Measurement of activities of daily living in hospitalized elderly: a comparison of self-report and performance-based methods.

Objective: To determine the accuracy of self-reports of physical functioning by hospitalized elderly.
Design: Comparison of two measures.
Patients and Setting: Two-hundred forty-seven medical inpatients (mean age 78.7 years) hospitalized at St. Marys Hospital Medical Center, Madison, WI.
Main Outcome Measures: Measures of five activities of daily living by self-report and by performance.
Results: The rate of agreement between self-report and performance ADL measures was the lowest in the areas of bathing and dressing where the agreement was 63% and 64%, respectively. When patients reported needing no help in these two tasks, they were measured lower 32% of the time for dressing and 42% for bathing. When patients reported needing help in an activity the agreement rate between patient and occupational therapist varied widely, from only 42% for toileting to 78% for bathing. The two factors which were statistically associated with poor agreement between the two ADL measurements were cognitive impairment (P less than 0.001) and a decline from the pre-hospital level of ADL functioning which had occurred during hospitalization (P less than 0.001).
Conclusions: These data suggest that there may be significant differences between patient assessments and performance-based measurements of ADL functioning in hospitalized elderly at time of discharge. These differences may have implications for the collection of functional measurements for discharge planning or for geriatric research in the hospital environment.