Department of Internal Medicine and Geriatrics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
J Clin Epidemiol. 2011 Jun;64(6):619-27. doi: 10.1016/j.jclinepi.2010.07.005. Epub 2010 Nov 13.
To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.
We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.
In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.
This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.
研究用于测量住院老年医学患者（工具性）日常生活活动（IADL）功能和功能下降的工具以及所应用的定义。
我们系统地检索了 Medline、Embase 和 Cochrane 系统评价数据库，检索时间从 1990 年到 2010 年 1 月。如果文章（1）侧重于因医疗疾病而急性住院的老年患者；（2）描述用于测量功能的工具；并且（3）概述功能下降的临床定义，则将其纳入。两位审稿人独立提取数据。
共有 28 项研究纳入了本次综述。有 5 种不同的工具用于测量功能：Katz ADL 指数、Lawton 和 Brody 的 IADL 量表、Barthel 指数、功能独立性测量和护理需求评估。工具之间和内部的项目内容和评分差异很大。作者定义的下降最小幅度是指功能下降 2.4%至 20.0%。
本综述表明，测量住院老年患者（I）ADL 功能的方法存在很大的差异，并且功能下降的临床定义范围也很广。这些概念和临床计量学障碍阻碍了对流行病学和临床研究中功能结果数据的解释和比较。
