DIFFICULTY AND DEPENDENCE - 2 COMPONENTS OF THE DISABILITY CONTINUUM AMONG COMMUNITY-LIVING OLDER PERSONS

Background: Although most epidemiologic studies have defined disabilit y in basic activities of daily living (BADLs) as dependence, some inve stigators have argued that BADL disability should be defined as degree of difficulty. Objective: To determine whether the responses to quest ions about difficulty and dependence provide complementary information that together can depict the continuum of disability more fully than the response to either question alone. Setting: General community. Par ticipants: 1065 persons 72 years of age and older. Measurements: On th e basis of self-reported information collected at baseline, participan ts were categorized into three BADL groups: independent without diffic ulty, independent with difficulty, and dependent. Additional baseline information was collected on several measures of higher-level function and physical performance. Follow-up information was collected on regu lar home care visits and BADL function at 1 and 3 years and on hospita lizations, admissions to skilled-nursing facilities, and deaths over a 4-year period. Results: In a cross-sectional analysis, the proportion of participants with poor higher-level function and physical performa nce increased substantially across the three BADL groups. In a longitu dinal analysis, the rates of hospitalization and regular home care vis its for the independent without difficulty group, the independent with difficulty group, and the dependent group were 46%, 57%, and 72% (P < 0.001) and 17%, 30%, and 49% (P < 0.001), respectively; survival curv es for admission to a skilled-nursing facility and death differed sign ificantly for each pair-wise comparison. Among persons who were BADL i ndependent, those with difficulty were significantly more likely to de velop BADL dependence over a 3-year period than those without difficul ty (31% compared with 18%; P < 0.001). Conclusions: In the assessment of BADL function in older persons, questions about difficulty and depe ndence provide complementary information that together can depict the continuum of disability more fully than either question alone.