Elsevier

Journal of Aging Studies

Volume 11, Issue 4, Winter 1997, Pages 337-362
Journal of Aging Studies

A global disability indicator

https://doi.org/10.1016/S0890-4065(97)90026-8Get rights and content

Abstract

Disability is difficulty performing roles and activities due to health problems. It is largely experienced by older persons as they accumulate progressive chronic conditions. To measure functional status of individuals and populations, contemporary surveys include sets of detailed items about disability. Little effort has gone into developing global indicators of disability that cover the concept briefly but well. A global disability indicator is a compact and inexpensive device for public health surveillance and scientific study of disablement. I present and critique items that have been used in North American surveys. Good candidates are selected for methodological study. Both laboratory-based cognitive studies and large-scale statistical studies are recommended; the first will reveal meanings of items and responses and the second, items' systematic structure and prediction ability. The ultimate goal is to identify one or a few fine indicators for widespread inclusion in population health surveys.

References (62)

  • R.H. Brook et al.

    Overview of Adult Health Status Measures Fielded in Rand's Health Insurance Study

    Medical Care

    (1979)
  • Centers for Disease Control and Prevention

    Quality of Life as a New Public Health Measure—Behavioral Risk Factor Surveillance System, 1993

    Morbidity and Mortality Weekly Report

    (1994)
  • M. Chamie

    Report of the Committee on the Conceptual Harmonization of Statistics for the Study of Disability-Free Life Expectancy

    Reseau Esperance de Vie en Sante (REVES) Paper

    (1990)
  • E.M. Crimmins et al.

    Changes in Life Expectancy and Disability-Free Life Expectancy in the United States

    Population and Development Review

    (1989)
  • J.F. Fitzgerald et al.

    Replication of the Multidimensionality of Activities of Daily Living

    Journal of Gerontology: Social Sciences

    (1993)
  • J.M. Guralnik et al.

    Physical Performance Measures in Aging Research

    Journal of Gerontology: Medical Sciences

    (1989)
  • L.D. Haber

    Issues in the Definition of Disability and the Use of Disability Survey Data

  • T. Harris et al.

    Longitudinal Study of Physical Ability in the Oldest-Old

    American Journal of Public Health

    (1989)
  • C.Hagan Hennessy et al.

    Measuring Health-Related Quality of Life for Public Health Surveillance

    Public Health Reports

    (1994)
  • E.L. Idler

    Self-Assessed Health and Mortality: A Review of Studies

  • E.L. Idler et al.

    Self-Rated Health and Mortality in the NHANES-I Epidemiologic Follow-Up Study

    American Journal of Public Health

    (1990)
  • C. Jagger et al.

    Mortality Risks in the Elderly: Five-Year Follow-Up of a Total Population

    International Journal of Epidemiology

    (1988)
  • R.J. Johnson et al.

    The Structure of Health Status Among Older Adults: Disease, Disability, Functional Limitation and Perceived Health

    Journal of Health and Social Behavior

    (1993)
  • G.A. Kaplan et al.

    Perceived Health and Mortality: A Nine-Year Follow-Up of the Human Population Laboratory Cohort

    American Journal of Epidemiology

    (1983)
  • G. Kaplan et al.

    Subjective State of Health and Survival in Elderly Adults

    Journal of Gerontology: Social Sciences

    (1988)
  • J.N. Katz et al.

    Comparative Measurement Sensitivity of Short and Longer Health Status Instruments

    Medical Care

    (1992)
  • G.I.J.M. Kempen et al.

    The Development of a Hierarchical Polychotomous ADL-IADL Scale for Noninstitutionalized Elders

    The Gerontologist

    (1990)
  • M.P. Lawton

    Functional Assessment

  • E.N. Lazaridis et al.

    Do Activities of Daily Living Have a Hierarchical Structure? An Analysis Using the Longitudinal Study of Aging

    Journal of Gerontology: Medical Sciences

    (1994)
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