On Scaling Methodology and Environmental Influences in Disability Assessments: The Cumulative Structure of Personal and Instrumental ADL among Older Adults in a Swedish Rural District
Restricted accessResearch articleFirst published online December, 1997
On Scaling Methodology and Environmental Influences in Disability Assessments: The Cumulative Structure of Personal and Instrumental ADL among Older Adults in a Swedish Rural District
The ADL Staircase is a hierarchical instrument for assessment of independence/dependence in personal and instrumental activities of daily living (P-ADL and I-ADL). Its development was based on Katz's ADL-Index, applying the same assessment principles. The cumulativity among the items has previously been confirmed in Swedish urban elderly population samples. The purpose of this study was to test the instrument in a rural setting. Due to local environmental conditions, the authors developed alternative definitions for the “transportation” item. Data collected using 133 respondents suggested a different cumulative order among the I-ADL items from that identified in urban samples, and significant gender differences were found. The scale's cumulativity was analysed in-depth, and it revealed different results depending on which scaling analyses were used. Environmental factors highlighted the methodological difficulties inherent in I-ADL assessments, and the results revealed a higher prevalence of disability compared to previous gerontological studies. In clinical practice, awareness of the consequences of I-ADL assessments' limited generalizability between settings is strongly recommended. The study also has theoretical implications for further understanding of the complexity of disablement.
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