How can we determine where a person is along Verbrugge and Jette’s continuum? The answer to this question describes a person’s functional health status, that is, how well the person is functioning in daily life. In making these assessments, it is essen­tial to differentiate the tasks a person reports he or she can do, tasks a person can demonstrate in a laboratory or clinic that simulates the same tasks at home, and tasks the person actually does at home (Glass, 1998). To determine functional health status accurately, we must ensure that the assessment tool used measures a person’s true functional level.

In many cases, assessing functional health status is done for a very practical reason: to identify older adults who need help with everyday tasks. Frail older adults are those who have physical disabilities, are very ill, and may have cognitive or psychological disorders and need assistance with everyday tasks. They constitute a minority of older adults, but the size of this group increases a great deal with age.

Frail older adults are people whose competence is declining. However, they do not have one specific problem that differentiates them from their active, healthy counterparts; rather, they tend to have sev­eral (Rockwood et al., 2004). To identify the areas in which people experience limited functioning, researchers have developed observational and self­report techniques to measure how well people can accomplish daily tasks.

Everyday competence assessment consists of examining how well people can complete activities of daily living and instrumental activities of daily living (Johnson et al., 2004; Sternberg & Grigorenko, 2004). Activities of daily living (ADLs) include basic self-care tasks such as eating, bathing, toileting, walk­ing, or dressing. A person can be considered frail if

140 CHAPTER 4 he or she needs help with one or more of these tasks. Instrumental activities of daily living (IADLs)

are actions that entail some intellectual competence and planning. Which activities constitute IADLs varies widely across cultures. For example, for most adults in Western culture, IADLs would include shopping for personal items, paying bills, making telephone calls, taking medications appropriately, and keeping appointments. In other cultures, IADLs might include caring for animal herds, making bread, threshing grain, and tending crops.

The number of older adults who need assistance with ADLs and IADLs increases with age (AgingStats. gov, 2008b). As you can see in Figure 4.10, about 26% of older adults enrolled in Medicare need assis­tance with at least one ADL, about 12% need help with at least one IADL, and about 4% are sufficiently impaired that they live in an assisted living or nurs­ing home facility. As you can see in Figure 4.11, the percentage of people needing assistance increases with age, from 8.2% of people aged 65-69 to 30% of those over age 80 (Steinmetz, 2006). The per­centage of people needing assistance also varies across ethnic groups, with European Americans over age 65 having the lowest rate (15%), African Americans having the highest rate (25%), and Asian Americans (19%) and Latino Americans (21%) in between (Administration on Aging, 2001). Rates for Native Americans were not reported.

In addition to basic assistance with ADLs and IADLs, frail older adults have other needs. Research shows that these individuals are also more prone to depression and anxiety disorders (Solano, 2001). Although frailty becomes more likely with increas­ing age, especially during the last year of life, there are many ways to provide a supportive environment for frail older adults. We take a closer look at some of them in Chapter 5.