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Comparing proxy and patients' perceptions of patients' functional status: results from an outpatient geriatric clinic
M Weinberger1, G P Samsa, K Schmader
1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, North Carolina 27705.
Objective:
To compare ratings of patients referred for geriatric evaluation and their proxies with respect to patients' ability to perform activities of daily living.
Design:
Retrospective chart audit.
Setting:
University-based Outpatient Geriatric Clinic.
Patients:
Elderly medicine patients referred to a university-based outpatient geriatrics clinic for the first time.
Main Outcome Measures:
Modified Katz Physical Activities of Daily Living (PADL) and Instrumental Activities of Daily Living (IADL).
Results:
With regard to PADLs, patients were generally rated as independent by both patients (91%) and proxies (87%); for IADLs, ratings of independence by both patients (68%) and proxies (51%) were significantly lower. Concordance between patient and proxy ratings was significantly (P less than 0.001) greater for PADLs (92%) than for IADLs (82%). When disagreement occurred, patients consistently rated themselves as more independent than their proxies, especially for IADLs. Moreover, concordance between patients and proxies regarding IADLs was significantly (P less than 0.001) worse for patients who had scores below 24 on the Folstein Mini-Mental State Examination (72%) compared with those scoring 24 or higher (95%).
Conclusions:
Patient and proxy ratings were concordant when rating patients' ability to perform PADLs. Moreover, concordance was extremely high on IADLs when patients' Folstein scores were 24 or higher. Concordance with respect to IADLs was relatively poor only among patients with Folstein scores below 24. In that case, patients had a more optimistic view of their independence, compared with their proxies.