title: Simple counts of ADL dependencies do not adequately reflect older adults' preferences toward states of functional impairment.
abstract: 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.
authors: Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305-6019, United States. Electronic address: tamarasims@stanford.edu.
authors: Tamara
authors: T
authors: Sims
authors: Division of Biostatistics, Health Research and Policy, Stanford University, United States.
authors: Tyson H
authors: TH
authors: Holmes
authors: Center for Primary Care and Outcomes Research, 117 Encina Commons, Stanford University, Stanford, CA 94305-6019, United States.
authors: Dena M
authors: DM
authors: Bravata
authors: 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.
authors: Alan M
authors: AM
authors: Garber
authors: Division of Epidemiology, Health Research and Policy, Stanford University, United States.
authors: Lorene M
authors: LM
authors: Nelson
authors: 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.
authors: Mary K
authors: MK
authors: Goldstein
mesh_terms: 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