Getting Better? Change or Error in the Measurement of Functional Limitations 1

Abstract

The ability to perform basic activities of everyday life is increasingly being proposed by policy makers as a key criterion in eligibility determination for long-term care services. As a result, the assessment and estimation of this population becomes critical for planning purposes. This paper illustrates the issues and potential limitations of measuring functional status using an Activities of Daily Living measurement approach and addresses the implications of these issues for making national estimates of functional disability. Data from the 1987 National Medical Expenditure Survey indicate that significant proportions (31–66%) of the elderly report improvement in functioning over a one year period. The patterns of change reported in this paper, not unlike those found in other national surveys, call into question the reliability of reported ADL measures and point to the need to examine correlates of patterns of change, particularly improvement, over time. Findings indicate that while decline can be predicted reasonably well by demographic and health characteristics of the person, improvement tends to be more a function of methodological factors.