Development and validation of a self-reported scale for difficulty in activities of daily living among older adults

Population aging demands tools that capture not only observed dependence but also perceived difficulty, an area where validated Spanish-language instruments remain scarce. To develop and psychometrically validate the Difficulty Scale for Activities of Daily Living (EDAAD), a self-administered, Spanish-language instrument that measures perceived difficulty across basic, instrumental, and advanced ADLs in community-dwelling older adults. We conducted a cross-sectional study in the Biobío Region (Chile) using multi-stage, stratified random sampling at the commune-block-household levels. Trained interviewers administered face-to-face surveys between October 2022 and February 2023. Independence was screened with the Chilean EFAM-A scale, including only participants scoring ≥ 43 points. The final sample comprised 201 independent older adults aged 60-99 years. Confirmatory factor analysis (CFA; WLSMV estimator) tested an 8-factor structure. Reliability was assessed with Cronbach's α and McDonald's ω. Known-groups validity examined associations between EDAAD scores and sociodemographic variables. CFA supported an 8-factor model with acceptable fit for key indices (CFI = 0.905; TLI = 0.891; RMSEA = 0.149; SRMR = 0.103). Internal consistency was excellent for the total scale (α = 0.954; ω = 0.962). Higher perceived difficulty was associated with female gender, older age, lower education, and lower income. Among domains, technology use (M = 3.71) and hobbies (M = 3.43) were the most difficult; personal care (M = 1.96) and mobility (M = 2.70) were the least difficult. EDAAD is, to our knowledge, one of the first self-administered, Spanish-language instruments validated in a Latin American community sample that focuses on perceived difficulty across ADLs. It complements performance-based and dependence measures, enables classification of activities by difficulty level, and can inform user-centered and inclusive interventions to support healthy aging.