The Development of Physical Functioning Scale for Community-Dwelling Older Persons

지역사회 노인의 신체기능 평가도구 개발

  • Lee, Kyung-Jong (Department of Preventive Medicine & Public Health, Ajou University School of Medicine) ;
  • Han, Geun-Shik (Department of Information & Telecommunications, Hanshin University) ;
  • Yoon, Soo-Jin (Manan-Gu Senior Health Center, Anyang City) ;
  • Lee, Yeon-Kyung (Manan-Gu Health Center, Anyang City) ;
  • Kim, Chan-Ho (Manan-Gu Health Center, Anyang City) ;
  • Kim, Jeong-Lim (Department of Preventive Medicine & Public Health, Ajou University School of Medicine) ;
  • Lee, Yun-Hwan (Department of Preventive Medicine & Public Health, Ajou University School of Medicine)
  • 이경종 (아주대학교 의과대학 예방의학교실) ;
  • 한근식 (한신대학교 컴퓨터정보통신학부) ;
  • 윤수진 (안양시 만안구 노인보건센터) ;
  • 이연경 (안양시 만안구 보건소) ;
  • 김찬호 (안양시 만안구 보건소) ;
  • 김정림 (아주대학교 의과대학 예방의학교실) ;
  • 이윤환 (아주대학교 의과대학 예방의학교실)
  • Published : 2002.12.01

Abstract

Objectives : To develop a physical functioning instrument for older adults living in the community. Methods : A representative sample of 979 people aged 65 years or over were interviewed in-person. Of these, 199 people also completed a detailed in-hospital examination. The scale items were selected based on the frequency of endorsement, along with the item-total and inter-item correlations. The associations of the scale with their physical performance and clinical examination were analyzed to evaluate the criterion-related validity. Construct validity was assessed using factor analysis, and internal consistency through Cronbach's alpha and item-total correlations. Test-retest reliability was measured by agreement between the household survey and the repeat survey at the in-hospital examination. Results : Initially, 23 items on the level of difficulty, ranging from no difficulty to an inability to complete a task, with the specific mobility and self-care tasks were included. Those with a high frequency of endorsement and a low inter-item or item-total correlations were excluded, resulting in a 10-item Physical Functioning (PT) scale. Equal weights were given to each item and a summated score was calculated. Significant associations were found between the PF scores and the physical performance, surrey and clinical data. The scale revealed a 2-factor (mobility and self-care) structure. Cronbach's alpha was 0.92 and the item-total correlations were in the 0.63 to 0.78 range. Pearson's correlations for the test-retest ranged between 0.56 and 0.61. Conclusions : The newly developed Physical Functioning (PF) scale showed good psychometric properties in older people. Further work, however, is needed to improve its sensitivity to discriminate higher levels of functioning, in addition to assessing its predictive value in detecting changes in health.

Keywords

References

  1. Guralnik JM, LaCroix AZ. Assessing physical function in older populations. In: Wallace RE, Woolson RF (eds). The Epidemiologic Study of the Elderly. New York: Oxford University Press; 1992. p.159-181
  2. Evashwick CJ. Definition of the continuum of care. In: Evashwick CJ. The Continuum of Long-Term Care: An Integrated Systems Approach. Albany: Delmar Publishers; 1996. p. 3-22
  3. Bierman AS. Functional status. The sixth vital sign. (Editorial). J Gen Intern Med 2001; 16: 785-786
  4. WHO. Health and ageing. A discussion paper. Department of Health Promotion, Non-Communicable Disease Prevention and Surveillance, World Health Organization; 2001
  5. 정경희, 조애저, 오영희, 변재관, 변용찬, 문현상. 1998년도 전국 노인생활실태 및 복지욕구조사. 한국보건사회연구원; 1998
  6. Clark DO, Stump TE, Hui SL, Wolinsky FD. Predictors of mobility and basic ADL difficulty among adults aged 70 years and older. J Aging Health 1998; 10: 422-440 https://doi.org/10.1177/089826439801000402
  7. Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM. Association of comorbidity with disability in older women: the Women's Health and Aging Study. J Clin Epidemiol 1999; 52: 27-37 https://doi.org/10.1016/S0895-4356(98)00124-3
  8. Kivinen P, Sulkava R, Halonen P, Nissinen A. Self-reported and performance- based functional status and associated factors among elderly men: the Finnish cohorts of Seven Countries Study. J Clin Epidemiol 1998; 51: 1243-1252 https://doi.org/10.1016/S0895-4356(98)00115-2
  9. Woo J, Ho SC, Yu LM, Yuen YK. Impact of chronic diseases on functional limitations in elderly Chinese aged 70 years and over: a cross-sectional and longitudinal survey. J Gerontol A Biol Sci Med Sci 1998; 53A: M102-M106
  10. Branch LG, Meyers AR. Assessing physical function in the elderly. Clin Geriatr Med 1987; 3: 29-51
  11. Fried LP, Bush TL. Morbidity as a focus of preventive health care in the elderly. Epidemiol Rev 1988; 10: 48-64
  12. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701-1707 https://doi.org/10.1056/NEJM198812293192604
  13. Manton KG. A longitudinal study of functional change and mortality in the United States. J Gerontol A Bioi Sci Med Sci 1988; 43: M5153-M5161
  14. Mor V, Wilcox V, Rakowski W, Hiris J. Functional transitions among the elderly: patterns, predictors, and related hospital use. Am J Public Health 1994; 84: 1274-1280 https://doi.org/10.2105/AJPH.84.8.1274
  15. Atchley RC, Scala MA. Long-range antecedents of functional capability in later life. J Aging Health 1998; 10: 3-19 https://doi.org/10.1177/089826439801000101
  16. Greiner PA, Snowdon DA, Greiner LH. The relationship of self-rated function and self-rated health to concurrent functional ability, functional decline, and mortality: findings from the Nun Study. J Gerontol B Psychol Sci Soc Sci 1996; 51B: S234-S241
  17. Lawrence RH, Jette AM. Disentangling the disablement process. J Gerontol B PsycholSci Soc Sci 1996; 51B: S173-S182
  18. Lee Y. The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults. J Epidemiol Community . Health 2000; 54: 123-129 https://doi.org/10.1136/jech.54.2.123
  19. Bernard SL, Kincade JE, Konard TR, Arcury TA, Rabiner DJ, Woomert A, tality from community surveys of older adults: the improtance of self-rated functional ability. J Gerontol B Psychol Sci Soc Sic 1997; 52B: S155-S163
  20. Deeg DJH, van Zonneveld RJ. van der Maas PJ, Habbema JDF. Medical and social predictors of longevity in the elderly: total predictive value and interdependence. Soc Sci Med 1989; 29: 1271-1280 https://doi.org/10.1016/0277-9536(89)90067-1
  21. Scott WK, Macera CA, Cornman CB, Sharpe PA. Functional health status as a predictor of mortality in men and women over 65. J Clin Epidemiol 1997; 50: 291-296 https://doi.org/10.1016/S0895-4356(96)00365-4
  22. Tsuji I, Kuwahara A, Nishino Y, Ohkubo T, Sasaki A, Hisamichi S. Medical cost for disability: a longitudinal observation of National Health Insurance bene-ficiaries in Japan. J Am Geriatr Soc 1999; 47: 470-476
  23. Fried TR, Bradley EH, Williams CS, Tinetti ME. Functional disability and health care expenditures for older persons. Arch Intern Med 2001; 161: 2602-2607 https://doi.org/10.1001/archinte.161.21.2602
  24. Rhee S, Oh J-J. A study on the scale to measure health status of the elderly: in regard to measures of physical functioning. J Korea Community Health Nurs Acad Soc 1992; 6(2): 11-20 (Korean)
  25. 이가옥, 서미경, 고경환, 박종돈. 노인생활실태 분석 및 정책과제. 한국보건사회연구원; 1994
  26. 보건복지부. 1998년도 국민건강. 영양조사. 총괄보고서. 한국보건사회연구원; 1999
  27. Rah UW, Bae HS, Chun S-I, Jang JC, Lee IY. Functional evaluation of elderly with modified Barthel Index and modified Lambeth Disability screening questionnaire. J Korean Acad Rehab Med 1995; 19: 559-571 (Korean)
  28. Song M. Effects of the sensory impairment on functioning levels of the elderly. J Acad Nursing 1993; 23: 678-693 (Korean)
  29. Oh HK, Bae CY, Shin HS, Shin DH. The epidemiologic study for functional capacity of daily living and depression in healthy elderly. N Med J 1992; 35(9): 21-30 (Korean)
  30. Lee YJ, Kim KS, Song M. A study of health status of hospitalized Korean elderly. Development and application of the scale to measure physical and cognitive ability. J Korean Public Health Assoc 1986; 12(2): 13-27 (Korean)
  31. Lee Y, Choi K. Factors associated with physical functioning among community-dwelling older adults. Korean J Prev Med 1999; 32: 325-332 (Korean)
  32. Park J, Cho SW, Shon H. Reliability of functional status measurements in elderly people. J Korean Neuropsychiatr Assoc 1995; 34: 475-483 (Korean)
  33. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness of the aged. The Index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914-919 https://doi.org/10.1001/jama.1963.03060120024016
  34. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179-186 https://doi.org/10.1093/geront/9.3_Part_1.179
  35. Nagi SZ. An epidemiology of disability among adults in the United States. Milbank Mem Fund QHealth Soc 1976; 54: 439-467 https://doi.org/10.2307/3349677
  36. Kane RL, Kane RA. Assessing older persons. Measures, meaning, and practical applications. Oxford: Oxford University Press; 2000
  37. McDowell I, Newell C. Measuring Health. A Guide to Rating Scales and Questionnaires. 2nd ed., New York: Oxford University Press; 1996. p. 254-259
  38. McDowell I, Newell C. Measuring Health. A G Guide to Rating Scales and Questionnaires. 2nd ed., New York: Oxford University Press; 1996. p. 254-259
  39. 이윤환, 한근식, 이연경, 윤수진. 수원시 노인 건강 실태조사. 아주대학교 의과대학 예방의학교실, 수원시 권선구 보건소; 2001
  40. Guralnik JM, Fried LP, Simonsick EM, Kasper JD, Lafferty ME (eds). The Women's Health and Aging Study: health and social characteristics of older women with disability. Bethesda, MD: National Institute on Aging; 1995
  41. 대한임상병리학회(편). 임상병리학. 제3판. 고려의학; 2001
  42. Cho MJ, Bae IN, Suh GH, Hahm BJ,. Kim JK, Lee DW, Kang MH. Validation of Geriatric Depression Scale, Korean version (GDS) in the Assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc 1999; 38: 48-63 (Korean)
  43. National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestion and Kidney Diseases. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, MD: National Institutes of Health; 1998
  44. Streiner DL, Norman GR. Health measurement scales. A practical guide to their development and use. 2nd ed., Oxford: Oxford University Press; 1995
  45. Agresti A. Categorical data analysis. New York: John Wiley & Sons; 2000
  46. Nagi SZ. Disability concept revisited: implications for prevention. In: Pope AM, Tarlov AR (eds). Disability in America. Toward a National Agenda for Prevention. Washington, D.C.: National Academy Press; 1991. p. 309-327
  47. Park J. Assessment of functional status in the elderly. J Korean Neuropsychiatr Assoc 1995; 34: 636-641 (Korean)
  48. Stewart AL, Kamberg CJ. Physical functioning measures. In: Stewart AL, Ware JE, Jr (eds). Measuring Functioning and Well-being. The Medical Outcomes Study Approach. Durham: Duke University Press; 1992.p. 86-101
  49. Stewart AL, Ware JE, Jr (eds). Measuring functioning and well-being. The Medical Outcomes Study approach. Durham: Duke University Press; p. 1992
  50. Choi YH, Chung SE. A study on the development of physical health assessment tool and health status of Korean elderly. J Korean Acad Adult Nurs 1991; 3: 70-96 (Korean)
  51. Williamson JD, Maloney P, Skinner EA, Corti MC, Brancati FL, Ladenson PW, Guralnik JM, Fried LP. Hematologic, biochemical, and hormonal characteristics. In: Guralnik JM, Fried LP, Simonsick EM, Kasper JD, Lafferty ME (eds). The Women' s Health and Aging Study: Health and Social Characteristics of Older Women with Disability. Bethesda, MD: National Institute on Aging; 1995. p. 169-177
  52. Wells KB, Stewart A, Hays RD, Burnam A, Rogers W, Daniels M, Berry S, Greenfield S, Ware J. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA 1989; 262: 914-919 https://doi.org/10.1001/jama.262.7.914
  53. Mulsant BH, Ganguli M, Seaberg EC. The relationship between self-rated health and depressive symptoms in an epidemiological sample of community-dwelling older adults. J Am Geriatr Soc 1997; 45: 954-958 https://doi.org/10.1111/j.1532-5415.1997.tb02966.x
  54. Friedmann JM, Elasy T, Jensen GL. The relationship between body mass index and self-reported functional limitation among older adults: a gender difference. J Am Geriatr Soc 2001; 49: 398-403 https://doi.org/10.1046/j.1532-5415.2001.49082.x
  55. Benrud-Larson LM, Dewar MS, Sandroni P, Rummans TA, Hay thornwaite JA, Low PA. Quality of life in patients with postural tachycardia syndrome. Mayo Clin Proc 2002; 77: 531-537 https://doi.org/10.4065/77.6.531
  56. Rozkovec A, Papouchado M, James MA, Kendrick AH, Clarke LM, Rees JR. The relationship of symptoms to performance in paced patients with breathlessness. Eur Heart J 1989; 10: 63-69 https://doi.org/10.1093/oxfordjournals.eurheartj.a059382
  57. WHO Study Group on Epidemiology and Prevention of Cardiovascular Diseases in the Elderly. Epidemiology and Prevention of Cardiovascular Diseases in Elderly People: Report of a WHO Study Group. Geneva: World Health Organization; 1995
  58. Supiano MA. Hypertension. In: Duthie EH, Katz PRo Practice of Geriatrics. 3rd ed. Philadelphia: W.B. Saunders Co.; 1998. p. 375-382
  59. Ishizaki T, Watanabe S, Suzuki T, Shibata H, Haga H. Predictors of functional decline among nondisabled older Japanese living in a community during a 3-year follow-up. J Am Geriatr Soc 2000; 48: 1424-1429 https://doi.org/10.1111/j.1532-5415.2000.tb02632.x
  60. Sarkisian CA, Liu H, Ensrud KE. Stone KL, Mangione CM. Correlates of attributing new disability to old age. J Am Geriatr Soc 2001 ; 49: 134-141 https://doi.org/10.1046/j.1532-5415.2001.49033.x
  61. Shinkai S, Watanabe S, Kumagai S, Fujiwara Y, Amano H, Yoshida H, Ishizaki T, Yukawa H, Suzuki T, Shibata H. Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Age Ageing 2000; 29: 441-446 https://doi.org/10.1093/ageing/29.5.441
  62. Gill TM, Williams CS, Tinetti ME. Assessing risk for the onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc 1995; 43: 603-609 https://doi.org/10.1111/j.1532-5415.1995.tb07192.x
  63. Simonsick EM, Kasper JD, Guralnik JM, Bandeen-Roche K, Ferrucci L, Hirsch R, Leveille S, Rantanen T, Fried LP. Severity of upper and lower extremity functional limitation: scale development and validation with self-report and performance-based measures of physical function. J Gerontal B Psychol Sci Soc Sci 2001; 56B: S10-S19 https://doi.org/10.1093/geronb/56.1.S10
  64. Simonsick EM, Newman AB, Nevitt MC, Kritchevsky SB, Ferrucci L, Guralnik JM, Harris T. Measuring higher level physical function in well-functioning older adults: expanding familiar approaches in the Health ABC Study. J Gerontal A Biol Sci Med Sci 2001; 56A: M644-M649 https://doi.org/10.1093/gerona/56.10.M644