Gender differences in functioning for older adults in ruralBangladesh. The impact of differential reporting?

BACKGROUND: The purpose of this study is to examine gender differences in functional ability among older adults in rural Bangladesh in terms of both self-reported activities of daily living and observed physical performance and to evaluate the extent to which differential reporting by gender contributes to disparities between the two measures. METHODS: In 1996, the Matlab Health and Socio-Economic Survey collected data on self-reported activities of daily living (ADLs) and observed physical performance for 1,893 men and women aged 50 and older in the Matlab Surveillance area in rural Bangladesh. Gender differences were examined in both self-reported ADLs and physical-performance measures. With physical-performance measures as the gold standard, logistic regression was used to determine how much of the gender difference in the self-reported function was explained by physical-performance ability controlling for age. RESULTS: Older women in this study population consistently had more limitations than men in both self-reported ADLs and observed physical performance. For the same level of observed physical performance, however, older women were more likely than men were to report a higher level of ADL limitation. This reported female health disadvantage varied considerably depending on the nature of the ADLs being examined and the type of scoring system used for the ADLs. CONCLUSIONS: One has to be somewhat cautious in interpreting gender differences in self-reported ADL limitations, as they are affected by the gender-specific nature of the reported activity and by gender differences in the perception of response categories.