Correspondence of the Functional Independence Measure (FIM) self-care subscale with real-time observations of dementia patients' ADL performance in the home

Objective: To determine if caregivers of dementia patients can validly report (a) the level of patient activities of daily living (ADL) dependence and (b) the amount of time they spend providing ADL assistance. Design: Seven ADLs were assessed through caregiver report using the Functional Independence Measure (FIM) and then videotaped. Videotapes were coded using a computer-assisted data collection system that documented the nature and duration of caregiver assistance provided during ADLs. Setting: The study took place in the homes of the caregiver-patient dyads. Subjects: Twenty-one people with dementia and their primary caregivers participated in the study. Main outcome measures: Data analysis examined (a) the degree to which caregiver-reported FIM scores corresponded to FIM scores derived from the observational data and (b) the extent to which caregivers' estimates of ADL assistance time corresponded to the assistance time observed during ADL interactions. Results: For all ADLs, caregiver-reported FIM scores were correlated significantly with observation-derived FIM scores (r(s) values ranged from 0.620 to 0.909), and means were similar. Assistance durations were also significantly correlated for some ADLs, but means were significantly different, indicating poor correspondence. Conclusions: Although caregivers of dementia patients can describe the nature of their ADL assistance with reasonable accuracy, they consistently overestimate their ADL assistance time, suggesting that caregiver reports of ADL assistance duration be used with caution. Additionally, the degree to which the assistance provided corresponds to the assistance actually needed needs to be addressed in future studies.