Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111221

Steven M. Albert, PhD, MSc, Gertrude H. Sergievsky Center, Columbia University, PH-19, 630 West 168th St., New York, NY 07666, 212-305-2503, smalbert@pitt.edu, Jane Bear-Lehman, PhD, Occupational Therapy, New York University, 35 West 4th Street, 11th Floor, New York, NY 10012, and Ann Burkhardt, OTD, Occupational Therapy, Columbia University, Milstein Pavillon, Columbia Presbyterian Medical Center, New York, NY 10032.

Objective: To determine (i) concordance between clinician-observed and self-reported disability in home settings among community-dwelling elderly, and (ii) the clinical significance of discordant assessments. Methods: The Sources of Independence among Elderly (SITE) study enrolled 375 Medicare beneficiaries without dementia, aged 70+, residing in northern Manhattan, NYC, all at risk for disability transitions. All were observed by occupational therapists, who rated participants using the Assessment of Motor and Process Skills (AMPS). The AMPS assesses disability in the instrumental activities of daily living (IADL: preparing meals, light housekeeping). Participants with an AMPS score <-2sd below age-specific norms were considered disabled. Results: Participants had a mean age of 79 and median of 10 years of school. Two-thirds were women, two-thirds were born outside the U.S., 60% were non-white, and nearly half lived alone. Clinician and self-reports broadly concurred, with a quarter indicating disability by each method. However, discordance was evident in 30% of participants. In models adjusting for sociodemographic factors, clinician-rated disability was independently predicted by gait speed and cognitive performance; self-reported disability was predicted only by gait speed. Discordance in ratings was clinically significant. Respondents who reported no disability in the presence of clinician-rated disability were more likely to have cognitive impairment and cluttered and unsafe living environments. Conclusion: Use of a clinical criterion measure is valuable for assessing disability in high-level function and suggests sources of disability and compensation.

Learning Objectives:

• Understand sources of disability and compensation in the face of disability in community-dwelling elderly
• Examine differences between clinical and self-report measures of disability
• Examine risk factors for disability in a prospective cohort

Keywords: Disability, Aging

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.