Assessment of dependence in daily activities combined with a self-rating of difficulty.

OBJECTIVE: To study the information gained by extending a well-established instrument of dependence/independence in activities of daily living with a self-rating of difficulty, and to illustrate the relevance and usefulness of this combined approach with cross-national data. DESIGN AND SUBJECTS: Cross-sectional survey study data collected with 1918 very old persons in 5 European countries. METHODS: The "ADL staircase assessment" of dependence/independence, extended with a self-rating of difficulty, was administered at home visits. Data distribution in the 5 national samples and analyses with or without use of the self-rating data were carried out. RESULTS: High proportions of the subjects were independent in most of the activities assessed, while substantial proportions reported difficulties. Considerable differences were identified among the national samples. In personal activities of daily living, those assessed as independent varied from 87% to 100%, while the proportion of those who rated themselves as "independent without difficulty" ranged from 53% to 98%. In instrumental activities, 33-91% were assessed as independent, while the proportions of "independent without difficulty" ranged from 24% to 77%. Analysis results differed as to whether or not self-ratings of difficulty were used. CONCLUSION: The combined approach to data collection gave a diversified, information-rich picture. The assessment used is easy to administer and can be used in practice contexts in different countries.