title: Understanding non-performance reports for instrumental activity of daily living items in population analyses: a cross sectional study.
abstract: BACKGROUND
  Concerns about using Instrumental Activities of Daily Living (IADLs) in national surveys come up frequently in geriatric and rehabilitation medicine due to high rates of non-performance for reasons other than health. We aim to evaluate the effect of different strategies of classifying "does not do" responses to IADL questions when estimating prevalence of IADL limitations in a national survey.
  
  
  METHODS
  Cross-sectional analysis of a nationally representative sample of 13,879 non-institutionalized adult Medicare beneficiaries included in the 2010 Medicare Current Beneficiary Survey (MCBS). Sample persons or proxies were asked about difficulties performing six IADLs. Tested strategies to classify non-performance of IADL(s) for reasons other than health were to 1) derive through multiple imputation, 2) exclude (for incomplete data), 3) classify as "no difficulty," or 4) classify as "difficulty." IADL stage prevalence estimates were compared across these four strategies.
  
  
  RESULTS
  In the sample, 1853 sample persons (12.4 % weighted) did not do one or more IADLs for reasons other than physical problems or health. Yet, IADL stage prevalence estimates differed little across the four alternative strategies. Classification as "no difficulty" led to slightly lower, while classification as "difficulty" raised the estimated population prevalence of disability.
  
  
  CONCLUSIONS
  These analyses encourage clinicians, researchers, and policy end-users of IADL survey data to be cognizant of possible small differences that can result from alternative ways of handling unrated IADL information. At the population-level, the resulting differences appear trivial when applying MCBS data, providing reassurance that IADL items can be used to estimate the prevalence of activity limitation despite high rates of non-performance.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. mstinema@exchange.upenn.edu.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.affiliation: Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvani, 423 Guardian Drive, 617 Blockley Hall, Philadelphia, PA, 19104, USA. dxie@mail.med.upenn.edu.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Biostatistics and Epidemiology, The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvani, 423 Guardian Drive, 617 Blockley Hall, Philadelphia, PA, 19104, USA. panqiang@mail.med.upenn.edu.
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 Pennsylvani, 423 Guardian Drive, 617 Blockley Hall, Philadelphia, PA, 19104, USA. jkurichi@mail.med.upenn.edu.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Anna and Harry Borun Chair in Geriatrics and Gerontology at UCLA, RAND, Santa Monica, CA, USA. saliba@rand.org.|Research Physician, VA GLAHS GRECC, RAND, Santa Monica, CA, USA. saliba@rand.org.|UCLA/JH Borun Center for Gerontological Research, RAND, Santa Monica, CA, USA. saliba@rand.org.|RAND Health, RAND, Santa Monica, CA, USA. saliba@rand.org.
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
authors.affiliation: Spinal Cord Injury Service, Veterans Affairs Palo Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA. cms@alumni.med.upenn.edu.|Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. cms@alumni.med.upenn.edu.
authors.forename: Sophia Miryam Schüssler-Fiorenza
authors.initials: SM
authors.lastname: Rose
authors.affiliation: Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Joel.Streim@uphs.upenn.edu.|VISN 4 Mental Illness Research Education & Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA. Joel.Streim@uphs.upenn.edu.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult