ENVIRONMENTAL-INFLUENCES ON THE CUMULATIVE STRUCTURE OF INSTRUMENTAL ADL - AN EXAMPLE IN OSTEOPOROSIS PATIENTS IN A SWEDISH RURAL DISTRICT

Introduction: The ADL Staircase is a hierarchical instrument for the a ssessment of dependence/independence in personal and instrumental acti vities of daily living (P-ADL and I-ADL). Previous results indicated t hat environmental factors might affect assessment results, and revisio ns for use in rural areas have been tested with a gerontological popul ation sample. Objective: To investigate further the cumulative structu re of I-ADL in osteoporosis patients in a Swedish rural district. Meth od: Patients were interviewed consecutively concerning their pre-injur y dependence in P-ADL and I-ADL, using a revised version of the ADL St aircase (n = 276). Results: In contrast to results from urban areas, ' transportation' was the activity generating the most dependence among the respondents. In addition, different gender-specific cumulative ord ers among I-ADL were demonstrated. Guttman's scaling analysis confirme d the cumulativity of the revised scale (C of R = 0.94/0.97, C of S = 0.77/0.88). Conclusion: Environmental factors influence the validity o f instruments as well as the prevalence of disability.