Introduction:

The "activities of daily living" or ADLs are the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring (i.e., getting in and out of a bed or chair). When people are unable to perform these activities, they need help in order to cope, either from other human beings or mechanical devices or both. Problems performing the activities of daily living cut across diagnoses, but are especially prevalent among persons with arthritis, osteoporosis and stroke. Although persons of all ages may have problems performing the ADLs, prevalence rates are much higher for the elderly than for the nonelderly.1 Within the elderly population, disability rates rise steeply with advancing age and are especially high for persons aged 85 and over.

Measurement of the activities of daily living is critical because the have been found to be significant predictors of admission to a nursing home,2 use of home care,3 use of hospital services,4 living arrangements,5 overall Medicare expenditures,6 insurance coverage,7 and mortality.8 For research on the elderly, the ability to perform the ADLs has become a standard variable to include in analyses, like age, sex, marital status and income.

Estimates of the number and characteristics of people with problems performing ADLs are also important because of the increasing number of private long-term care insurance policies and proposed public long-term care insurance programs that rely on ADL dependency measures to determine whether an individual qualifies for benefits. For example, private insurance policies sold by John Hancock, Aetna, Travelers, Metropolitan Life and CNA rely on ADL measures as triggers for benefits.9 All of the developed public insurance plans, including those proposed by Senators Mitchell and Kennedy and by Representatives Waxman, Stark and Pepper, do the same. Obviously, the amount of long-term care benefits paid out by such private and public plans will largely depend on the number of persons who meet the various ADL eligibility criteria.