Saliba D, Orlando M, Wenger N S, Hays R D, Rubenstein L Z
Geriatric Research Education and Clinical Center, VA Greater Los Angeles Health Care System, California, USA.
J Gerontol A Biol Sci Med Sci. 2000 Dec;55(12):M750-6. doi: 10.1093/gerona/55.12.m750.
Disability in instrumental activities of daily living (IADLs) or activities of daily living (ADLs) is an indicator of health risk. The inclusion of these items in population screens may be limited by variation in item performance across gender and age groups. Further, identification of shortened lists may encourage inclusion of these items in screens.
We applied item response theory (IRT) methods to assess the responses of 9865 community-dwelling elders in the 1993 Medicare Current Beneficiary Survey to 11 IADL/ADL items. Items were classified as "receive help/not receive help" for the overall population and stratified by age and gender. We assessed the same IADL/ADL items using responses classified as "difficulty/no difficulty." After eliminating items that performed poorly, we performed all-subsets analyses to identify abbreviated sets of items that would select the highest proportion of persons with IADL/ADL disability.
Responses classified in receive help format showed consistency by gender and age group. Changing the response classification to difficulty/no difficulty influenced the reported order and relationship of IADL/ADL items. Receipt of help for any one of five items--shopping, doing light housework, walking, bathing, or managing finances--identified 93% of individuals receiving help with any IADL/ADL. A slightly different set of five items--walking, shopping, transferring, doing light housework, or bathing--identified 91% of persons reporting difficulty with any IADL or ADL.
The relationship of IADL and ADL items to the underlying construct of disability was similar for men and women. The relationship was also similar for oldest-old and younger-old individuals. This study also identified abbreviated lists of disability items that can be used to efficiently screen community-dwelling elders for the presence of IADL/ADL disability.
日常生活工具性活动（IADL）或日常生活活动（ADL）中的残疾是健康风险的一个指标。在人群筛查中纳入这些项目可能会受到不同性别和年龄组项目表现差异的限制。此外，确定缩短的清单可能会促使在筛查中纳入这些项目。
我们应用项目反应理论（IRT）方法，评估了1993年医疗保险当前受益人调查中9865名社区居住老年人对11项IADL/ADL项目的回答。项目按总体人群分为“接受帮助/未接受帮助”，并按年龄和性别分层。我们使用分类为“有困难/无困难”的回答评估相同的IADL/ADL项目。在剔除表现不佳的项目后，我们进行了全子集分析，以确定能够选出最高比例IADL/ADL残疾者的简短项目集。
按接受帮助格式分类的回答在性别和年龄组中显示出一致性。将回答分类改为有困难/无困难会影响IADL/ADL项目报告的顺序和关系。对购物、做轻松家务、行走、洗澡或管理财务这五项中的任何一项接受帮助，可识别出93%接受任何IADL/ADL帮助的个体。一组略有不同的五项——行走、购物、转移、做轻松家务或洗澡——可识别出91%报告任何IADL或ADL有困难的人。
IADL和ADL项目与残疾潜在结构的关系在男性和女性中相似。在最年长者和较年长者中关系也相似。本研究还确定了残疾项目的简短清单，可用于有效筛查社区居住老年人是否存在IADL/ADL残疾。
