Transcript Everyday Competence

Everyday Competence:
Implications for Decision Making in Older Adults*
Manfred Diehl, Ph.D.
Colorado State University
*No part of this presentation can be used or reproduced
without the expressed permission of the author.
Contact [email protected] for permission.
Presentation for the
Colorado Coalition for Elder Rights and Adult Protection
October 20, 2010
Aurora, Colorado
It’s Not The Same Old Story Anymore!
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Human aging is going through some fundamental
changes.
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Increases in active life expectancy.
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Plasticity of human behavior even in old age.
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Compression of morbidity.
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Third age vs. Fourth age  young-old vs. old-old vs. veryold
It’s Still The Same Old Story
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Very late in life, individuals are confronted with
serious challenges to their health, cognition, and
everyday functioning.
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“…the fourth age entails a level of biocultural
imcompleteness, vulnerability and unpredictability
that is distinct from the positive views of the third
age (young old). The oldest old are at the limits of
their functional capacity and science and social
policy are constrained in terms of intervention”
(Baltes & Smith, 2003, p. 123).
Everyday Competence
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How do we know when a person is still capable of:
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Making good decisions?
Meeting all the demands of everyday life?
Living independently without being at risk of self-injury or
self-neglect?
Dilemma: Respecting the older adult’s rights to be
independent and autonomous—and providing the
support and protection that is needed to prevent bad
things from happening.
Presentation Overview
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How have aging researchers traditionally looked at
everyday competence?
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What assessment approaches have traditionally
been used?
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What new developments have occurred in the past
two decades?
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Where are we going from here?
Everyday Competence
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Definition: “Everyday competence refers to a
person’s ability to perform, when needed, a broad
array of activities considered essential for
independent living, even though in daily life the
individual may not perform these tasks on a regular
basis or may only perform a subset of these
activities” (Diehl, 1998, p. 422).
Three Important Points
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1. Everyday competence refers to a person’s
potential or capability, not the actual daily behavior.
 Can the person adequately respond to a situation when it
arises?
 Adaptive reserve capacity
 Legal importance in terms of capacity assessment
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2. Everyday competence involves multiple domains
of behavior and multiple components
 not only functional health, but a person’s physical,
psychological, and social functioning
Three Important Points

3. Competent behavior in everyday life does not exist in
a vacuum but is expressed and receives its validation
in transactions with the physical and social
environment.
 transactional concept  P-E fit
 need to be sensitive to contextual and cultural variation
 what is considered competent behavior changes over time 
computerization of everyday life
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Bottom line: Everyday competence is a dynamic
concept with important implications.
Traditional Views on Everyday Competence
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Traditionally, everyday competence has been
conceived in terms of functional health
 functional health was primarily operationalized in terms of
ability to perform basic Activities of Daily Living (ADLs)
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Limitation of this approach was that more complex
and cognitively demanding tasks of everyday life
were not considered
 reasoning required to make decisions with legal
implications (e.g., signing a contract; making a purchase)
 reasoning required for more complex everyday tasks
Traditional Views on Everyday Competence
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Inclusion of Instrumental Activities of Daily Living
(IADLs; Lawton & Brody, 1969)
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Ability to use the telephone
Shopping
Food preparation
Housekeeping
Managing transportation
Responsibility for own medications
Ability to handle finances
Advantage: IADLs require more competencies.
Disadvantage: Assessed usually through self-report.
Problems With Self-Report Assessments
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Although IADLs found great acceptance among
practitioners and researchers alike, there are several
limitations with regard to the objective assessment
of everyday competence:
1. Self-reports based on single items.
2. Older adults have difficulty evaluating their everyday
competence accurately.
 Overestimation vs. underestimation of competence
3. Self-report assessment is also limited because it does not
tell us anything about what a person’s deficits may look like
and what the causes of these deficits might be.
 Examples: Medication taking; driving a car; reading a legal
document.
New Approach: Looking At Actual Behavior
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Given the shortcomings of self-reports, researchers
have increasingly focused on performance-based
assessment of everyday competence.
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Although objective, performance-based
assessments might be the “gold standard,” they are
not without problems either:
1. No widely accepted performance-based measure available.
2. Measures for clinical groups tend to be too easy for healthy
older adults.
3. Time consuming to administer and to interpret.
4. Issue of what behavioral domains to focus on.
Available Performance-Based Measures
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Several performance-based measures have been
developed and are available to assess older adults’
everyday competence:
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Direct Assessment of Functional Status (DAFS; Loewenstein
et al., 1989)
Structured Assessment of Independent Living Skills (SAILS;
Mahurin et al., 1991)
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Assessment of Living Skills and Resources (ALSAR;
Williams et al, 1991)
Observed Tasks of Daily Living (OTDL; Diehl et al., 1995)
Performance-Based Measures
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Advantages of performance-based measures:
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Evaluation of everyday competence is based on observation
of actual behavior on prototypical tasks
 Element of unfamiliarity; activation of existing skills
 Eliminates self-report or proxy bias
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Permit assessment of capacities and deficits.
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Permit identification of areas for training/intervention.
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Allow the assessment of possibly adopted compensatory
strategies.
Sample Case: Assessment of Driving Competency
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Performance-based assessment is already used more
systematically for the objective evaluation of older
adults’ competence to drive a car.
Odenheimer et al. (1994) developed a simulated road test
for measuring the driving skills of elderly drivers.
Performance on this driving test and cognitive test
scores were significantly correlated with older adults’
actual driving behavior (e.g., frequency of accidents).
Useful Field of View (UFOW): Assesses the visual field
that is necessary to operate a motor vehicle safely.
 UFOW and mental status were the best predictors of elderly
drivers’ accident frequency (Owsley et al., 1991).
 Adopted by DOTs (e.g., in the state of Florida)
Where Do We Go From Here?
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Performance-based assessment is clearly the trend of the
future.
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Future cohorts of older adults (e.g., Baby Boomers) will
insist that their competencies are evaluated objectively
and fairly.
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Will capitalize on the notion of plasticity  Educational
programs that may teach essential skills for independent
living.
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Development of increasingly more sensitive tests of early
signs of age-related declines and losses.
Where Do We Go From Here?
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Future cohorts of older adults will take a more proactive
stance toward their own aging  Increasing recognition
that old age is a life stage in its own right that requires
foresight and planning.
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Outlook: A larger number of adults than ever before in
human history will grow old in dignity and with increased
quality of life.
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Stereotypes of aging will change and this change will
affect how society at large looks at older adults and how
they are treated by the legal community and with regard
to their competencies.
Literature cited in this presentation:
1. Baltes, P. B., & Smith, J. (2003). New frontiers in the future of aging: From successful aging of the young old to the
dilemmas of the fourth age. Gerontology, 49, 123-135.
2. Diehl, M. (1998). Everyday competence in later life: Current status and future directions. The Gerontologist, 38, 422433.
3. Diehl, M., Marsiske, M., Horgas, A., Rosenberg, A., Saczynski, J., & Willis, S. L. (2005). The Revised Observed
Tasks of Daily Living: A performance-based assessment of everyday problem solving. Journal of Applied
Gerontology, 24, 211-230.
4. Diehl, M., Willis, S. L., & Schaie, K. W. (1995). Everyday problem solving in older adults: Observational assessment
and cognitive correlates. Psychology and Aging, 10, 478-491.
5. Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of
daily living. The Gerontologist, 9, 179-185.
6. Loewenstein, D. A., Amigo, E., Duara, R., Guterman, A. et al. (1989). A new scale for the assessment of functional
status in Alzheimer’s disease and related disorders. Journal of Gerontology: Psychological Sciences, 44, P114P121.
7. Mahurin, R. K., DeBettignies, B. H., & Pirozzolo, F. J. (1991). Structured assessment of independent living skills:
Preliminary report of a performance measure of functional abilities in dementia. Journal of Gerontology:
Psychological Sciences, 46, P58-P66.
8. Odenheimer, G. L., Beaudet, M., Jette, A. M., Albert, M. S., Grande, L., & Minaker, K. L. (1994). Performancebased driving evaluation of the elderly driver: Safety, reliability, and validity. Journal of Gerontology: Medical
Sciences, 49, M153-M159.
9. Owsley, C., Ball, K., Sloane, M. E., Roenker, D. L., & Bruni, J. R. (1991). Visual/cognitive correlates of vehicle
accidents in older drivers. Psychology and Aging, 6, 403-415.
10. Williams, J. H., Drinka, T. J. K., Greenberg, J. R., Farrell-Holtan, J., Euhardy, R., & Schram, M. (1991).
Development and testing of the Assessment of Living Skills and Resources (ALSAR) in elderly community-dwelling
veterans. The Gerontologist, 31, 84-91.
Thank you for your attention.
Visit the website of the
Center on Aging at Colorado State University:
http://www.coa.cahs.colostate.edu/
You can contact Dr. Diehl at:
[email protected]