Observational sssessment of independent living skills

J.C. Rogers and M.B. Holm

Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA

Observational performance-based assessment of daily living activities is an integral component of rehabilitation because it yields information about clients’ activity abilities and disabilities as well as interventions to facilitate improvement. Standardized instruments, such as the Functional Independent Measure, are available for measuring functional mobility and personal care activities. In contrast, the complexity of home management activities, such as managing medications and preparing meals, has retarded the development of observational measures for independent living skills. The Performance Assessment of Self-Care Skills (PASS) was developed to fill this void and will be described in this presentation. The PASS is a criterion-referenced, performance-based observational tool that consists of 26 primary items, categorized in 4 domains: functional mobility (FM: 5 items); personal care (PC: 3 items); and, 18 instrumental activities of daily living (IADL) – physical IADL (P-IADL: 4 items), and cognitive IADL (C-IADL: 14 items). Content validity is based on interview and questionnaire items commonly used in geriatric practice. For rating, each PASS item is broken down into its component activities and the rating is based on the performance observed for the component activities. Medication management, for example, consists of 6 components – reports time for taking one medication, opens (child proof cap) pill container, distributes pills for 2 days, reports time for second medication, opens (non-child proof cap) pill container, distributes pills for 2 days. Each PASS item is rated for three separate measurement parameters – independence, safety, and adequacy of activity performance. Interobserver reliability, calculated from percent agreement, was acceptable to excellent – for overall independence 96% (3.410/3.564 observations), safety, 96% (360/382 observations), and adequacy, 88% (525/596 observations). Group comparisons indicate that the PASS functions as anticipated with non-disabled older participants scoring higher than those with disabilities and participants with depression scoring higher than those with macular degeneration or early dementia.

Paper presented at Measuring Behavior 2005 , 5^th International Conference on Methods and Techniques in Behavioral Research, 30 August - 2 September 2005, Wageningen, The Netherlands.

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