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Variation in Sources of Clinician-Rated and Self-Rated Instrumental Activities of Daily Living Disability

¹ Gertrude H. Sergievsky Center, ² Department of Sociomedical Sciences
³ Department of Occupational Therapy, Columbia University, New York.
⁴ Research Division, Hebrew Home for the Aged & Stroud Center, New York State Psychiatric Institute, Riverdale.

Address correspondence to Steven M. Albert, PhD, MSc, A211 Crabtree Hall, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261. E-mail: smalbert{at}pitt.edu

Background. It is unclear how well self-reports and clinician ratings of performance in the instrumental activities of daily living (IADLs; household maintenance tasks) correspond and why they may differ.

Methods. We assessed clinician-rated IADL performance using an occupational therapy protocol, the Assessment of Motor and Process Skills (AMPS). AMPS and self-rated IADL disability were compared in two groups of nondemented elderly persons without ADL limitation: a group with functional limitation only (self-reported difficulty in some area of upper or lower body function, n = 139) and a group that reported functional limitation plus IADL disability (difficulty in at least one IADL task, n = 49). Occupational therapists were blind to self-reports, and all assessments were conducted in respondent homes.

Results. Self-rated IADL disability was significantly associated with the AMPS motor skill score (r = –.34, p <.001), but the motor skill score was only moderately sensitive (61%) and specific (67%) in identifying self-rated disability. In adjusted logistic regression models, clinician-rated performance and self-rated IADL disability shared some physical predictors, but only clinician-rated performance was related to cognitive status. AMPS process skill scores did not relate to self-rated IADL disability or physical or cognitive status.

Conclusions. In this sample of older adults without dementia or ADL disability, clinician ratings of IADL motor skill and self-rated IADL disability were correlated. Physical deficits appear to be more salient in self-ratings than is cognitive ability, because cognitive ability (in particular, verbal fluency) was associated only with clinician-rated IADL performance.