Functional autonomy measurement system: development of a social subscale

Abstract

The purpose of this study was to develop a subscale assessing social functioning for the functional autonomy measurement system (SMAF). The development of this new dimension was based on consultations (focus groups and nominal groups) of experts from different health care disciplines in Quebec, Canada, and France. Two interrater reliability studies were carried out with older people presenting a loss of functional autonomy and living either in an institution or at home. With the focus groups, the experts clarified the definition of social functioning and identified the factors involved. The nominal groups were used to construct a subscale composed of six items. The results of the first interrater reliability study showed a mean agreement percentage of 60% for the subscale and an intraclass correlation coefficient (ICC) of 0.70 (CI: 0.57–0.80). The results of the second interrater reliability study showed higher coefficients with an agreement percentage of 74% for the subscale and an ICC of 0.83 (CI: 0.61–0.93). These preliminary results demonstrate that the new social functioning subscale has good reliability, but more studies are needed to show its validity. The new SMAF, including the social functioning subscale, should help clinicians and researchers to obtain a comprehensive profile of functional autonomy. It could also contribute to the improvement of health care for older people.

Introduction

It is now well established that the percentage of older people in the population is increasing and that they are living longer. However, longer life is not necessarily associated with good health. In fact, ageing is accompanied by biological, psychological, and social vulnerability which can result in a loss of functional autonomy in many older people who could need health care to reduce disabilities and prevent the development of handicap situations.

To facilitate the planning of care, it is important to adequately assess the level of functional autonomy. The evaluation generates a profile of functional abilities and disabilities and can be used to adjust the care given to elders. Generally, functional autonomy measuring instruments primarily assess activities of daily living and mobility. Some also consider instrumental activities, mental functions and communication. One of these is the functional autonomy measurement system (SMAF), a 29-item scale based on the WHO classification of disabilities (Hébert et al., 1988, Desrosiers et al., 1995).

The SMAF measures functional ability through five subscales: activities of daily living, mobility, communication, mental functions, and instrumental activities of daily living. Disability on each item is scored on a five-point scale: 0 (independent), −0.5 (difficulty), −1 (needs supervision), −2 (needs help), and −3 (dependent). The SMAF must be administered by a health professional who obtains information on the subject either by questioning the subject and proxies, or by observing and even testing the subject. The interviewer scores the ability of the subject to perform each task. Validation studies have demonstrated that the SMAF has excellent psychometric properties (Hébert et al., 1988, Desrosiers et al., 1995).

However, to date and to our knowledge, there are no functional autonomy measuring instruments, including the SMAF, that evaluate the social functioning of older people.

The term ‘social functioning’ is widely used in the literature but is often undefined. According to MontPlaisir and Tremblay (1986), social functioning is a concept involving different social aspects such as social relationships, social behaviours, and social activities. In fact, when reference is made to the broad concept of social functioning, it is generally related to social participation (Starr et al., 1983, MontPlaisir and Tremblay, 1986, Kane, 1987, Bennet and Morgan, 1992), social network, social support (Kane, 1987, Bennet and Morgan, 1992), social resources, social relationships (Starr et al., 1983, Kane, 1987), and social roles (Starr et al., 1983, Bloom and Spiegel, 1984, Kane, 1987 Williams et al., 1989, Patterson et al., 1997).

Many studies have shown that a decrease in one of the components of social functioning is associated to an increase of the risk of mortality and morbidity (Bangerter and Smith, 1981, Fabrigoule et al., 1985, Adams et al., 1989, O'Connor, 1995, Lang et al., 1997, Su and Ferraro, 1997, Unger et al., 1997). In fact, when social functioning is optimal, it can help to maintain and restore a person's health. It seems, therefore, that social functioning may have a substantial impact on health and functional autonomy and thus it becomes essential to consider it.

The aims of the present study were: (1) to develop items measuring social functioning in order to add them to the SMAF; and (2) to verify the interrater reliability of this new subscale.