An Incomplete Model of Disability: Discrepancies Between Performance-Based and Self-Reported Measures of Functioning

Area of Science:

• Gerontology and Public Health
• Health Services Research
• Disability Studies

Background:

• Accurate measurement of disability is crucial for effective resource allocation and policy development.
• Both self-reported and performance-based measures are used to assess functioning, but each has limitations.
• Environmental context and self-perception can affect self-reports, while performance measures may not reflect real-world functioning.

Purpose of the Study:

• To examine the agreement between self-reported and performance-based functioning measures in older adults.
• To compare the diagnostic characteristics (sensitivity, specificity) of these two types of measures.
• To investigate how agreement varies across different sociodemographic groups.

Main Methods:

• Utilized cross-sectional data from the 2021 National Health and Aging Trends Study.
• Assessed vision, hearing, mobility, and memory domains using both self-report and performance-based assessments.
• Employed logistic regression to analyze agreement differences across sociodemographic factors.

Main Results:

• Performance measures for hearing and mobility demonstrated high sensitivity but low to moderate specificity.
• Vision measures showed moderate sensitivity and specificity, while memory measures had high specificity but low sensitivity.
• Performance-based discrimination varied by domain, and agreement between measures differed across sociodemographic groups.

Conclusions:

• Significant divergence exists between performance-based and self-reported functioning in older adults.
• This discordance highlights potential areas for environmental interventions to address real-world functional barriers.
• Further research is necessary to understand individual and environmental factors influencing these observed differences.