Not daily, sometimes not ever - mixed methods exploration of the contemporary relevance of tasks contained in extended activities of daily living scales.

BACKGROUND: Assessment of functional status is an integral part of older adult healthcare and research. Therefore, it is essential that tools to capture function are contextually appropriate. Many tools designed to evaluate extended Activities of Daily Living (eADLs) were developed decades ago. OBJECTIVE: Our aim was to explore which eADL tasks are commonly performed by older adults and map these tasks to popular eADL scales, seeking stakeholder perspectives to inform recommendations on scale content. DESIGN: Online survey with quantitative questions and free text followed-by semi-structured interviews. SUBJECTS: Older adults (≥60-years), carers and health, social care and voluntary/community professionals. METHODS: We extracted eADL tasks from existing scales to develop a survey on frequency of performance, with space for additional comment. The survey was disseminated via Join Dementia Research and other clinical and professional networks. Online semi-structured interviews were undertaken with thematic analysis of verbatim transcripts. RESULTS: From 2244 online survey responses, 87% came from older people and two-thirds of respondents were female. Some eADL tasks were never performed by many participants. Tasks not part of existing tools included online banking and mobile phone use. From fifteen interviews, a recurring theme was that technological and societal changes have altered daily tasks. CONCLUSIONS: Commonly used eADL scales contain obsolete tasks and omit tasks older people consider part of their everyday lives. There is a need to work collaboratively to update eADL tools to reflect the priorities and activities of older people to ensure these remain valid measures for use in practice and research. To complement this abstract, a video abstract is available online. A more detailed video-based summary of the content is also available as supplemental material.

An assessment of the content and properties of extended and instrumental activities of daily living scales: a systematic review.

PURPOSE: We performed a systematic review to assess the psychometric properties of extended Activities of Daily Living (eADL) scales. MATERIALS AND METHODS: Articles assessing eADL scales' properties were retrieved by searching multidisciplinary databases, and reference screening. Data on the following properties were extracted: validity, reliability, responsiveness, and internal consistency. The COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) risk of bias checklists are used to assess the quality of included articles. All aspects were performed by two independent researchers. RESULTS: Of 245 titles, 26 articles were eligible, comprising 15 different eADL scales. The Lawton scale had the most papers describing properties, while the Performance-based Instrumental Activities of Daily Living received the highest COSMIN rating. Properties most often assessed were convergent validity and reliability, no articles assessed all COSMIN properties. The COSMIN assessment rated 43% of the properties as 'positive', 31% 'doubtful' and 26% 'inadequate'. Only Lawton was assessed in more than one paper, available data suggest that this scale has excellent reliability, construct validity, internal consistency, and medium criterion validity. CONCLUSION: Despite their common use, there are limited data on the properties of eADL scales. Where data are available there are potential methodological issues in the studies.Implications for RehabilitationThe functional abilities of older adults are most commonly measured using extended activities of daily living scales (eADL).There are many eADL scales available to clinicians and no guidance on a preferred tool.Despite the frequent use of eADL scales in research and practice, there is limited published literature on their psychometric properties (for example validity, reliability and responsiveness).The Lawton Scale has the most supporting evidence and its properties are generally acceptable, more research is needed on other eADL scales.