Tm. Gill et al., A PREDICTIVE MODEL FOR ADL DEPENDENCE IN COMMUNITY-LIVING OLDER ADULTS BASED ON A REDUCED SET OF COGNITIVE STATUS ITEMS, Journal of the American Geriatrics Society, 45(4), 1997, pp. 441-445
OBJECTIVE: To develop and validate a simple tool, based on a reduced s
et of Mini-Mental State Examination (MMSE) items, that can be used to
predict the onset of ADL dependence, and to compare the predictive acc
uracy of this new tool with that of the MMSE. DESIGN: Two prospective,
population-based cohort studies, in tandem. The predictive model deve
loped in the initial cohort was subsequently validated in a separate c
ohort. SETTING: General community in New Haven, Connecticut. PARTICIPA
NTS: For the development cohort, 775 community-living persons, 72 year
s of age and older, who were independent at baseline in their ADL func
tion. For the validation cohort, 1038 comparable subjects. MEASUREMENT
S: All subjects underwent a baseline interview and cognitive assessmen
t in their homes by a trained research nurse using standard instrument
s. Self-reported ADLs were ascertained at 1 year and 3 years for the d
evelopment cohort and at 1 year and 21/2 years for the validation coho
rt. RESULTS: ADL dependence developed in 221 (28.5%) subjects in the d
evelopment cohort. Although the rate of ADL dependence increased withi
n each MMSE domain as the number of incorrect items increased, only or
ientation and short-term memory remained significantly associated with
ADL dependence in multivariable analysis. A predictive model, based o
n the presence of impairments in these two domains, was developed that
stratified subjects into three risk groups. Rates of ADL dependence w
ere 22% (neither domain impaired), 44% (one domain impaired), and 68%
(both domains impaired) (P<.001). The corresponding rates in the valid
ation cohort, in which 191 (18.4%) subjects developed ADL dependence,
were 15%, 26%, and 45% (P<.001). The area under the ROC curves for the
MMSE and the reduced item strategy were nearly identical at 0.63 and
0.62, respectively. CONCLUSIONS: A simple and valid six-item strategy,
based on the presence of impairments in orientation and short-term me
mory, predicts the onset of ADL dependence as effectively as does the
30-item MMSE. This new tool may be useful as part of a more comprehens
ive assessment when determining an older person's risk for developing
ADL dependence.