Original article
Life-Space Assessment and Physical Activity Scale for the Elderly: Validity of Proxy Informant Responses

https://doi.org/10.1016/j.apmr.2014.03.027Get rights and content

Abstract

Objective

To validate the administration of the Life-Space Assessment (LSA) and Physical Activity Scale for the Elderly (PASE) surveys to proxy informants, as would be necessary when measuring long-term outcomes in acutely ill, hospitalized older adults who are initially incapacitated but eventually return to the community.

Design

Cross-sectional study.

Setting

General community.

Participants

Convenience sample of dyads (N=40) composed of an ambulatory older adult and a familiar companion.

Interventions

Dyads completed the LSA and PASE surveys on 1 occasion. Companions based their responses on the recent mobility and physical activity of the older adult.

Main Outcome Measures

Paired total scores for each instrument.

Results

At a group level, the difference between older adult and companion mean scores for each instrument was not significant (P>.05). Standardized mean difference values were small (d<0.1). Paired scores were significantly yet moderately associated: intraclass correlation coefficient(1,1)=.84 to .88; P<.01. Difference in scores was not associated with time spent together (P>.05) or older adult gait speed (P>.05). At an individual level, older adults and companions agreed more closely on the LSA than on the PASE. However, disagreement in excess of estimated measurement error occurred in 40% of the dyads for the LSA and in none of the dyads for the PASE.

Conclusions

Older adults and companions collectively provided similar responses on each instrument. Nonetheless, varying levels of agreement within individual dyads suggested that proxy responses should be considered carefully. Implications for clinical research and practice research are discussed.

Section snippets

Design and participants

The study used a cross-sectional design in which dyads formed by a community-dwelling older adult and his or her close companion were recruited as a sample of convenience. Older adult participants were aged at least 60 years and identified their companion as “someone who they have spent at least 7 hours per week with during the last month.” Study candidates were recruited by advertisement and word of mouth. In promoting the study (eg, at local retirement communities), every effort was made to

Results

Forty-five dyads were screened initially. None were rejected because of language, cognitive, or physical limitations. Four dyads were unable to participate in data collection because of scheduling conflicts. Data from 1 dyad were incomplete and therefore not included in the analysis.

The final sample contained 22 women and 18 older men (mean age ± SD, 80.7±7.5y). Mean gait speed ± SD was 0.82±0.26m/s. Companions included 33 women and 7 men (mean age ± SD, 69.2±14.4y). Two companions did not

Agreement

Consistent with previous studies of proxy agreement on measures of physical function,6, 7, 8, 9 our hypothesis that older adults and their familiar companions would provide similar responses on each survey was generally supported. At a group level, there was no statistical difference for either instrument between mean older adult and mean companion scores, their standardized mean difference was very small,17 and older adult scores were strongly and significantly associated with companion

Conclusions

Older adults and their familiar companions collectively provided similar responses on the LSA and PASE instruments. Nonetheless, agreement within individual older adult-companion dyads varied enough to warrant recommendations for thoughtful consideration of each instrument in the collection of proxy responses. Both instruments show promise for collecting community-level clinical outcomes in circumstances when an acutely ill, hospitalized older adult is unable to provide information about his or

Suppliers

  • a.

    New England Research Institute, 9 Galen St, Watertown, MA 02472.

  • b.

    SPSS, Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

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    Sponsored by the Department of Physical Therapy of the University of New England, Portland, ME.

    Disclosures: None.

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