Functional status of elderly home care users: Do subjects, informal and professional caregivers agree?

Professional or informal proxy respondents are frequently used in surveys w hen physical or mental health may compromise the ability to participate or the quality of responses. Functional status (Katz activities of daily livin g [ADL], Lawton instrumental activities of daily living [IADL]) was assesse d in a sample of 420 chronically dependent elderly receiving home care. Sep arate in-person interviews were conducted with subjects, main informal care givers and professionals coordinating home care. We found substantial agree ment (Kappa) particularly between subjects and informal caregivers in all A DL except continence and in all IADL except housekeeping. High levels of ag reement were also found for cognitively impaired subjects (Mini-Mental Stat e Examination <24). Disagreement was characterized by more frequent reports of dependence from informal and professional caregivers. Our data suggest that proxy responses by informal caregivers conform with answers provided b y subjects but produce slightly higher estimates of dependence and that cog nitively impaired elderly living in the community will provide accurate inf ormation on their functional status in most cases. J CLIN EPIDEMIOL 52;3:18 1-186, 1999. (C) Elsevier Science Inc.