A Short Functional Survey Is Responsive to Changes in Functional Status in Vulnerable Older People

Authors

  • Lillian C. Min MD,

    1. From the *Divisions of GeriatricsGeneral Internal Medicine and Health Services Research, David Geffen School of MedicineMulticampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Los Angeles, California§RAND Health, Santa Monica, CaliforniaGeriatric Research, Education and Clinical Care Center, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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  • Neil S. Wenger MD,

    1. From the *Divisions of GeriatricsGeneral Internal Medicine and Health Services Research, David Geffen School of MedicineMulticampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Los Angeles, California§RAND Health, Santa Monica, CaliforniaGeriatric Research, Education and Clinical Care Center, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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  • David B. Reuben MD,

    1. From the *Divisions of GeriatricsGeneral Internal Medicine and Health Services Research, David Geffen School of MedicineMulticampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Los Angeles, California§RAND Health, Santa Monica, CaliforniaGeriatric Research, Education and Clinical Care Center, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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  • Debra Saliba MD

    1. From the *Divisions of GeriatricsGeneral Internal Medicine and Health Services Research, David Geffen School of MedicineMulticampus Program in Geriatric Medicine and Gerontology, University of California at Los Angeles, Los Angeles, California§RAND Health, Santa Monica, CaliforniaGeriatric Research, Education and Clinical Care Center, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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Address correspondence to Lillian Min, MD, MSHS, 10945 Le Conte Avenue, Suite 2339, Box 951687, Los Angeles, CA 90095-1687. E-mail: lmin@mednet.ucla.edu

Abstract

OBJECTIVES: To investigate whether an abbreviated five-item functional status survey consisting of five activities of daily living (ADLs) reflects changes measured over time in a full 12-item functional status survey.

DESIGN: Longitudinal evaluation with mean follow-up of 11 months.

SETTING: Two managed-care organizations in the United States.

PARTICIPANTS: Four hundred twenty community-dwelling older people at moderate to high risk of death and functional decline enrolled in the Assessing Care of Vulnerable Elders (ACOVE) observational study.

MEASURES: Number of ADL abilities according to the short (range 0–5) and full functional status surveys (range 0–12); change in function as defined according to a 1-point change in short score and 1- to 2-point change in full survey scores.

RESULTS: Changes in short functional status survey scores were highly correlated to changes in long survey scores (correlation coefficient=0.88). On average, a 1-point change in the short survey score was associated with a 1.4-point change on the long survey score (P<.001). The short survey correctly classified 93% of those who declined according to the long survey, adjusting for chance agreement (κ=0.82) and was responsive to decline in function (sensitivity 82–94%, specificity 94–97%, and area under the receiver operating curve 0.91–0.93 for 1- to 2-point decreases in full survey ADL counts).

CONCLUSION: The short functional status survey is an efficient way to detect changes in functional status in vulnerable older populations for clinical and research purposes.

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