Development of ADL index for partially dependent older adults

The purpose of this study was to develop an index of activities of daily living (ADL) for partially dependent older adults (PD). The index is intended to assess the capability of PD in performing basic daily tasks. A questionnaire of 22 items representing 7 ADL domains was administered by institutional therapists (nurse, OT, PT, social worker) on 466 PD 60 years or more of age, excepting completely dependent people. As a result of examining achievement rates and sex/age differences, inter- and intra-rater reliability (perfect agreement rates), and scalability, 17 reliable items were selected. The validity, reliability and unidimensionality of the ADL index using the 17 items were verified. Age and ADL score calculated based on Hosokawa's extended ADL scale were used as the external standard of validity. Furthermore, the relationships between ADL score and self-assessment of health status and physical fitness level were examined. The main findings of this study can be summarized as follows: 1) The reliability of the ADL index using 17 items was high (r = 0.996 in inter-reliability, and r = 0.940 in intra-reliability). Cronbachs' alpha coefficient of the ADL index was also high (0.926). 2) Based on scalogram analysis, the Guttman's CR, an index of unidimensionality, was very high (CR = 0.939, CS = 0.691). 3) The validity examination showed that ADL score tended to decrease significantly with age, and had a high correlation with Hosokawa's extended ADL scale (r = 0.939). 4) The ADL score tended to be higher in people with a higher self-assessment of health status and physical fitness level.