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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

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Differences between self-reported and observed physical functioning in independent older adults.

Rona Feuering¹, Elisha Vered, Talma Kushnir

¹Department of Physical Therapy and.

Disability and Rehabilitation

|September 5, 2013

Summary

Older adults and clinicians show agreement on lower extremity function, but not upper extremity function. This systematic bias, especially in upper limb assessments, requires awareness in clinical practice.

Keywords:

Elderly fear of fall observed physical function self-reported function

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Evaluating the Function of the Foot Core System in the Elderly

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Area of Science:

Geriatric medicine
Rehabilitation science
Outcome assessment

Background:

Assessing functional status in older adults is crucial for developing effective outcome measures.
Understanding agreement between patient self-reports and clinician assessments is a key step.

Purpose of the Study:

To investigate the agreement between self-reported and clinician-assessed physical function in older adults.
To compare agreement for lower versus upper extremity tasks.

Main Methods:

Fifty community-dwelling older adults (70-91 years) underwent separate, blinded assessments.
The Life Function and Disability Instrument (LLFDI) was used for self-reported and observed lower/upper extremity tasks.
Intra-class correlation coefficients (ICCs) and 'mountain plots' analyzed agreement; associations with Fear of Fall Scale (FES) and Geriatric Depression Scale (GDS) were explored.

Main Results:

High agreement (ICC=0.83) for lower extremity function, but poorer agreement (ICC=0.31) for upper extremity function.
Mountain plots indicated systematic overestimation of function by older adults, particularly for upper extremity tasks.
Self-reported function showed stronger associations with FES and GDS than observed function.

Conclusions:

A significant systematic bias exists between self-reported and clinician-assessed physical function in older adults.
This bias is more pronounced for upper extremity function compared to lower extremity function.
Clinicians must recognize potential discrepancies, especially in upper limb assessments, for accurate patient evaluation.