Scaling ADLs within the MDS

Background. Dependency in activities of daily living (ADLs) is a reality wi thin nursing homes, and we describe ADL measurement strategies based on ite ms in the Minimum Data Set (MDS) and the creation and distributional proper ties of three ADL self-performance scales and their relationship to other m easures. Methods. Information drawn from four data sets for a multistep analysis was guided by four study objectives: (1) to identify the subcomponents of ADLs that are present in the MDS battery; (2) to demonstrate how these items co uld be aggregated within hierarchical and additive ADL summary scales; (3) to describe the baseline and longitudinal distributional properties of thes e scales in a large, seven-state MDS database; and (4) to evaluate how thes e scales relate to two external criteria. Results. Prevalence and factor structure findings for seven MDS ADL self-pe rformance variables suggest that these items can be placed into early, midd le, and late loss ADL components. Two types of summary ADL self-performance measures were created: additive and hierarchical. Distributional propertie s of these scales are described, as is their relationship to two external A DL criteria that have been reported in prior studies: first as an independe nt variable predicting staff time involved in resident care; second as a de pendent variable in a study of the efficacy of two programs to improve resi dent functioning. Conclusions. The new ADL summary scales, based on readily available MDS dat a, should prove useful to clinicians, program auditors, and researchers who use the MDS functional self-performance items to determine a resident's AD L status.