Measuring the Activities of Daily Living Among the Elderly: A Guide to National Surveys

The activities of daily living (ADLs) are the basic task of everyday life: eating, bathing, dressing, toileting, and transferring. Although persons of all ages may have problems performing ADLs, disability prevalence rates are much higher for the elderly — rising steeply with advancing age. When an effort is made to standardize ADL items for comparison, estimates for the community-based population vary by no more than 3.1 percentage points and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. The main conclusion is that ADL estimates will differ for good reasons and that there is no one "right" estimate. Researchers and policy analysts alike need to be aware that ADL disability rates are simply much "softer" measure than, say, mortality rates. From wording decisions made by those designing the survey questionnaire, to analysts who chose a particular ADL question(s) to analyze and report, to programmers who handle multiple question recodes and deal with missing and inconsistent data, each step will influence the final results. Thus, even an extremely large sample could not provide a definitive estimate. [30 PDF pages]