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Evaluating Disability Over Discrete Periods of Time

Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut.

Address correspondence to: Thomas M. Gill, MD, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504. E-mail: thomas.gill{at}yale.edu

Background. To advance the field of disability assessment, additional developmental work is needed. The objective of this study was to determine the potential value of participant recall when evaluating disability over discrete periods of time.

Methods. We studied 491 residents of greater New Haven, Connecticut, who were 76 years old or older. Participants completed a comprehensive assessment that included several new questions on disability in four essential activities of daily living (bathing, dressing, transferring, and walking). Participants were also assessed for disability in the same activities during monthly telephone interviews before and after the comprehensive assessment. Chronic disability was defined as a new disability that was present for at least three consecutive months.

Results. We found that up to half of the incident disability episodes, which would otherwise have been missed, can be ascertained if participants are asked to recall whether they have had disability "at any time" since the prior assessment; that these disability episodes, which are ascertained by participant recall, confer high risk for the subsequent development of chronic disability, with an adjusted hazard ratio of 2.5 (95% confidence interval, 1.1–5.8); and that participant recall for the absence of disability becomes increasingly inaccurate as the duration of the assessment interval increases, with 2.2%, 6.0%, 6.9%, and 9.1% of participants having inaccurate recall at 1, 3, 6, and 12 months, respectively.

Conclusions. Our results demonstrate both the promise and limitations of participant recall and suggest that additional strategies are needed to more completely and accurately ascertain the occurrence of disability among older persons.

Key Words: Disability evaluation • Activities of daily living • Cohort studies