@article {10933, title = {A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults.}, journal = {Medical Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {534-9}, abstract = {

BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs.

OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data.

METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model.

RESULTS: At 2-year follow-up, 8.0\% and 7.3\% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness.

CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Body Mass Index, Chronic disease, Female, Humans, Male, Mobility Limitation, Models, Statistical, Risk Assessment, Sex Factors}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a50c}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} }