This application responds to PA-01-037, research objective #22: Improved Measures and Methodologies. The activities of daily living and instrumental activities of daily living have been the foundation of geriatric assessment for four decades. A wide variety of assessment protocols have been developed during that time. However, almost no empirical research has been conducted on the meaning of these items to older persons. What references do individuals use when responding to questions about ability to function in these domains? How does race, diagnosis, or physical impairment influence the individual's subjective assessment of ability? These questions will be pursued during a 12-month exploratory study in an assisted living facility with a largely African American population. Data collection methods include observation of resident assessments followed by think aloud exercises with each resident. In-depth resident interviews will be conducted with a sub-sample selected by impairment level (low, moderate and high) as identified by the formal assessment. Research outcomes will include a set of domains that individuals use when responding to questions about functional ability. Comparisons between the professional and personal assessment will be made. In addition, perspectives on functional ability based on race and gender will be identified. This research in assisted living facilities will set the stage for additional study of geriatric assessment in other long-term settings and with additional racial and ethnic minorities. Future research would compare health and service outcomes to the functional status domains identified through this qualitative study.
