen, 2010), with the exception of the Harvard Automated Phone Task that takes only 10 min (Marshall, Dekhtyar et al, 2015;Marshall, Zoller et al, 2015). The scope of the Harvard Automated Phone Task, and other existing performance-based IADL measures, is limited to the isolated assessment of complex functional capabilities, and thereby requires additional time and resources to administer a complete neuropsychological test protocol to evaluate cognitive function.…”