Chest
Volume 127, Issue 3, March 2005, Pages 830-838
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Clinical Investigations: COPD
Construct Validity of Activities of Daily Living Scale: A Clue To Distinguish the Disabling Effects of COPD and Congestive Heart Failure

https://doi.org/10.1378/chest.127.3.830Get rights and content

Study objectives

To assess differences, if any, in the pattern of disability measured using basic activities of daily living (BADL) and instrumental activities of daily living (IADL) in COPD and congestive heart failure (CHF), using diabetes mellitus as a reference noncardiorespiratory disabling condition

Design

Multicenter survey

Setting

General medicine or geriatric wards in tertiary hospitals throughout Italy

Patients

Patients admitted because of CHF (n = 432), COPD (n = 305), and diabetes mellitus (n = 534)

Measurements and results

Construct validity of self-reported preadmission BADL-IADL was assessed for each group by main component analysis. The three populations had a comparable average degree of dependency in BADL-IADL. In both CHF and diabetes mellitus patients, three components cumulatively explained most of variance in BADL-IADL: the BADL, 10 IADL, and 4 housework-related IADL. In COPD, a four-factor solution was generated, with factor 4 having loading with IADL items assessing mobility and outdoor moving, and factor 3 with selected IADL requiring both physical and mental capabilities such as managing money, taking medicine, and traveling. Correlates of dependency in IADL related to factor 4 in COPD were older age, cognitive impairment, widowhood, and comorbidity. Both factors 3 and 4 were associated with longer stay (factor 3: 13.9 ± 9.5 days vs 11.5 ± 7.6 days, p < 0.05; factor 4: 14.2 ± 8.8 days vs 11.0 ± 5.5 days, p < 0.05) of COPD patients (mean ± SD)

Conclusion

COPD was associated with a distinctive pattern of disability expressed by loss of selected BADL-IADL but not by the crude number of lost BADL-IADL

Section snippets

Patients

The present study uses data from a large collaborative observational study group, the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA), based in community and university hospitals located throughout Italy, that periodically surveys drug consumption, occurrence of adverse drug reactions, and quality of hospital care. We used data on patients consecutively admitted to the 24 participating centers during the 4-month survey carried out in 1998. Methods of the GIFA have been previously

Results

Sociodemographic, neuropsychological, and clinical characteristics of CHF, COPD, and diabetes mellitus patients are reported in Table 1. CHF patients were characterized by older age and higher prevalence of widowhood than COPD and diabetes mellitus patients, whereas male gender prevailed in the COPD group. Admission to a geriatric ward was more frequent in both CHF and COPD groups. The cognitive status, as reflected by the mean AMT score, was fairly normal, whereas the mean GDS score was

Discussion

The main finding from this study is that BADL-IADL cluster in a very similar manner in two populations with different chronic conditions such as CHF and diabetes mellitus. A quite different hierarchy of IADL characterizes COPD, with a factor being expression of IADL related to outdoor mobility and another summarizing selected highly demanding IADL. These findings demonstrate that the crude computation of lost IADL may not be fully representative of the impact the loss has on personal

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    †The GIFA is a research group of the Italian Society of Gerontology and Geriatrics—Fondazione Italiana per la Ricerca sull'Invecchiamento

    The GIFA is partially supported by a grant from the Italian National Research Council (No. 94000402)

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