title: Comparison of complex versus simple activity of daily living staging: validation of simple stages.
abstract: OBJECTIVE
  To compare activities of daily living (ADL) staging based on 2-level responses to ADL difficulty questions (simple ADL stages) with ADL staging based on 4-level ADL question responses (complex ADL stages).
  
  
  METHODS
  Analysis of the Second Longitudinal Study of Aging, a prospective cohort study, using descriptive statistics and logistic regression.
  
  
  METHODS
  Participants' homes.
  
  
  METHODS
  Community-dwelling persons (N=9447) aged ≥70 years in 1994.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  (1) Agreement and face validity: baseline simple ADL stage; (2) construct validity: baseline health, difficulty, and need characteristics; (3) prognostic comparison (determined at the Wave 2 interview): primary-nursing home use and/or death; secondary-death.
  
  
  RESULTS
  The systems showed good agreement (κ=.75). The simple ADL stages stratified people into distinct groups and reflected the expected stepwise increases from stage 0 to stage IV in health and need characteristics, such as the prevalence of home-related challenges (2.9%-84.5%) and perceived need for home modifications (2.1%-33.6%). In comparing the prognostic ability using the primary outcome, the complex system model demonstrated slightly increased discrimination between milder stages and a slightly higher C statistic (.666 vs .664).
  
  
  CONCLUSIONS
  Although complex staging appears slightly better at classifying people into distinct prognostic strata with respect to nursing home use and/or death at Wave 2, simple ADL stages demonstrate strong, clinically relevant associations with health and need characteristics.
authors: Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors: C Miryam
authors: CM
authors: Schüssler-Fiorenza
authors: Dawei
authors: D
authors: Xie
authors: Qiang
authors: Q
authors: Pan
authors: Margaret G
authors: MG
authors: Stineman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results