Research attempting to promote healthy aging in Mexican Americans may wish to target individuals who are still independent in Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) but at high risk for incident disability. We believe that there is an identifiable group of individuals who have measurable decrements in function, but do not perceive themselves to be disabled. These persons maintain independence by invoking functionally adaptive strategies (changing the manner or the frequency of task performance). As their functionally decrements have not yet produced frank disability, we have labeled these persons subclinically disabled (SCD). We will utilize a well established, population-based aging cohort of Mexican Americans in San Antonio to develop and validate an instrument which detects and quantifies subclinical disability by assessing adaptive strategies (the ADAPT) used to maintain independence in BADLs or IADLs. Initial instrument development phases, including construct identification, item selection and item scaling will use qualitative research techniques. 24 subjects and 24 subject-selected family members will be interviewed in depth regarding use of adaptive strategies in performing BADLs and IADLs. Content analysis of these data will be performed to develop a typology of adaptive strategies and to select ADAPT items. The final ADAPT will also include questions which ascertain the: value of maintaining independence in BADLs or IADLs; and perceived self-efficacy for utilizing various types of adaptive strategies to maintain independence. After pretest, the questionnaire will be administered to 200 elderly MAs from SALSA. Validation of the questionnaire will use SALSA measures of health status, affective function, social function, cognitive function, self-report and performance-based measures of physical function, and medical comorbidity. Test-retest and inter-rater reliability will be determined. Exploratory analyses will be conducted to discover common patterns of BADLs or IADLs in which SCD is present. Information gained by the proposed work will not only expand the range of functional status measurement but will provide information necessary for researchers to develop directed, acceptable, and potentially successful interventions to promote independence in elderly MAs: This information will include identification of successful strategies in use by MAs and common patterns of tasks in which SCD is present. We will also explore which activities are the most highly valued and establish acceptability of and self efficacy for a range of potential adaptive interventions.
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