Among the greatest challenges of the 21st century is the reduction of disabilities that often evolve in the last decades of a long life and the adverse consequences associated with them. Severity of disability is often conventionally reported in population surveillance studies by counting the numbers of activity of daily living (ADL) and instrumental ADL (IADL) limitations which fail to express the types of activities that are limited. Thus, we propose to develop several approaches to staging activity limitation and test the predictive validity of each approach as alternative ways of aggregating ADL and IADL limitation for population surveillance. Staging is innovative because it conveys information about which activities are limited in addition to the overall severity of limitation. It therefore improves on he simple counts methodology which only captures overall severity. Baseline information will be obtained from new entrants into the 2005, 2006, 2007, and 2008 panels of the ongoing Medicare Current Beneficiary Survey (MCBS) (estimated N=16,000) Access to Care files. Adverse outcomes will be obtained by merging the Cost and Use files and will include inpatient hospitalization(s), skilled nursing facility (SNF), long-term care (LTC) facility use, and all-caus mortality with a follow-up time of 3 years.
Aim 1 will establish alternative ways of defining stages in the baseline data that express both individuals'types of limitation and their severity based on difficulty or assistance needed.
Aim 2 will determine which staging approaches best explain occurrences of each adverse outcome after adjusting for age, gender, and race.
Aim 3 is theory driven and will explore how well ADL and IADL stages explain risks of adverse events in combination with separate domains consisting of sets of related variables describing individuals'social living circumstances and resources;health status;subjective physical and psychological well being;and functional expectations, respectively.
Aim 4 is data driven and will culminate in the development and internal validation of parsimonious indices to predict each adverse outcome compiling the most predictive variables in each domain as identified in Aim 3. All analyses will account for the complex design of the MCBS. If successful, staging can be expected to serve as a tool for population surveillance and patient screening that can help stimulate future efforts to reduce the burdens of illness and disability in the US population by enabling disease and disability management and the tracking of economic, social, and health policies targeted to reduce adverse outcomes among people with ADL and IADL limitation. Knowledge of which ADLs and IADLs are limited (defined by stage thresholds) will have important implications for assessing quality of life and to the understanding of either the qualitative nature of difficulty experienced or ascertaining the types of assistance needed. This qualitative information is currently missing from ADL or IADL limitation counts.

Public Health Relevance

The Healthy People 2020 objectives, latest Centers for Disease Control and Prevent (CDC) report on Health Disparities and Inequalities (2011), and the Patient Protection and Affordable Care Act of 2010 all call for the development of data aggregation techniques that can be used to identify and reduce health disparities among vulnerable populations such as those with disabilities that limit activities. The main innovation o our data aggregation approach is to incorporate information about the type of activity limited as well as severity with the goal of improving on conventional aggregate measures which typically only capture severity.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG040105-03
Application #
8699622
Study Section
Nursing and Related Clinical Sciences Study Section (NRCS)
Program Officer
Patmios, Georgeanne E
Project Start
2012-08-01
Project End
2016-04-30
Budget Start
2014-08-15
Budget End
2015-04-30
Support Year
3
Fiscal Year
2014
Total Cost
$300,681
Indirect Cost
$107,212
Name
University of Pennsylvania
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Kurichi, Jibby E; Streim, Joel E; Xie, Dawei et al. (2016) The Association Between Activity Limitation Stages and Admission to Facilities Providing Long-term Care Among Older Medicare Beneficiaries. Am J Phys Med Rehabil :
Kurichi, Jibby E; Streim, Joel E; Bogner, Hillary R et al. (2016) Comparison of predictive value of activity limitation staging systems based on dichotomous versus trichotomous responses in the Medicare Current Beneficiary Survey. Disabil Health J 9:64-73
Stineman, Margaret G; Xie, Dawei; Pan, Qiang et al. (2016) Understanding non-performance reports for instrumental activity of daily living items in population analyses: a cross sectional study. BMC Geriatr 16:64
Ji, Xinyao; Small, Dylan S; Leonard, Charles E et al. (2016) The Trend-in-Trend Research Design for Causal Inference. Epidemiology :
Schüssler-Fiorenza Rose, Sophia Miryam; Xie, Dawei; Streim, Joel E et al. (2016) Identifying neuropsychiatric disorders in the Medicare Current Beneficiary Survey: the benefits of combining health survey and claims data. BMC Health Serv Res 16:537
Bogner, Hillary R; de Vries McClintock, Heather F; Hennessy, Sean et al. (2015) Patient Satisfaction and Perceived Quality of Care Among Older Adults According to Activity Limitation Stages. Arch Phys Med Rehabil 96:1810-9
Hennessy, Sean; Kurichi, Jibby E; Pan, Qiang et al. (2015) Disability Stage is an Independent Risk Factor for Mortality in Medicare Beneficiaries Aged 65 Years and Older. PM R 7:1215-25
Byrne, D D; Newcomb, C W; Carbonari, D M et al. (2015) Increased risk of hip fracture associated with dually treated HIV/hepatitis B virus coinfection. J Viral Hepat 22:936-47
Brown, Janice; Kurichi, Jibby E; Xie, Dawei et al. (2014) Instrumental activities of daily living staging as a possible clinical tool for falls risk assessment in physical medicine and rehabilitation. PM R 6:316-23; quiz 323
Stineman, Margaret G; Streim, Joel E; Pan, Qiang et al. (2014) Activity Limitation Stages empirically derived for Activities of Daily Living (ADL) and Instrumental ADL in the U.S. Adult community-dwelling Medicare population. PM R 6:976-87; quiz 987