Abstract
Purpose To identify functional dimensions related to changes in activities of daily living (ADL) and appropriate outcome measures for evaluating change in ADL of residents in a health care home for the elderly.
Subjects and methods The subjects were 123 residents living for three months or more in a health care home for the elderly in Osaka Prefecture. ADL on admission and three months these after were evaluated using four standardized outcome measures: ADL criteria for disabled elderly people developed by the Ministry of Health and Welfare (ADL criteria), the Barthel Index (BI), the Functional Independence Measure (FIM), and the Office of Population Censuses and Surveys (OPCS) scale. Responsivenese was also determined with the same four measures. The subjects were divided into two groups according to the frequency of functional training: twice or more and once or less per week. Appropriateness of the outcome measures was determined by examining score distributions and floor and ceiling effects, and by correlating changes in scores with frequency of functional training.
Results The floor effect of the FIM was the smallest among the four outcome measures. The average FIM score on admission was significantly higher than that three months these after (70.7±30.8 and 71.6±30.6, respectively P<.05). In terms of funcional dimensions of the BI, FIM and OPCS measures, the average FIM scores for transfer, walking, and stairs on admission were significantly higher than three months after admission (4.6±1.8 and 4.8±1.7 for transfer, 3.8±2.3 and 4.0±2.2 for walking, 3.0±2.1 and 3.2±2.1 for stairs, respectively, P<.05). Total FIM scores for the same three dimensions were the most responsive among the four outcome measures. Furthermore, when improvement in ADL was evaluated in terms of changes in total scores for the three FIM functional dimensions, those who received functional training twice or more per week showed a significantly higher rate of improvement in ADL than those who received functional training less frequently.
Conclusion FIM was found to be the most appropriate ADL measurement for evaluating changes in ADL of elderly residents. Regarding functional dimensions, locomotion in terms of transfer, walking and stairs was the most responsive. These findings indicate that the FIM functional dimension of locomotion is the most suitable for evaluating changes in ADL of elderly residents.
