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The Development of a Hierarchical Polychotomous ADL-IADL Scale for Noninstitutionalized Elders
Abstract
A hierarchical scale comprising 18 activities of daily living (ADL) and instrumental activities of daily living (IADL) items was tested on a sample of 101 noninstitutionalized people of 60 years and older in a northern part of the Netherlands. Three possible answers per item were used. The results confirmed the possibility of constructing a unidimensional, hierarchical, polychotomous scale for older people, measuring "functional problems on ADL-IADL." Moreover, the possibility of using two separate subscales (for ADL and IADL) was observed.
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“The study was registered in the ClinicalTrials.gov repository (ID NCT02499653), and the details of the protocol were previously published (44).”
From Promoting Acceptance and Adherence to Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. (2022) · cites this paper as [44]
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“Functional impairments were measured with the 18-item Groningen Activity Restrictions Scale (Kempen & Suurmeijer, 1990; Cronbach alpha in this study = .94).”
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“The GARS meets the stochastic cumulative scalability criteria of the Mokken model (Kempen, Miedema, Ormel, & Molenaar, 1996; Kempen & Suurmeijer, 1990) and has proven its effectiveness for measuring levels of disability in international, comparative, and longitudinal studies, both across countries…”
MethodSelf-citationA HOME-BASED MULTIDIMENSIONAL EXERCISE PROGRAM REDUCED PHYSICAL IMPAIRMENT AND FEAR OF FALLING
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“Neuroticism as emotional instability has been shown to be associated with less adaptive coping styles and thus related to experiencing more psychological distress (Suurmeijer et al. 2005).”
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“7 taken to indicate a reliable scale [24].”
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Knurowski, T., Lazić, D., van Dijk, J. P., Gecková, A. M., Tobiasz‐Adamczyk, B., & van den Heuvel, W. J. (2004) · PubMed · Cited by 28
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“To test the validity of the use of retrospective recall measures in this study, test–retest reliability was calculated among a subsample of individuals (n 24) who completed the GARS (Kempen & Suurmeijer, 1990) ADL measure both prior to, and 6 weeks following, amputation.”
MethodInfluentialWang, C.-Y., Sheu, C., & Protas, E. (2007) · Journal of Aging and Physical Activity · doi:10.1123/japa.15.1.75 · Cited by 27
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“Moreover, the Fatigue Severity Scale was used to assess fatigue (46); activities of daily living and instrumental activities of daily living were used to assess basic self-care tasks (47).”
MethodFieo, R. A., Watson, R. A., Deary, I. J., & Starr, J. M. (2009) · Gerontology · doi:10.1159/000271603 · Cited by 26
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“Mystakidou & Tsilika (12), Spector & Fleischman (36), and Kempen & Surrmeijer (45) reported one factor, while Cumming et al. (46) and Fitzgerlad et al. (47) have reported three factors.”
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MethodPositive aging: At the crossroads of positive psychology and geriatric medicine.
Hill, R. D., & Smith, D. J. (2015) · American Psychological Association eBooks · doi:10.1037/14458-013 · Cited by 22
Are IADLs comparable across countries? Sociodemographic associates of harmonized IADL measures
the CLESA Working Group, Nikula, S., Jylhä, M. K., Bardage, C., Deeg, D. J. H., Gindin, J., Minicuci, N., Pluijm, S. M. F., & Rodríguez‐Laso, Á. (2003) · Aging Clinical and Experimental Research · doi:10.1007/bf03327367 · Cited by 24
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Improving the Retirement Prospects of Lower-Wage Workers in a Defined-Contribution World
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“…Liu, Spritzer, & Cella, 2007; Heinemann, Linacre, Wright, Hamilton, & Granger, 1993; Jenkinson, Fitzpatrick, Garratt, Peto, & Stewart-Brown, 2001; Kempen & Suurmeijer, 1990; Linacre, Heinemann, Wright, Granger, & Hamilton, 1994; McHorney, 2002; McHorney, Haley, & Ware, 1997; Raczek et al., 1998;…”
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“However, most studies have included a limited number of tasks (usually 10),[11,13– 16,18] with the most comprehensive study including 18 tasks.[19] Further, nearly all research in this area has focused on populations over the age of 75, by which time a significant proportion of the population have already developed di…”
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“In contrast, IADL refers to activities supporting daily life within the home and community and are more concerned with self-reliant functioning in a given environment and often require more complex interactions (5).”
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Four-Year Lower Extremity Disability Trajectories Among African American Men and Women
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“[37, 38] Quality of life: as measured by the EQ-5D-3L questionnaire.”
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“Results of previous studies show that GARS meets the stochastic cumulative scalability criteria of the Mokken Model (Kempen et al., 1996; Kempen and Suurmeijer, 1990).”
BackgroundSelf-citationReliabilität der deutschen Kurz-Version des „Late Life Function and Disability Instrument“
Denkinger, M. D., Nikolaus, T., Weyerhäuser, K., & Coll‐Planas, L. (2008) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-008-0550-y · Cited by 18
“Bis dato wurde klassischerweise unter dem Begriff „Disability“ eine Beeinträchtigung im Bereich der Aktivitäten des täglichen Lebens (ADLs), häufig unterteilt in basale und instrumentelle ADLs (BADLs und IADLs), verstanden [14, 15, 23].”
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“Eating and bladder continence are the last ADLs to decline, while bathing and mobility are among the first to decline (Katz et al., 1963; Kempen and Suurmeijer, 1990).”
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“Because no one scale was found, a SEARCH-procedure was performed. With this procedure two scales were found. One item (No. 17, Physical Pain) did not: belong to either scale. The first scale contained the items from the subscales ~ e a l t h Perceptions and Social Functioning (H-coefficient = .49). The second scale co…”
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“Most theorists agree that a Rho more than .80 is desirable, and a Rho more than .70 is a minimum requirement (Kempen & Suurmeijer, 1990).”
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Activities of daily living in Greek cancer patients treated in a palliative care unit
Mystakidou, K., Tsilika, E., Parpa, E., Mitropoulou, E., Panagiotou, I. E., Galanos, A., & Gouliamos, A. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1497-5 · Cited by 14
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Lemij, A. A., de Glas, N. A., Derks, M. G. M., Linthorst-Niers, E., Guicherit, O. R., van der Pol, C. C., Lans, T. E., van Dalen, T., Vulink, A. J. E., Merkus, J. W. S., et al. (2023) · European Journal of Cancer · doi:10.1016/j.ejca.2023.04.001 · Cited by 15
“…on nutritional status (using the Malnutrition Universal Screening Tool (MUST)) [17], cognition (using the Mini-Mental State Examination (MMSE)) [18], functional status (using the Groningen Activity Restriction Scale (GARS)) [19], and mobility (using the Timed Up and Go test (TUG)) [20].”
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Depression and Anxiety in Persons with Parkinson's Disease With and Without “On–Off” Phenomena
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“ADL-related disabilities affect an individual’s direct self-care, including bathing, dressing, eating, walking across a room, getting in/out of bed, and using a toilet independently [20, 21].”
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Can We Live Longer, Healthier Lives?
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A New Direction for Intervention with Depressed Caregivers to Alzheimer's Patients
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Was it worth it? Benefits of transcatheter aortic valve implantation from a patient's perspective
Beishuizen, S. J. E., Festen, S., van der Werf, H. W., de Graeff, P., & Munster, B. C. V. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17216 · Cited by 10
“These categories can be recoded into a dichotomous outcome: independent (levels 1– 3) or dependent (level 4), which is how it was used in this analysis (thus namedGARS-2).(12) During the rest of the study period the 15-item modified Katz Index of Activities of Daily Living (Katz-15) was used.”
MethodAction identification and meaning in life in chronic pain
Richardson, H., & Morley, S. (2015) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2015.04.024 · Cited by 10
Han, Y., Xue, J., Pei, W., & Fang, Y. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02460-y · Cited by 9
“It has been found that ADL are hierarchical in nature [9, 12].”
BackgroundVoshaar, M. A. H. O., ten Klooster, P. M., Vonkeman, H. E., & van de Laar, M. A. F. J. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1627-0 · Cited by 9
Gastrointestinal motility has more of an impact on postoperative recovery than you might expect
Viannay, P., Hamel, J. F., Bougard, M., Barbieux, J., Hamy, A., & Venara, A. (2020) · Journal of Visceral Surgery · doi:10.1016/j.jviscsurg.2020.06.012 · Cited by 9
Health status of independently living older adults in Romania
Ghinescu, M. C., Olăroiu, M., van Dijk, J. P., Olteanu, T., & van den Heuvel, W. J. (2013) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.12199 · Cited by 9
McGrory, S., Austin, E. J., Shenkin, S. D., Starr, J. M., & Deary, I. J. (2015) · Psychological Assessment · doi:10.1037/pas0000091 · Cited by 9
“Hierarchical tests have proven valuable in the assessment of several constructs, for example, psychological distress (Watson, Deary, & Shipley, 2008), feeding difficulty in dementia (Watson, 1996), and activities of daily living (Fieo, Watson, Deary, & Starr, 2010; Kempen & Suurmeijer, 1990).”
Backgroundvan Deudekom, F. J., Kallenberg, M. H., Berkhout-Byrne, N. C., Blauw, G. J., Boom, H., de Bresser, J., van Buchem, M. A., Gaasbeek, A., Hammer, S., Lagró, J., et al. (2020) · BMC Nephrology · doi:10.1186/s12882-020-01764-2 · Cited by 9
Wengreen, H. J., Nelson, C., Munger, R. G., & Corcoran, C. (2010) · The journal of nutrition health & aging · doi:10.1007/s12603-010-0303-7 · Cited by 8
“Information on the degree of help needed for intermediate activities of daily living (IADL) that included shopping and preparing meals was collected and used to create a IADL score (range: 0-9) (30).”
MethodDEVELOPMENT OF ADL INDEX FOR OLDER COMMUNITY PEOPLE
Demura, S., SATO, S., Minami, M., Kobayashi, H., NODA, Y., Matsuzawa, J., Kobayashi, K., & AOKI, J. (2000) · 体力科學 · doi:10.7600/jspfsm1949.49.375 · Cited by 8
Shafizadeh, M., Sharifnezhad, A., & Wheat, J. S. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04216-4 · Cited by 8
Beishuizen, S. J. E., Festen, S., Loonstra, Y. E., van der Werf, H. W., de Rooij, S. E., & Munster, B. C. V. (2020) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14064 · Cited by 8
Molecular and biochemical analyses of iodopsin in rd chick retina.
Semple‐Rowland, S. L., & GREEN, D. A. (1994) · PubMed · Cited by 8
Physical Health and Long-Term Care
Stull, D. E., KERCHER, K., & Kosloski, K. (1996) · American Behavioral Scientist · doi:10.1177/0002764296039003008 · Cited by 7
Mack, J. L., & Patterson, M. B. (2006) · The Clinical Neuropsychologist · doi:10.1080/13854040590967081 · Cited by 7
Harawa, N. T., Morgenstern, H., Beck, J. C., & Moore, A. A. (2001) · Aging Clinical and Experimental Research · doi:10.1007/bf03351531 · Cited by 7
Identifying Prosthetic Capabilities That Define Functionality of Individuals With Amputation
Bell, E. M., Carrignan, J., Collier, D. K., Yang, J. S., & Shim, J. K. (2021) · JPO Journal of Prosthetics and Orthotics · doi:10.1097/jpo.0000000000000356 · Cited by 6
Zervou, Z., Plooij, R., van Velsen, E. F. S., Timmermans, R. G. M., Demirdas, S., & Zillikens, M. C. (2024) · European Journal of Medical Genetics · doi:10.1016/j.ejmg.2024.104915 · Cited by 5
Assessment of an Expanded Functional Disability Scale for Older Adults With Diabetes
Ng, X., Quinn, C. C., Burcu, M., & Harrington, D. (2014) · Journal of Applied Gerontology · doi:10.1177/0733464814563607 · Cited by 5
“Finally, literature has also shown the possibility of a hierarchical relationship between ADL and IADL (Kempen & Suurmeijer, 1990; LaPlante, 2010; Spector et al., 1987), which might necessitate the use of scaling techniques to verify whether a hierarchical, combined scale applies within our study…”
BackgroundMethodResultInfluential
Metadata
- Authors
- Kempen, G. I. J. M., & Suurmeijer, T. P. B. M.
- Affiliations
- University of Groningen (NL)
- ORCID
- Kempen, G. I. J. M.
- Venue
- The Gerontologist
- Publisher
- Oxford University Press (OUP)
- Published
- 1990-08-01
- Volume
- 30
- Issue
- 4
- Pages
- 497-502
- ISSN
- 0016-9013 (ISSN-L)
- 1758-5341
- OpenAlex
- W2116669982
- Cited by
- 285
- References
- 16
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 11 · 2021: 11 · 2020: 12 · 2019: 35 · 2018: 5 · 2017: 11 · 2016: 8 · 2015: 9 · 2014: 5 · 2013: 9 · 2012: 5
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Gerontologist (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- activities of daily living, instrumental activities of daily living, functional assessment, hierarchical scales, older adults, non-institutionalized elderly, scale development, functional difficulties
- MeSH terms
- Activities of Daily Living, Aged, Community Health Services, Disability Evaluation, Home Care Services, Humans, Netherlands, Geriatric Assessment
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