Background/Purpose:

Rheumatic conditions are more prevalent among women than men and increase with age. Over 4 million African Americans affected are by rheumatic conditions and yet disparities and underrepresentation of this group exist in research studies. The burden of physical disability confronting older African American women can affect their ability to engage in everyday activities. Thus, performance-based data are needs in the home environment where effective patient management and aging in place occurs. However, differences exist between self-report and performance-based data. Therefore, the purpose of this descriptive, non-intervention study uses mixed methods to identify the degree of concordance between self-reported performance capabilities and real-time performance of criterion-referenced task situations within the home environment.

Methods:

Eighteen community-dwelling African American females with rheumatic conditions (age 64.7, widowed = 38.9%, living with family = 50%, self-reported quality of life = “good”) participated in brief qualitative interviews on the perception of participation in daily activities and home safety. During the in-home assessment, participants completed demographic questionnaires, the PASS-SR (self-report of performance capabilities, what they “could do” compared to what they “routinely do”, and the PASS-Home (observational data of real-time performance of 26 criterion-referenced, standardized task situations). The PASS-Home includes 4 domains: basic ADL (dressing), physical and cognitive instrumental ADL (IADL-physical: sweeping & IADL-cognitive: managing home safety), and functional mobility (indoor walking). The interviews were audio-recorded and transcribed verbatim. Content analysis was used for initial codes and summary statements were generated for each code. Based on summary statements data were aggregated into eight key themes. Data from the interviews, PASS-SR, and PASS-Home were integrated. Concordance was defined as the percent agreement between self-reported capability (PASS-SR) and performance-based (PASS-Home) data of task situations.

Results: Generally, participants reported that physical factors of rheumatic conditions negatively affected their lives with regard to symptoms triggers, physical problems, limitations on their activity, and safety concerns. Chores, daily living, and movement were the most prominent symptoms triggers. The primary safety concerns included falling, difficulty-using hands, and lack of proper safety equipment. Percent agreement between self-reported capability on the PASS-SR and performance-based data of the task situations (PASS-Home) ranged from 22.2% (4 of 18) for functional mobility-stair use to 94.4% (17 of 18) for IADL (current event) obtaining critical audio information from the media and IADL (money management) checkbook balancing. There were 9 of 26 task situations with less than 50% concordance.

Conclusion: Using mixed methods, we were able to examine real and perceived performance patterns among older African American women with rheumatic conditions. Participant perceptions of their independence were typically underestimated for functional mobility and physical IADL.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/independence-at-home-real-or-perceived/