Development and psychometric properties of the instrumental activities of daily living: compensation scale

Abstract

The Instrumental Activities of Daily Living - Compensation (IADL-C) scale was developed to capture early functional difficulties and to quantify compensatory strategy use that may mitigate functional decline in the aging population. The IADL-C was validated in a sample of cognitively healthy older adults (N=184) and individuals with mild cognitive impairment (MCI; N=92) and dementia (N=24). Factor analysis and Rasch item analysis led to the 27-item IADL-C informant questionnaire with four functional domain subscales (money and self-management, home daily living, travel and event memory, and social skills). The subscales demonstrated good internal consistency (Rasch reliability 0.80 to 0.93) and test-retest reliability (Spearman coefficients 0.70 to 0.91). The IADL-C total score and subscales showed convergent validity with other IADL measures, discriminant validity with psychosocial measures, and the ability to discriminate between diagnostic groups. The money and self management subscale showed notable difficulties for individuals with MCI, whereas difficulties with home daily living became more prominent for dementia participants. Compensatory strategy use increased in the MCI group and decreased in the dementia group.

Keywords: Aging; Compensatory strategies; Everyday functioning; Functional status; Mild cognitive impairment; Rasch analysis.

Fig. 1.

Box and Whisker plots of the Instrumental Activities of Daily Living-Compensation (IADL-C) total and subscale scores for the healthy older adult (OAs), mild cognitive impairment (MCI), and dementia groups.

Fig. 2.

Box and Whisker plots of the IADL-C total and subscale scores for the middle-aged (50–59), young-old (60–74), and old-old (75+) groups.