Discrepancy Between Activities of Daily Living Self-Report and Performance-Based Functional Cognitive Assessments

PURPOSE: Occupational therapists often rely on client self-report of ADL/IADL that are difficult to directly observe given the complexity and cost of conducting observed testing (Bravell, Zarit, & Johansson, 2011). Performance based tests (PBTs) of functional cognition (FC) replicate typical IADL tasks, by requiring integration of multiple steps and actions, sequencing for goal completion, and reliance on multiple cognitive processes (Wesson, Clemson, Brodaty, & Reppermund, 2016). The purpose of this study was to determine if self-reported evaluations of ADL/IADL tasks are predictive of FC PBT scores.

DESIGN: This study used a cross-sectional design to assess a convenience sample of 89 community residing adults over the age of 55. Inclusion criteria were: age 55 years or older, living independently in the community, able to read and communicate in English.

METHOD: The following measures of FC and ADL/IADL performance were administered to participants: the Menu Task (MT), the Weekly Calendar Planning Activity (WCPA), the Performance Assessment of Self-Care Skills (PASS – shopping (S-PASS), checkbook balancing (C-PASS), medication management (M-PASS)), and the Activities of Daily Living Inventory (ADCS). Descriptive statistics for all participants were analyzed. Bivariate correlations were computed between the FC assessments and two sections of the ADCS that comprise ADL and IADL self-report[DF1] . Mean participant age was 70.29 (SD = 8.69) and mean years of education was 15.08 (SD = 2.77). Of 89 participants 72 % were female and 80% were white.

RESULTS: The MT was weakly correlated with the IADL ADCS (r=.23). Participants prediction of MT performance was weakly correlated with actual MT performance (r=.20). Of participants who predicted they would do “well” or “extremely well” on the MT, 16.8% scored as impaired and 66.3% scored as unimpaired. All WCPA scores demonstrated fair correlations with the IADL ADCS[DF2] (r[DF3] =.28, r=.32 r=-.28, r=-.25, r=-.21). C-PASS demonstrated a weak correlation, while the M-PASS demonstrated a fair correlation and the S-PASS demonstrated a moderate correlation with IADL ADCS (r=.09, r=.31, r=.54). Overall, participants self-report of IADL independence did not correlate strongly with actual performance on PBTs of FC.

CONCLUSION: A better understanding of IADL independence is derived from performance based assessment of FC abilities. Our results indicate that participants under/over estimated their ability to perform complex IADL tasks, supporting the hypothesis that self-report measures may not effectively identify individuals who may have difficulty managing complex IADLs. Occupational therapists should consider both self-report and PBTs of FC when determining ability to function independently in the community.

IMPACT STATEMENT: Given discrepancies between IADL self-reports and actual assessed ability, clinicians should supplement self-report with FC PBTs when making discharge recommendations in post-acute settings.

References

Bravell, M. E., Zarit, S. H., & Johansson, B. (2011). Self-reported activities of daily living and performance-based functional ability: A study of congruence among the oldest old. European Journal of Ageing, 8(3), 199-209. doi:10.1007/s10433-011-0192-6

Wesson, J., Clemson, L., Brodaty, H., & Reppermund, S. (2016). Estimating functional cognition in older adults using observational assessments of task performance in complex everyday activities: A systematic review and evaluation of measurement properties. Neuroscience & Biobehavioral Reviews, 68, 335-360. doi:10.1016/j.neubiorev.2016.05.024