Work

Response to Gary Esses and Stacie Deiner

Year: 2015

Type: letter

Abstract: To the Editor: We thank Esses and Deiner for their letter that addresses three main topics: the novelty of cognitive instrumental activities of daily living (C-IADLs) for discriminating between older adults with mild cognitive impairments (MCI) and those with normal cognition, the potential benefits of measures of observed performance of daily activities, and the assessment of observed performance in a short amount of time.1 We did not intend to imply that we were the first to show an association between C-IADL performance and cognitive status.2 As Esses and Deiner note, we cited several published articles that address the association between C-IADL performance and cognitive status.3-6 We thank Esses and Deiner for providing additional support for the association through the work by Pedrosa et al.7 Nonetheless, how C-IADL performance is measured may matter. We focused on observed performance.8 There are many benefits to using observed performance of daily activities. We can measure nuanced variability in performance and therefore detect even small changes over time. Validated measures of observed performance detect systematic errors in performance before such errors accumulate to the point of disability. Thus, if the goal is to make specific and well-grounded suggestions for improving performance, observation would be preferable. As Esses and Deiner suggest, the contextual environment influences observed performance. Additionally, observed performance does not measure frequency or perceived limitation in performance, which are better assessed with proxy or self-report measures. These are distinct dimensions of performance, and they do not always yield the same results. As Esses and Deiner note, proxy and self-report measures have limitations, too, including recall bias. Observed performance need not take extensive time. Trained raters may observe C-IADLs using standardized tools such as the Performance Assessment of Self-Care Skills (PASS),2, 9 which offers standardized shopping and checkbook balancing tasks that can be completed and rated using established criteria in 10–15 minutes.8 Observed performance differs from measures based on written scenarios, such as the Everyday Problems Test, that ask older adults how they understand, interpret, or solve problems based on the written information.10 Our study showed that observed performance using the PASS, administered in a short amount of time, discriminated between older adults with normal cognition and those with MCI.8 Dialogue about measurement of daily activities is critical, especially related to how and what we choose to measure. We thank Esses and Deiner for raising these issues and agree that we need to operationalize diagnostic criteria for performance of daily activities. Conflict of Interest: Funding was received from National Institutes of Health (NIH) Grants P30 MH090333 (Reynolds, Dew, Butters, Skidmore), R01 MH043823 (Reynolds, Dew, Rogers, Holm, Butters, Lopez), R01 MH072947 (Butters), and T32 MH019986 (Reynolds, Rodakowski), P50 AG05133 (Butters, Lopez); Clinical and Translational Science Institute Grants UL1RR024153 and UL1TR000005 (Reynolds); and University of Pittsburgh Medical Center Endowed Chair in Geriatric Psychiatry (Reynolds). Dr. Skidmore reports receiving grants from the NIH (R01 HD074693, R03 HD073770), National Institute on Disability and Rehabilitation Research, SanBio, UPMC Rehabilitation Institute, and University of Pittsburgh Office of Research and serving as a consultant for Boston University, RTI International, and MediPAC. Dr. Reynolds reports receiving pharmaceutical support for NIH-sponsored research studies from Bristol-Myers Squibb, Forest, Pfizer, and Lilly; receiving grants from the National Institute of Mental Health, National Institute on Aging, National Center for Minority Health Disparities, National Heart Lung and Blood Institute, Centers for Medicare and Medicaid Services, Patient Centered Outcomes Research Institute, the Commonwealth of Pennsylvania, the John A Hartford Foundation, National Palliative Care Research Center, Clinical and Translational Science Institute, and American Foundation for Suicide Prevention; and serving on the American Association for Geriatric Psychiatry editorial review board. He is the co-inventor (Licensed Intellectual Property) of Psychometric analysis of the Pittsburgh Sleep Quality Index PRO10050447 (PI: Buysse). Dr. Butters reports receiving grants from the National Institute of Mental Health (R01 MH072947, MH080240) and remuneration for interpreting neuropsychological evaluations as a consultant to GlaxoSmithKline. Dr Lopez served as a consultant for Lilly, Baxter, and Grifols. Dr. Rogers reports receiving funding from the National Institute of Nursing Research (NR010904), National Center for Medical and Rehabilitation Research (HD055931), and National Institute of Disability and Rehabilitation Research (H133B090024; H133A080053) and speaker's fees from the Association of Arthritis Health Professionals and has stock in Bristol Myers Squibb. Author Contributions: All authors contributed to concept and design, analysis and interpretation of data, and manuscript preparation. Sponsor's Role: None.

Source: Journal of the American Geriatrics Society

DOI: 10.1111/jgs.13312