Lifestyle-adjusted function: Variation beyond BADL and IADL competencies

Purpose: Using the Activity Card Sort (ACS), we derived a measure of lifestyle-adjusted function and examined the distribution of this measure and its correlates in a community sample of older adults at risk for disability transitions. Design and Methods: Participants in the Sources of Independence in the Elderly project (n = 375) completed the ACS using a Q-sort (successive pile sort procedure), in which respondents sorted 39 nonbasic activities of daily living (non-BADL) and noninstrumental activities of daily living (non-IADL) tasks into four categories: "never performed," "used to but no longer perform," "hard to do," and "easy to do." Lifestyle-adjusted function was defined as the number reported easy/(number easy + number hard + number no longer performed). Results: Respondents reported that they found it easy to perform about 60% of the activities they ever performed. However, people reporting BADL and IADL disability found it easy to perform only 32% of these activities. Lower extremity performance and depressive symptoms were significant independent correlates of lifestyle-adjusted function in models that controlled for sociodemographic and clinical status. The same 2 correlates were significant in models that excluded people with self-reported BADL or IADL disability. Implications: Because this measure eliminates activities never performed, it can be considered "lifestyle adjusted." Its ability to identify differences in competency among people who do not report BADL or IADL disability suggests that it may be a useful addition to functional assessment.