Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

Stineman, Margaret G.; Henry-Sánchez, John T.; Kurichi, Jibby E.; Pan, Qiang; Xie, Dawei; Saliba, Debra; Zhang, Zi; Streim, Joel E.

doi:10.1097/phm.0b013e318241200d

Cited by 28 publications

(38 citation statements)

References 35 publications

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“…20 Briefly, stages of activity limitation were built to reflect the International Classification of Functioning, Disability and Health. These patient-centered outcomes were derived from patient- or proxy-reported answers to simple questions about difficulties performing basic activities.…”

Section: Methodsmentioning

confidence: 99%

Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

Bogner

McClintock

Hennessy

et al. 2015

Archives of Physical Medicine and Rehabilitation

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OBJECTIVE To examine whether patient satisfaction and perceived quality of medical care was related to stages of activity limitations among older adults. DESIGN Cross-sectional study. SETTING Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. PARTICIPANTS A population-based sample (n= 42,584) of persons 65 years of age and older living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physicians, interpersonal skills of primary care physicians, and quality of information provided by primary care physicians. Persons were classified into a stage of activity limitation (0-IV) derived from self-reported difficulty levels performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS Compared to older beneficiaries with no limitations at ADL Stage 0, the adjusted odds ratios (OR) (95% confidence intervals (CI)) for Stage I (mild) to Stage III (severe) for satisfaction with care coordination and quality ranged from OR = 0.85 (95% CI: 0.80-0.92) to OR = 0.79 (95% CI: 0.70-0.89). Compared to ADL Stage 0, satisfaction with access barriers ranged from OR = 0.81 (95% CI: 0.76-0.87) at Stage I (mild) to a minimum of OR = 0.67 (95% CI: 0.59-0.76) at Stage III (severe). Similarly, compared to older beneficiaries at ADL Stage 0, perceived quality of the technical skills of their primary care physician ranged from OR = 0.87 (95% CI: 0.82-0.94) at Stage I (mild) to a minimum of OR = 0.81 (95% CI: 0.72-0.91) at Stage III (severe). CONCLUSIONS Medicare beneficiaries at higher stages of activity limitation although not necessarily the highest stage of activity limitation reported less satisfaction with medical care.

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Section: Methodsmentioning

confidence: 99%

Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

Bogner

McClintock

Hennessy

et al. 2015

Archives of Physical Medicine and Rehabilitation

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“…We hypothesized that people at higher stages of ADL and IADL limitation would be more likely to have histories of previous strokes and diagnoses of Alzheimer’s disease or dementia. According to our previous findings [4], we further anticipated that people with medical conditions less often associated with intellectual impairment would tend to cluster at the intermediate stages of difficulty. Finally, we anticipated strong correlations between perceptions of poorer health and higher stages of ADL and IADL limitation.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, we derived a disability staging system based on the ICF concepts [4] of activity and participation. Within the ICF, activity constitutes the “execution of a task by an individual,” and participation represents “involvement in a life situation,” characterized according to identical sets of “chapters” [3].…”

Section: Introductionmentioning

confidence: 99%

Activity Limitation Stages Empirically Derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult Community‐Dwelling Medicare Population

Stineman

Streim

Pan

et al. 2014

PM&R

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Background Stages quantify severity like conventional measures but further specify the activities that people are still able to perform without difficulty. Objective To develop Activity Limitation Stages for defining and monitoring groups of adult community-dwelling Medicare beneficiaries. Design Cross-sectional. Setting Community. Participants There were 14,670 respondents to the 2006 Medicare Current Beneficiary Survey. Methods Stages were empirically derived for the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) by profiling the distribution of performance difficulties as reported by beneficiaries or their proxies. Stage prevalence estimates were determined, and associations with demographic and health variables were examined for all community-dwelling Medicare beneficiaries. Main outcome measures ADL and IADL stage prevalence. Results Stages (0-IV) define 5 groups across the separate ADL and IADL domains according to hierarchically organized profiles of retained abilities and difficulties. For example, at ADL-I, people are guaranteed to be able to eat, toilet, dress, and bathe/shower without difficulty, whereas they experience limitations getting in and out of bed or chairs and difficulties walking. In 2006, an estimated 6.0, 2.9, 2.2, and 0.5 million beneficiaries had mild (ADL-I), moderate (ADL-II), severe (ADL-III), and complete (ADL-IV) difficulties, respectively, with estimates for IADL stages even higher. ADL and IADL stages showed expected associations with age and health-related concepts, supporting construct validity. Stages showed the strongest associations with conditions that impair cognition. Conclusions Stages as aggregate measures reveal the ADLs and IADLs that people are still able to do without difficulty, along with those activities in which they report having difficulty, consequently emphasizing how groups of people with difficulties can still participate in their own lives. Over the coming decades, stages applied to populations served by vertically integrated clinical practices could facilitate large-scale planning, with the goal of maximizing personal autonomy among groups of community-dwelling people with disabilities.

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“…To address this shortcoming of existing disability measures, separate systems were derived for staging ADL and IADL limitations such that each stage was defined by the activities older persons are able to do without difficulty based on the International Classification of Functioning, Disability and Health (ICF) concepts of activity and participation. (7-9) Stineman et al used data from the Medicare Current Beneficiary Survey (MCBS) to derive activity limitation staging systems within the ADL and IADL domains that depict both the severity and types of limitations experienced, and specified clinically meaningful patterns of increasing difficulty with self-care. (8) By distinguishing activities that older people are still able to do without difficulty from those that they find difficult, these systems enable a more fine-grained description of disability at the patient and population levels, and can thus serve as a foundation for developing specific strategies to reduce disparities in the care and support of older adults with disabilities.…”

Section: Introductionmentioning

confidence: 99%

Comparison of predictive value of activity limitation staging systems based on dichotomous versus trichotomous responses in the Medicare Current Beneficiary Survey

Kurichi

Streim

Bogner

et al. 2016

Disability and Health Journal

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Background Traditional ways of measuring disability include summary indices, binary expressions, or counts of limitations. However, counts of activity of daily living (ADL) or instrumental activity of daily living (IADL) limitations do not specify which activities are limited. Activity limitation staging systems within the ADL and IADL domains depict both the severity and types of limitations experienced and specify clinically meaningful patterns of increasing difficulty with self-care. Objective To compare the predictive value and utility of ADL and IADL stages based on dichotomous versus trichotomous responses to ADL and IADL questions based on “difficulty” and “receive help” responses. Methods Data were analyzed from the 2005, 2006, and 2007 Medicare Current Beneficiary Survey (MCBS) entry panels on 11,706 beneficiaries. This was a prospective cohort study that examined time to inpatient admission, all-cause mortality, skilled nursing facility (SNF) admission, and long-term care (LTC) facility admission based on dichotomous versus trichotomous stages. Results For both ADLs and IADLs, Akaike information criteria for most outcomes were lower (indicating better-performing models) for the trichotomous staging systems than the dichotomous staging systems. The hazard ratios (HRs) and 95% confidence intervals (CIs) of the dichotomous ADL staging system increased as disability increased, whereas the HRs of the other staging systems fluctuated. Conclusions Both staging systems have strong associations with each outcome. The dichotomous staging system is more clinically relevant while the trichotomous staging system may provide utility for clinicians, healthcare organizations, and policy makers seeking to predict death or admission to a hospital, SNF, or LTC facility.

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Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

Cited by 28 publications

References 35 publications

Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages

Activity Limitation Stages Empirically Derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult Community‐Dwelling Medicare Population

Comparison of predictive value of activity limitation staging systems based on dichotomous versus trichotomous responses in the Medicare Current Beneficiary Survey

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