title: Activity Limitation Stages empirically derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult community-dwelling Medicare population.
abstract: BACKGROUND
  Stages quantify severity like conventional measures but further specify the activities that people are still able to perform without difficulty.
  
  
  OBJECTIVE
  To develop Activity Limitation Stages for defining and monitoring groups of adult community-dwelling Medicare beneficiaries.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Community.
  
  
  METHODS
  There were 14,670 respondents to the 2006 Medicare Current Beneficiary Survey.
  
  
  METHODS
  Stages were empirically derived for the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) by profiling the distribution of performance difficulties as reported by beneficiaries or their proxies. Stage prevalence estimates were determined, and associations with demographic and health variables were examined for all community-dwelling Medicare beneficiaries.
  
  
  METHODS
  ADL and IADL stage prevalence.
  
  
  RESULTS
  Stages (0-IV) define 5 groups across the separate ADL and IADL domains according to hierarchically organized profiles of retained abilities and difficulties. For example, at ADL-I, people are guaranteed to be able to eat, toilet, dress, and bathe/shower without difficulty, whereas they experience limitations getting in and out of bed or chairs and/or difficulties walking. In 2006, an estimated 6.0, 2.9, 2.2, and 0.5 million beneficiaries had mild (ADL-I), moderate (ADL-II), severe (ADL-III), and complete (ADL-IV) difficulties, respectively, with estimates for IADL stages even higher. ADL and IADL stages showed expected associations with age and health-related concepts, supporting construct validity. Stages showed the strongest associations with conditions that impair cognition.
  
  
  CONCLUSIONS
  Stages as aggregate measures reveal the ADLs and IADLs that people are still able to do without difficulty, along with those activities in which they report having difficulty, consequently emphasizing how groups of people with difficulties can still participate in their own lives. Over the coming decades, stages applied to populations served by vertically integrated clinical practices could facilitate large-scale planning, with the goal of maximizing personal autonomy among groups of community-dwelling people with disabilities.
authors.affiliation: Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA∗
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.affiliation: Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and VISN 4 Mental Illness Research Education & Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA†
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.affiliation: Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA‡
authors.forename: Qiang
authors.initials: Q
authors.lastname: Pan
authors.affiliation: Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; 423 Guardian Drive, 907 Blockley Hall, Philadelphia, PA 19104-6021§. Electronic address: jkurichi@mail.med.upenn.edu.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Mental Illness Research Education & Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA; and VA Healthcare System Palo Alto, Spinal Cord Injury Service‖
authors.forename: Sophia Miryam
authors.initials: SM
authors.lastname: Schüssler-Fiorenza Rose
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA¶
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
mesh_terms: D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D051346:Mobility Limitation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States