Discordance Between Self-Report and Performance-Based Measures Among At-Risk Older Adults: A Secondary Data Analysis

IMPORTANCE: Subtle, age-related declines in occupational performance among at-risk older adults may go undetected when assessed solely with self-report measures, potentially leading to missed intervention opportunities. Understanding discrepancies between self-reported and performance-based occupational performance outcomes can inform assessment selection and interpretation. OBJECTIVE: To examine the discrepancies between the two types of measure among community-dwelling older adults at risk for losing independence. DESIGN: Cross-sectional study using secondary data analysis. PARTICIPANTS: Seventy-one community-dwelling older adults (M age = 74 yr, SD = 9) who showed muscle weakness and reported difficulty with activities of daily living. OUTCOMES AND MEASURES: Canadian Occupational Performance Measure (COPM) Performance score and Assessment of Motor and Process Skills (AMPS) Motor Skills score were used as outcome measures. Participants were categorized as overestimators if they reported a higher COPM Performance score but had a relatively lower AMPS Motor Skills score and as underestimators if the reverse was true. RESULTS: Participants who overestimated their occupational performance (n = 12, M age = 79 yr, SD = 10 yr) were generally older (Z = 2.91, p = .004) and had poorer physical functioning (Zs = -2.54 to 2.42, all ps < .05) but reported higher satisfaction with their performance (Z = 4.72, p < .001) compared with those who underestimated their performance (n = 20, M age = 69 yr, SD = 7 yr). CONCLUSIONS AND RELEVANCE: Use of both self-report and performance-based assessments may be warranted to identify late-life disability, particularly among older adults of advanced age or with declined physical functioning. Plain-Language Summary: Older adults of advanced age or with poor physical functioning may rate their occupational performance differently from how they actually perform everyday activities. This study found that some older adults tend to overestimate their performance, even when their actual performance suggests otherwise. These mismatches between how older people think they are performing and how they actually perform could lead to missed chances for support or intervention if only a self-report measure is used. Using self-report followed by performance-based measures is recommended to identify late-life disability among these older adults.