The interrelationship among achievement patterns of activities of daily living for institutionalized dependent elderly

The purpose of the present study was to examine the interrelationship of achievement patterns between 74 activities by selecting nine ADL domains, including 27 items used in existing ADL index for the institutionalized disabled elderly (Disabled-ADL). For these 74 ADL items, 706 institutionalized dependent elderly were assessed using a dichotomous scale of "possible" or "impossible" by staff working at the subjects' institutions. The difficulty of each item was examined by calculating the proportion of "possible" responses. The interrelationships among activities were determined by calculating phi coefficients. Furthermore, the degree of agreement assessed between ADL items was calculated by dividing the total response by the number of "possible-possible" and "impossible-impossible" responses, in order to examine the similarity of the achievement pattern of ADL. The phi coefficient values were high among ADL items with comparable difficulty where the item proportions were within about 10%. Even if belonging to a different ADL domain, the relationship was high among ADL items with similar difficulty and kinds of activity. All of the 27 activities used in Disabled-ADL indicated high agreement of over 80% with one or more activities among the other 47 activities used in this study. Especially, three lower extremity activities of "putting on trousers while standing", "going up and down stairs" and "squatting down from a standing posture" agreed more than 90% with many other lower extremity activities. The possibility is suggested in determining lower extremity functional levels by assessing these three activities. The selection of ADL items considering these influences is necessary to comprehensively assess ADL ability of disabled elderly.