Abstract
Objectives
To internally validate a 15-item dichotomous activities of daily living (ADL) and
instrumental activities of daily living (IADL) index.
Study Design and Setting
Data were extracted from The Older Persons and Informal Caregivers Survey Minimum
DataSet (TOPICS-MDS). Using Rasch modeling, six aspects of the ADL/IADL scale were
assessed: (1) overall fit, (2) internal consistency, (3) individual item and person
fit, (4) local dependency, (5) targeting, and (6) differential item functioning (DIF)
(RUMM 2030). All analyses were stratified by living situation [community-dwelling
(n = 21,926) or residential care facility (n = 2,458)].
Results
In both settings, “eating” was the easiest activity on the scale and “performing household
tasks” was the most difficult activity. However, based on the location on the logit
scale, the level of difficulty for certain items varied between residential settings,
suggesting summary scores are not equivalent between these settings. DIF by gender
and age group was observed for several items, indicating potential measurement bias
in the scale.
Conclusion
Unless adjustments are undertaken, ADL/IADL summary scores retrieved from older persons
residing in the community or residential care facilities should not be directly compared.
This 15-item scale is poorly targeted for a community-dwelling older population, underscoring
the need for items with improved discriminative ability.
Keywords
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Article info
Publication history
Published online: November 17, 2015
Accepted:
November 5,
2015
Footnotes
Country of study: The Netherlands.
Funding: This study was funded by Dutch National Care for the Elderly Programme under ZonMw (the Dutch Organization for Health Research and Development; grant reference number: 310300002). The financial sponsor had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of this manuscript.
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