Abstract
Objective: To measure functional status, determine risk of functional decline and assess consistency between responses and standardized instruments.
Design: A mailed survey which measured functional impairment, recent hospitalization and bereavement. A positive response on at least one of these factors indicated that the individual was “at risk” for functional decline. A random sample (n=73) of “at risk” subjects (specifically, family practice patients aged 70 and older) were assessed by a nurse.
Results: The response rate was 89% (369/415), 59% of seniors were female and the mean age was 77.1 (SD=5.5) years. Selfreported risk, based on activities of daily living (ADLs), was associated with impairment in at least one basic ADL (p<0.0005) using a standardized instrument. The positive predictive value of the survey for ADL impairment was 65%.
Conclusion: Response to a mailed survey was high and self-reported ADL risks were consistent with findings from standardized assessment tools.
Résumé
Objectif: mesurer l’état fonctionnel, déterminer le risque de déclin fonctionnel et évaluer la cohérence entre les résultats obtenus et les instruments normalisés.
Méthode: enquête postale mesurant la déficience fonctionnelle, l’hospitalisation récente et le deuil. Une réponse positive dans l’une ou l’autre de ces catégories suggère que la personne est susceptible (« à risque ») de subir un déclin fonctionnel. Une infirmière a évalué un échantillon aléatoire (n = 73) de sujets « à risque ».
Échantillon: patients suivis par un médecin de famille et âgés de 70 ans ou plus.
Résultats: taux de réponse de 88,9 % (369 sur 415). L’échantillon était composé de 59,3 % de femmes et l’âge moyen des répondants était de 77,1 ans (DS = 5,5). Le risque déclaré par les répondants relativement aux activités de la vie quotidienne (AVQ) était associé à une déficience dans au moins une AVQ élémentaire (p < 0,0005) à l’aide d’un instrument normalisé. La valeur prédictive positive de l’enquête sur la déficience relative aux AVQ était de 65,2 %.
Conclusion: taux de réponse élevé à l’enquête postale. Le risque déclaré par les répondants relativement aux AVQ est cohérent avec les résultats des outils d’évaluation normalisés.
Footnotes
This project was supported by the Ontario Ministry of Health, Community Health Branch.
References
- 1.Hébert R, Brayne C, Spiegelhalter D. Incidence of functional decline and improvement in a community-dwelling, very elderly population. Am J Epidemiol. 1997;145:935–44. doi: 10.1093/oxfordjournals.aje.a009053. [DOI] [PubMed] [Google Scholar]
- 2.Rockwood K, Fox RA, Stolee P, et al. Frailty in elderly people: An evolving concept. Can Med Assoc J. 1994;150:489–95. [PMC free article] [PubMed] [Google Scholar]
- 3.Guralnik JM, Wallace RB. The conceptualization and design of intervention studies on frailty in the older population: Insights from observational epidemiologic studies. In: Weindruch R, Hadley EC, Ory MG, editors. Frailty Reconsidered: Reducing Frailty and Fall-related Injuries in the Elderly. Springfield, IL: Charles C. Thomas; 1991. [Google Scholar]
- 4.Bowns I, Challis D, Sum Tong M. Case finding in elderly people: Validation of a postal questionnaire. Br J Gen Pract. 1991;41:100–4. [PMC free article] [PubMed] [Google Scholar]
- 5.Hébert R, Bravo G, Korner-Bitensky N, Voyer L. Predictive validity of a postal questionnaire for screening community-dwelling elderly individuals at risk of functional decline. Age Ageing. 1996;25:159–67. doi: 10.1093/ageing/25.2.159. [DOI] [PubMed] [Google Scholar]
- 6.Boult C, Dowd B, McCaffrey D, et al. Screening elders for risk of hospital admission. J Am Geriatr Soc. 1993;41:811–17. doi: 10.1111/j.1532-5415.1993.tb06175.x. [DOI] [PubMed] [Google Scholar]
- 7.Pathy MSJ, Bayer A, Harding K, Dibble A. Randomised trial of case finding and surveillance of elderly people at home. Lancet. 1992;340:890–93. doi: 10.1016/0140-6736(92)93294-W. [DOI] [PubMed] [Google Scholar]
- 8.Hutner-Winograd C. Targeting strategies: An overview of criteria and outcomes. J Am Geriatr Soc. 1991;39(suppl.):25S–35S. doi: 10.1111/j.1532-5415.1991.tb05930.x. [DOI] [PubMed] [Google Scholar]
- 9.Green BH, Copeland JR, Dewey ME, et al. Risks for depression in the elderly: A prospective study. Acta Psychiatr Scand. 1992;86:213–17. doi: 10.1111/j.1600-0447.1992.tb03254.x. [DOI] [PubMed] [Google Scholar]
- 10.van Rossum E, Frederiks CM, Philipsen H, et al. Effects of preventive home visits to elderly people. Br Med J. 1993;307:27–32. doi: 10.1136/bmj.307.6895.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86. doi: 10.1093/geront/9.3_Part_1.179. [DOI] [PubMed] [Google Scholar]
- 12.McDowell I, Newell C. Measuring Health: A Guide to Rating Scales and Questionnaires. Second. New York: Oxford University Press; 1996. [Google Scholar]
- 13.Barber JH, Wallis JB, McKeating E. A postal screening questionnaire in preventive geriatric care. J R Coll Gen Pract. 1980;30:49–51. [PMC free article] [PubMed] [Google Scholar]
- 14.O’Toole BI, Battistutta D, Long A, Crouch K. A comparison of costs and data quality of three health survey methods: Mail, telephone and personal interview. Am J Epidemiol. 1986;124:317–28. doi: 10.1093/oxfordjournals.aje.a114390. [DOI] [PubMed] [Google Scholar]
- 15.Sullivan LM, Dukes KA, Harris L, et al. A comparison of various methods of collecting selfreported health outcomes data among lowincome and minority patients. Med Care. 1995;33:AS183–AS194. [PubMed] [Google Scholar]
- 16.Ontario Ministry of Health. Morbidity and Mortality Statistics Report of Ontario (1986–1990) Toronto: Queen’s Printer for Ontario; 1992. [Google Scholar]
- 17.Ontario Ministry of Health. 1990 Ontario Health Survey. Regional Report for Hamilton-Wentworth. Toronto: Queen’s Printer for Ontario; 1992. [Google Scholar]
- 18.Wilkins R, Park E. Chronic conditions, physical limitations and dependency among seniors living in the community. Health Rep. 1996;8:7–15. [PubMed] [Google Scholar]
- 19.Centre on Aging. Manitoba Fact Book on Aging. Manitoba: University of Manitoba; 1996. [Google Scholar]
- 20.Harris T, Kovar MG. National statistics on the functional status of older persons. In: Weindruch R, Hadley EC, Ory MG, editors. Frailty Reconsidered: Reducing Frailty and Fall-related Injuries in the Elderly. Springfield, IL: Charles C. Thomas; 1991. [Google Scholar]
- 21.Tulloch AJ, Moore V. A randomized controlled trial of geriatric screening and surveillance in general practice. J R Coll Gen Pract. 1979;29:733–42. [PMC free article] [PubMed] [Google Scholar]
- 22.Williams ME, Gaylord SA, Gerrity MS. The timed manual performance test as a predictor of hospitalization and death in a community-based elderly population. J Am Geriatr Soc. 1994;42:21–27. doi: 10.1111/j.1532-5415.1994.tb06068.x. [DOI] [PubMed] [Google Scholar]
- 23.Langlois JA, Maggi S, Harris T, et al. Self-report of difficulty in performing functional activities identifies a broad range of disability in old age. J Am Geriatr Soc. 1996;44:1421–28. doi: 10.1111/j.1532-5415.1996.tb04065.x. [DOI] [PubMed] [Google Scholar]
- 24.Gill TM, Williams CS, Richardson ED, et al. A predictive model for ADL dependence in community-living older adults based on a reduced set of cognitive status items. J Am Geriatr Soc. 1997;45:441–45. doi: 10.1111/j.1532-5415.1997.tb05168.x. [DOI] [PubMed] [Google Scholar]
- 25.Rozzini R, Frisoni GB, Bianchetti A, et al. Physical Performance Test and Activities of Daily Living scales in the assessment of health status in elderly people. J Am Geriatr Soc. 1993;41:1109–13. doi: 10.1111/j.1532-5415.1993.tb06460.x. [DOI] [PubMed] [Google Scholar]
- 26.Fletcher RH, Fletcher SW, Wagner EH. Clinical Epidemiology: The Essentials. Second. Baltimore: William and Wilkins; 1988. [Google Scholar]