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. 2025 Oct 28;15(1):37646.
doi: 10.1038/s41598-025-21426-3.

Development and validation of a self-reported scale for difficulty in activities of daily living among older adults

Juan Carlos Briede-Westermeyer  1 , Cristhian Pérez-Villalobos  2 , José Luis Dinamarca-Montecinos  3 , Mary Jane Schilling-Norman  2 , Elizabeth N-B Sanders  4 , Marianela Luzardo-Briceño  5
Affiliations

Development and validation of a self-reported scale for difficulty in activities of daily living among older adults

Juan Carlos Briede-Westermeyer et al. Sci Rep. .

Abstract

Population aging demands tools that capture not only observed dependence but also perceived difficulty, an area where validated Spanish-language instruments remain scarce. To develop and psychometrically validate the Difficulty Scale for Activities of Daily Living (EDAAD), a self-administered, Spanish-language instrument that measures perceived difficulty across basic, instrumental, and advanced ADLs in community-dwelling older adults. We conducted a cross-sectional study in the Biobío Region (Chile) using multi-stage, stratified random sampling at the commune-block-household levels. Trained interviewers administered face-to-face surveys between October 2022 and February 2023. Independence was screened with the Chilean EFAM-A scale, including only participants scoring ≥ 43 points. The final sample comprised 201 independent older adults aged 60-99 years. Confirmatory factor analysis (CFA; WLSMV estimator) tested an 8-factor structure. Reliability was assessed with Cronbach's α and McDonald's ω. Known-groups validity examined associations between EDAAD scores and sociodemographic variables. CFA supported an 8-factor model with acceptable fit for key indices (CFI = 0.905; TLI = 0.891; RMSEA = 0.149; SRMR = 0.103). Internal consistency was excellent for the total scale (α = 0.954; ω = 0.962). Higher perceived difficulty was associated with female gender, older age, lower education, and lower income. Among domains, technology use (M = 3.71) and hobbies (M = 3.43) were the most difficult; personal care (M = 1.96) and mobility (M = 2.70) were the least difficult. EDAAD is, to our knowledge, one of the first self-administered, Spanish-language instruments validated in a Latin American community sample that focuses on perceived difficulty across ADLs. It complements performance-based and dependence measures, enables classification of activities by difficulty level, and can inform user-centered and inclusive interventions to support healthy aging.

Keywords: Activities of daily living (ADL); Chile; Co-design; Older adults; Perceived difficulty; Psychometrics; Spanish-language scale; User-centered design.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The study was approved by Institutional Ethics Committee (Ethics Report No.: 263/2020). All methods were carried out following relevant guidelines and regulations. Informed consent was obtained from all the participants.

Figures

Fig. 1
Fig. 1
Confirmatory factorial structure for the Scale of difficulty assigned to activities of daily living for older adults (model B). Circles: Latent variables; Squares: Observed variables; Numbers next to squares: Standardized estimated coefficient (Standard error); Numbers next to curve line: Correlated error (Standard error).
Fig. 2
Fig. 2
Activities considered in the study. Source: Preparation by the authors.
Fig. 3
Fig. 3
Sociodemographic variables, degree of difficulty, and relationship with the variables considered in the study.
Fig. 4
Fig. 4
Intervention strategy based on a codesign approach. Source: Preparation by the authors.
See this image and copyright information in PMC

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