Screening for dependence in activities of daily living in the elderly: minimum set of questions

Abstract

OBJECTIVE: To analyze non-redundant questions on independence in activities of daily living in the elderly, representing the spectrum of dependency. METHODS: Multicenter project with a probabilistic population sample of 5,371 elderly residents in Sao Paulo, SP, Rio de Janeiro, RJ, Fortaleza, CE and Bambui, MG in 2008. A household survey was carried out and a questionnaire with 20 activities of daily living applied for the elderly to self-assess the difficulty/need for help in performing them. The responses were analyzed according to: the prevalence of some kind of difficulty/need for help for each activities of daily living, the frequency of non-response, and the grouping of activities in factor analysis. RESULTS: The personal activities (e.g., dressing) have, on average, a low prevalence of difficulty or need for help, compared to instrumental activities (e.g., shopping), and have lower rates of non- response. In factor analysis it was possible to identify three factors grouping the activities of daily living: one relative to mobility (e.g., walking 100 m), another for personal needs (e.g., bathing) and one relative to what someone else can do for the elderly (e.g., washing clothes). The activities of daily living with the highest eigenvalues in each group were also analyzed in the light of the prevalence of reported need for help and the proportion of non response. Three activities of daily living were selected as representing the spectrum of dependency and being well understood by the elderly - getting out of bed, bathing and walking 100 m. CONCLUSIONS: With only three activities of daily living we can have a simple and reliable screening instrument capable of identifying elderly in need of help in daily life. Estimating demand for care on a daily basis is an important indicator for planning and administration of health services within the paradigm of chronic diseases and population aging.