Self-reported disability and its association with performance-based limitation in elderly men: A comparison of three European countries

OBJECTIVES:To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN:Cross-sectional data from a cohort study collected around 1990. SETTING:Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS:One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS:Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0¿3). Functional limitation was measured by performance tests (score 0¿16), with 0 indicated the healthiest score. RESULTS:Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23¿2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77¿1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21¿1.35) and did not differ between countries. CONCLUSION:Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy.