Simple counts of ADL dependencies do not adequately reflect older adults' preferences toward states of functional impairment.
OBJECTIVE
To use unweighted counts of dependencies in activities of daily living (ADLs) to assess the impact of functional impairment requires an assumption of equal preferences for each ADL dependency. To test this assumption, we analyzed standard gamble (SG) utilities of single and combination ADL dependencies among older adults.


METHODS
Four hundred older adults used multimedia software (FLAIR1) to report SG utilities for their current health and hypothetical health states of dependency in each of 7 ADLs and 8 of 30 combinations of ADL dependencies.


RESULTS
Utilities for health states of multiple ADL dependencies were often greater than for states of single ADL dependencies. Dependence in eating, which is the ADL dependency with the lowest utility rating of the single ADL dependencies, ranked lower than 7 combination states. Similarly, some combination states with fewer ADL dependencies had lower utilities than those with more ADL dependencies. These findings were consistent across groups by gender, age, and education.


CONCLUSIONS
Our results suggest that the count of ADL dependencies does not adequately represent the utility for a health state. Cost-effectiveness analyses and other evaluations of programs that prevent or treat functional dependency should apply utility weights rather than relying on simple ADL counts.
Sims
Tamara
T
Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305-6019, United States. Electronic address: tamarasims@stanford.edu.
Holmes
Tyson H
TH
Division of Biostatistics, Health Research and Policy, Stanford University, United States.
Bravata
Dena M
DM
Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305-6019, United States.
Garber
Alan M
AM
Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305-6019, United States; VA Palo Alto Health Care System, United States.
Nelson
Lorene M
LM
Division of Epidemiology, Health Research and Policy, Stanford University, United States.
Goldstein
Mary K
MK
VA Palo Alto Health Care System, United States; Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305-6019, United States.
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002140:California; D003858:Dependency, Psychological; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011788:Quality of Life; D012737:Sex Factors; D012959:Socioeconomic Factors; D012984:Software