Disability in the oldest old: "can do" or "do do"?
OBJECTIVE
To investigate the discrepancies between outcomes for competence (can do) and actual performance (do do) in activities of daily living (ADLs).


METHODS
Baseline measurements of a population-based follow-up study.


METHODS
Leiden 85-Plus Study, the Netherlands.


METHODS
Five hundred and ninety-nine persons, age 85. The response rate was 86%.


METHODS
Face-to-face interviews. Measurements of competence and actual performance were based on the Groningen Activity Restriction Scale. Help received was assessed for several domains. Prevalence rates for disability were assessed according to the concepts of both competence and actual performance. Analysis was performed separately for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs).


RESULTS
Seventy-seven percent of the oldest old were competent to perform all the BADLs and performed them regularly. Fifteen percent were not competent to perform certain BADLs independently but performed them regularly with help from others. The prevalence of disability defined as inability in one or more BADLs was 22% for women and 10% for men. The prevalence of disability defined as inactivity in one or more BADLs was 16% for women and 17% for men. Only 5% of the oldest old were competent to perform all IADLs and performed them regularly. In spite of being competent, 70% did not perform certain IADLs regularly. The prevalence of disability defined as inability in one or more IADLs was 64% for women and 55% for men. The prevalence of disability defined as inactivity in one or more IADLs was 92% for women and 98% for men.


CONCLUSIONS
The structural discrepancies between the outcomes of competence and actual performance have important consequences when estimating disability in old people. Promoting actual performance in IADLs may reduce disability.
Bootsma-van der Wiel
A
A
Section of Gerontology and Geriatrics, Department of General Internal Medicine, Leiden University Medical Center, the Netherlands.
Gussekloo
J
J
de Craen
A J
AJ
van Exel
E
E
Knook
D L
DL
Lagaay
A M
AM
Westendorp
R G
RG
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over / Q000502:physiology / Q000523:psychology / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008297:Male; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data