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LETTER TO THE EDITOR
Year : 2014  |  Volume : 58  |  Issue : 4  |  Page : 285-286  

Functional disability among elderly persons in a rural area: Do we have the right assessment tool?


Associate Professor, Department of Community Medicine, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Web Publication5-Dec-2014

Correspondence Address:
Lalitha Krishnappa
Department of Community Medicine, M.S. Ramaiah Medical College, MSR Nagar, MSRIT Post, Bengaluru - 560 054, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.146301

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How to cite this article:
Krishnappa L. Functional disability among elderly persons in a rural area: Do we have the right assessment tool? . Indian J Public Health 2014;58:285-6

How to cite this URL:
Krishnappa L. Functional disability among elderly persons in a rural area: Do we have the right assessment tool? . Indian J Public Health [serial online] 2014 [cited 2020 Sep 27];58:285-6. Available from: http://www.ijph.in/text.asp?2014/58/4/285/146301

Sir,

With reference to the original article on "Functional disability among elderly persons in a rural area of Haryana" by Gupta et al., I appreciate the author on highlighting the burden of the functional disability among elderly in rural area which emphasize the need for community-based actions. I would also like to reflect upon the method of assessment for functional disability. [1] There are various tools to assess the functional status in elderly in a community setting. The authors here have used one such tool - Barthel questionnaire to assess the activities of daily living (ADL). Though Barthel Index (BI) has been recommended for the functional assessment of older, there are uncertainties regarding its reliability for use in elderly age group. [2]

The Katz ADL and BIs are the two most widely used tools for assessing ability to perform ADL in geriatric. These indices assign and aggregate the scores to self-reported degrees of difficulty in performing a number of activities, such as feeding, dressing, moving, and bathing. However, both these indices have been criticized for the way the reported difficulties are aggregated and for not taking account of potential measurement errors in self-reported difficulties. [3] However, the Katz Index is easy to use and adaptable to most clinical settings as well as for use in community settings. Katz Index is most effectively used among older adults in a variety of care settings, when baseline measurements, taken when the client is well, are compared to periodic or subsequent measures. [4],[5] The Katz Index of ADL is very widely used, in a wide variety of populations and is sensitive to environment; that is, different scores may be obtained for individuals in different settings or with different environmental modifications. [6]

The authors in this article have not mentioned about the cognitive impairment of the elderly. There was evidence that the BI might be less reliable in patients with cognitive impairment and when scores obtained by interview. [2]

Hence, there is a varied view and opinion regarding the use of the appropriate tool to assess the functional disability. Based on various review of literature and studies conducted, I feel that Katz Index is better tool to assess functional ability in a community setting whereas BI better to assess the functional status of elderly patients in a hospital set up and evaluate the progress of the elderly. But, there are very few studies done to compare the Katz Index versus the BI in the community setting especially in India. There is a strong need to validate and study the appropriateness of the tool to assess the functional status of elderly in a community setting.

Further, the authors could have considered on the assessment of instrumental ADL in the elderly that will add to the comprehensive assessment of the functional status of the elderly.


   Acknowledgment Top


I thank HOD and Staff, Department of Community Medicine, MSRMC, Bangalore.

 
   References Top

1.
Gupta P, Mani K, Rai SK, Nongkynrih B, Gupta SK. Functional disability among elderly persons in a rural area of Haryana. Indian J Public Health 2014;58:11-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Sainsbury A, Seebass G, Bansal A, Young JB. Reliability of the Barthel Index when used with older people. Age Ageing 2005;34:228-32.  Back to cited text no. 2
    
3.
Hartigan I. A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. Int J Older People Nurs 2007;2:204-12.  Back to cited text no. 3
[PUBMED]    
4.
4. Shelkey M, Wallace M. Katz index of independence in activity of daily living (ADL). 2012. Available at: http://www.consultgerirn.com/uploads/File/trythis/try_this_2.pdf. [Accessed on 2014 Nov 3].  Back to cited text no. 4
    
5.
Wallace M, Shelkey M. Monitoring functional status in hospitalized older adults. Am J Nurs 2008;108:64-71.  Back to cited text no. 5
    
6.
Kates PP. Measures of adult general functional status. Arthritis Rheum 2003;49 Suppl 5:S15-27.  Back to cited text no. 6
    




 

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