Screening for dependence in activities of daily living in the elderly: minimum set of questions

Ramos, Luiz Roberto; Andreoni, Solange; Coelho-Filho, João Macedo; Lima-Costa, Maria Fernanda; Matos, Divane Leite; Rebouças, Monica; Veras, Renato

doi:10.1590/S0034-8910.2013047004325

OBJECTIVE:

To analyze non-redundant questions on independence in activities of daily living in the elderly, representing the spectrum of dependency.

METHODS:

Multicenter project with a probabilistic population sample of 5,371 elderly residents in Sao Paulo, SP, Rio de Janeiro, RJ, Fortaleza, CE and Bambui, MG in 2008. A household survey was carried out and a questionnaire with 20 activities of daily living applied for the elderly to self-assess the difficulty/need for help in performing them. The responses were analyzed according to: the prevalence of some kind of difficulty/need for help for each activities of daily living, the frequency of non-response, and the grouping of activities in factor analysis.

RESULTS:

The personal activities (e.g., dressing) have, on average, a low prevalence of difficulty or need for help, compared to instrumental activities (e.g., shopping), and have lower rates of non- response. In factor analysis it was possible to identify three factors grouping the activities of daily living: one relative to mobility (e.g., walking 100 m), another for personal needs (e.g., bathing) and one relative to what someone else can do for the elderly (e.g., washing clothes). The activities of daily living with the highest eigenvalues in each group were also analyzed in the light of the prevalence of reported need for help and the proportion of non response. Three activities of daily living were selected as representing the spectrum of dependency and being well understood by the elderly - getting out of bed, bathing and walking 100 m.

CONCLUSIONS:

With only three activities of daily living we can have a simple and reliable screening instrument capable of identifying elderly in need of help in daily life. Estimating demand for care on a daily basis is an important indicator for planning and administration of health services within the paradigm of chronic diseases and population aging.

Aged; Personal Autonomy; Activities of Daily Living; Questionnaires; Diagnostic Techniques and Procedures; Multicenter Studies as Topic

[1] The authors declare that there are no conflicts of interest.

Difficulty	None		A little		A lot		Unable to		Unanswered

	n	%	n	%	n	%	n	%	n	%

Grocery shopping	3,278	61.2	586	10.9	417	7.8	1,032	19.3	46	0.9
Using transport	3,323	62.0	733	13.7	800	14.9	459	8.6	44	0.8
Managing a bank account	2,547	47.5	406	7.6	602	11.2	1,661	31.0	143	2.7
Dealing with money	4,564	85.2	181	3.4	114	2.1	456	8.5	44	0.8
Bowel and bladder control	4,300	80.2	654	12.2	318	5.9	48	0.9	39	0.7
Going up and down stairs	2,847	53.1	1,402	26.2	727	13.6	340	6.3	43	0.8
Walking 1 km	3,218	60.0	792	14.8	443	8.3	853	15.9	53	1.0
Walking 100 m	4,006	74.8	552	10.3	381	7.1	365	6.8	55	1.0
Walking around the home	4,678	87.3	313	5.8	213	4.0	108	2.0	47	0.9
Preparing a meal	3,432	64.0	237	4.4	109	2.0	1,408	26.3	173	3.2
Washing clothes	2,801	52.3	402	7.5	218	4.1	1,757	32.8	181	3.4
Dressing	4,276	79.8	618	11.5	315	5.9	113	2.1	37	0.7
Bathing	4,665	87.0	285	5.3	256	4.8	112	2.1	41	0.8
Eating	4,871	90.9	214	4.0	172	3.2	62	1.2	40	0.7
Using the telephone	3,917	73.1	556	10.4	347	6.5	472	8.8	67	1.3
Managing prostheses	3,904	72.9	53	1.0	49	0.9	276	5.1	1,077	20.1
Cutting toenails	2,406	44.9	697	13.0	644	12.0	1,570	29.3	42	0.8
Combing hair	4,947	92.3	140	2.6	106	2.0	125	2.3	41	0.8
Sitting down/standing up	4,049	75.6	879	16.4	305	5.7	83	1.6	43	0.8
Getting into and out of bed	4,212	78.6	746	13.9	276	5.1	84	1.6	41	0.8

Need for help	None		A little		A lot		Unanswered

	n	%	n	%	n	%	n	%

Grocery shopping	3,242	60.5	690	12.9	1,174	21.9	253	4.7
Using transport	3,711	69.2	369	6.9	1,079	20.1	200	3.7
Managing a bank account	2,541	47.4	446	8.3	1,805	33.7	567	10.6
Dealing with money	4,660	87.0	127	2.4	392	7.3	180	3.4
Bowel and bladder control	4,995	93.2	79	1.5	247	4.6	38	0.71
Going up and down stairs	4,190	78.2	364	6.8	558	10.4	247	4.6
Walking 1 km	3,945	73.6	216	4.0	416	7.8	782	14.6
Walking 100 m	4,417	82.4	182	3.4	413	7.7	347	6.5
Walking around the home	4,964	92.6	117	2.2	179	3.3	99	1.8
Preparing a meal	3,254	60.7	635	11.8	944	17.6	526	9.8
Washing clothes	2,845	53.1	634	11.8	1,239	23.1	641	12.0
Dressing	4,770	89.0	223	4.2	351	6.5	15	0.3
Bathing	4,919	91.8	94	1.7	331	6.2	15	0.3
Eating	5,038	94.0	103	1.9	204	3.8	14	0.3
Using the telephone	4,244	79.2	235	4.4	619	11.6	261	4.9
Managing prostheses	3,974	74.2	26	0.5	75	1.4	1,284	24.0
Cutting toenails	2,718	50.7	640	11.9	1,835	34.2	166	3.1
Combing hair	5,087	94.9	65	1.2	177	3.3	30	0.6
Sitting down/standing up	4,891	91.3	195	3.6	237	4.4	36	0.7
Getting into and out of bed	4,929	92.0	159	3.0	242	4.5	29	0.5

Difficulty	Factor 1	Factor 2	Factor 3

Sitting down/standing up	0.7945	0.2367	0.3505
Getting into and out of bed	0.74625	0.2753	0.3978
Going up and down stairs	0.7203	0.4929	0.1558
Walking 1 km	0.6535	0.6214	0.1657
Dressing	0.6294	0.3253	0.5234
Walking around at home	0.6145	0.5674	0.4609
Cutting the toenails	0.6060	0.3512	0.2724
Bowel and bladder control	0.4591	0.2566	0.4081
Grocery shopping	0.3990	0.7594	0.3233
Using transport	0.4625	0.7292	0.2777
Dealing with money	0.2851	0.7083	0.5039
Managing a bank account	0.2463	0.7015	0.2172
Walking 100 m	0.6052	0.6927	0.2592
Using the telephone	0.2618	0.4953	0.4258
Combing hair	0.5272	0.3414	0.6915
Preparing a meal	0.0863	0.4400	0.6881
Eating	0.4620	0.3750	0.6711
Bathing	0.5658	0.4525	0.6522
Washing clothes	0.1869	0.4160	0.5839
Managing prostheses	0.2360	0.0214	0.5257