OBJECTIVES-To assess the predictive value of five performance-based measures for the onset of difficulty in basic activities of daily living (ADL).DESIGN-A prospective cohort study; home visits every 6 months for 18 months. SETTING-Community-basedPARTICIPANTS-Community-dwelling older adults, n=110, (mean age, 80; SD, 7.0; range, 67-98 years) who reported no difficulty in basic ADLs. MEASUREMENTS-TheShort Physical Performance Battery (SPPB), gait speed, Berg Balance Scale (BBS), grip strength, and Timed Up & Go Test (TUG) were evaluated at baseline. Seven ADL items were assessed at baseline, 6, 12 and 18 months. The onset of basic ADL disability was self-report of difficulty in any of the 7 ADL items. Logistic regression models were fitted for each of the physical performance measures to predict onset of basic ADL difficulty at 6, 12, and 18 months. RESULTS-After controlling for age, co-morbid conditions, and gender, the BBS was the most consistent and best predictor for the onset of basic ADL difficulty over an 18-month period (6 months, c-statistic=.725 (.60, .85); 12 months, c-statistic=.840 (.75, .93); 18 months, c-statistic=. 821 (.71, .93)). The SPPB showed excellent predictive value for the onset of difficulty at 12 months. The number of older adults completed the 6, 12, and 18-month follow-up visits were 95, 89, and 75, respectively. CONCLUSION-BBS, followed by SPPB, TUG, gait speed and grip strength were predictive for the onset of basic ADL difficulty over an 18-month period in community-dwelling older adults. Huang -concept and design, data collection, data analysis, interpretation of data and manuscript preparation. Perera -concept and design, data analysis, interpretation of data and manuscript preparation. VanSwearingen -data analysis, interpretation of data and manuscript preparation. Studenski -concept and design, data analysis, interpretation of data and manuscript preparation. Conflict of Interest:Authors retained complete independence in scientific investigation and reporting.Sponsor's Role: None. Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty, and may help to detect early functional decline. NIH Public Access

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our findings support using IADL scale to screen older community-dwelling residents for dementia: it has discriminant power comparable to that of the AD8 and MMSE. Combining the IADL and the AD8 improves specificity.

The present study provides insight into how caregivers perceived the usefulness of AT devices, and how that varied with context. Indicators of devices perceived as useful can serve as guidelines for modifying existing devices and designing new devices. Future application could also incorporate the points of view from the persons with dementia.