Affiliations: [a] Agency for Health Care Policy and Research, 2101 East
Jefferson Street, Suite 500, Rockville, MD 20852, USA | [b] SysteMetrics, 4401 Connecticut Avenue, N.W.,
Washington, D.C. 20008, USA
Note: [1] The views expressed in this paper are those of the authors and do not reflect
the views or policies of the Agency for Health Care Policy and Research, the
Department of Health and Human Services, or SysteMetrics. An earlier version
of this paper was presented at the 1991 Annual Scientific Meetings of the
Gerontological Society of America in San Francisco. The authors wish to
thank Nancy Kieffer for statistical programming support and Patricia Ellis,
Kelly Carper, and Mary Seidenberg for wordprocessing support.
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.
