Functional Activities Questionnaire (FAQ)

Abstract

The Functional Activities Questionnaire (FAQ) is a brief, informant-rated instrument designed to measure functional competence, specifically focusing on complex everyday tasks known as Instrumental Activities of Daily Living (IADLs). Developed by Pfeffer and colleagues, the scale aims to identify early functional decline often associated with conditions like Dementia or other cognitive impairments in older adults. It assesses the degree of independence or assistance required across ten crucial domains of daily function, providing a sensitive measure of functional impairment.

Keywords

Functional Activities Questionnaire, FAQ, Instrumental Activities of Daily Living (IADLs), functional status, cognitive impairment, Dementia, older adults, Gerontology, functional assessment.

Authors

Robert I. Pfeffer, T. T. Kurosaki, C. H. Harrah, J. M. Chance.

Purpose

The primary purpose of the FAQ is to serve as a screening and diagnostic tool for assessing declines in functional independence, particularly in high-level activities that require intact cognitive function. It is widely used in clinical and research settings to quantify the functional burden associated with conditions such as senile Dementia or Mild Cognitive Impairment (MCI).

The scale provides a quantifiable score that reflects the level of assistance or dependency an individual requires across 10 defined activities. This makes it useful for tracking disease progression, determining eligibility for care, and evaluating the effectiveness of interventions in Gerontology and geriatric psychiatry.

Construct

The FAQ specifically measures the construct of Instrumental Activities of Daily Living (IADLs), which are complex activities necessary for independent living in the community, differentiating them from basic self-care activities (ADLs). The ten items cover domains such as financial management, communication, household tasks, and mobility.

By focusing on these instrumental activities, the FAQ offers a sensitive measure of early cognitive decline. Impairment in IADLs often precedes deficits in basic ADLs and is considered a critical early marker for cognitive impairment or Dementia, as these tasks demand higher executive function and memory capacity.

Validity

The FAQ has demonstrated strong validity across numerous studies since its introduction. Early research by Pfeffer and colleagues established its utility as a diagnostic tool for senile Dementia, showing high correlation with clinical diagnoses and other established cognitive measures, such as the Mini-Mental State Examination (MMSE).

Specifically, the scale exhibits excellent criterion validity, proving effective in discriminating between cognitively normal older adults and those experiencing mild to moderate functional impairment. This strong relationship between FAQ scores and clinical status supports its use in screening for functional decline related to neurodegenerative diseases.

Reliability

Research confirms the strong psychometric properties of the Functional Activities Questionnaire, particularly its reliability. Studies have shown high inter-rater reliability, indicating consistency when different knowledgeable informants (such as family members or caregivers) rate the same individual’s functional status.

Furthermore, the FAQ demonstrates high internal consistency (typically high Cronbach’s alpha values), meaning the ten items effectively measure a unified construct of functional independence. Test-retest reliability is also robust, suggesting stable scores over short periods when the individual’s underlying functional status remains unchanged, enhancing its suitability for longitudinal studies in Gerontology.

Factor Analysis

While the FAQ is designed and often utilized as a single, unitary measure of IADL impairment, factor analytic studies generally support a dominant one-factor structure. This suggests that the ten items primarily load onto a single factor representing overall functional competence or the complexity of daily living skills required for independent community living.

Occasionally, exploratory factor analyses have hinted at potential sub-factors that might distinguish between tasks requiring primarily cognitive or executive function (e.g., financial management) and those that are more motor or environmental navigation-dependent (e.g., traveling). However, the standard clinical application relies on the total score for assessing overall functional decline severity.

Instrument

Test Type: Informant-rated questionnaire/Proxy assessment.

Format: 10-item questionnaire. Each item has six response options (A-F) that reflect varying levels of dependence, difficulty, or independence. Responses are scored on an ordinal scale, typically ranging from 0 to 3, where higher scores indicate greater functional impairment. The total score ranges from 0 to 30.

Language Available: English (original), with validated translations available in many languages globally.

Population Group: Older adults, especially those undergoing assessment for cognitive impairment, Dementia, or other conditions affecting functional capacity.

Age Group: Typically 60 years and older (Geriatric population).

Population Details: Utilized in community-dwelling populations, outpatient clinics, and research focused on aging and neurocognitive disorders.

Test Methodology: The scale is usually administered by interviewing a knowledgeable informant (e.g., spouse, child, or caregiver) who can accurately report on the older adult’s performance of the ten activities over the preceding month.

Keywords

IADL assessment, functional independence, geriatric assessment, cognitive decline screening, Pfeffer scale, Psychometrics, activities of daily living.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The FAQ was originally developed and published in 1982 by Pfeffer et al., with a revised version appearing in 1984. The scale is widely considered to be in the public domain for non-commercial and research purposes. It is frequently included in standard health measurement guides such as those published by McDowell (2006).

The instrument is publicly available and can be found in various academic resources. The original PDF can be downloaded here: www.a4ebm.org/sites/default/files/Measuring Health.pdf

Reference’s

1. Pfeffer, RI., Kurosaki, TT., Harrah, CH, et al. (1981). A survey diagnostic tool for senile dementia. American Journal Epidemiology, 114:515–527.
2. Pfeffer, RI., Kurosaki, TT., Harrah, CH., et al.(1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37:323–329.
3. Pfeffer, RI., Kurosaki, TT., Chance, JM., et al. (1984). Use of the Mental Function Index in older adults: reliability, validity and measurement of change over time. American Journal Epidemiology, 120:922–935.
4. McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

Items of the Functional Activities Questionnaire (FAQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Functional Activities Questionnaire (FAQ)

Pfeffer, 1982, Revised 1984

1. Writing checks, paying bills, balancing checkbook, keeping financial records

• _____ A. Someone has recently taken over this activity completely or almost completely.
• _____ B. Requires frequent advice or assistance from others (e.g., relatives, friends, business associates, banker), which was not previously necessary.
• _____ C. Does without any advice or assistance, but more difficult than used to be or less good job.
• _____ D. Does without any difficulty or advice.
• _____ E. Never did and would find quite difficult to start now.
• _____ F. Didn’t do regularly but can do normally now with a little practice if they have to.

2. Making out insurance or Social Security forms, handling business affairs or papers, assembling tax records

• _____ A. Someone has recently taken over this activity completely or almost completely, and that someone did not used to do any or as much.
• _____ B. Requires more frequent advice or more assistance from others than in the past.
• _____ C. Does without any more advice or assistance than used to, but finds more difficult or does less good job than in the past.
• _____ D. Does without any difficulty or advice.
• _____ E. Never did and would find quite difficult to start now, even with practice.
• _____ F. Didn’t do routinely, but can do normally now should they have to.

3. Shopping alone for clothes, household necessities and groceries

• _____ A. Someone has recently taken over this activity completely or almost completely.
• _____ B. Requires frequent advice or assistance from others.
• _____ C. Does without advice or assistance, but finds more difficult than used to or does less good job.
• _____ D. Does without any difficulty or advice.
• _____ E. Never did and would find quite difficult to start now.
• _____ F. Didn’t do routinely but can do normally now should they have to.

4. Playing a game of skill such as bridge, other card games or chess or working on a hobby such as painting, photography, woodwork, stamp collecting

• _____ A. Hardly ever does now or has great difficulty.
• _____ B. Requires advice, or others have to make allowances.
• _____ C. Does without advice, or assistance, but more difficult or less skillful than used to be.
• _____ D. Does without any difficulty or advice.
• _____ E. Never did and would find quite difficult to start now.
• _____ F. Didn’t do regularly, but can do normally now should they have to.

5. Heat the water, make a cup of coffee or tea, and turn off the stove

• _____ A. Someone else has recently taken over this activity completely, or almost completely.
• _____ B. Requires advice or has frequent problems (for example, burns pots, forgets to turn off stove).
• _____ C. Does without advice or assistance but occasional problems.
• _____ D. Does without any difficulty or advice.
• _____ E. Never did and would find quite difficult to start now.
• _____ F. Didn’t usually, but can do normally now, should they have to.

6. Prepare a balanced meal (e.g., meat, chicken or fish, vegetables, dessert)

• _____ A. Someone else has recently taken over this activity completely or almost completely.
• _____ B. Requires frequent advice or has frequent problems (for example, burns pots, forgets how to make a given dish).
• _____ C. Does without much advice or assistance, but more difficult (for example, switched to TV dinners most of the time because of difficulty).
• _____ D. Does without any difficulty or advice.
• _____ E. Never did and would find quite difficult to do now even after a little practice.
• _____ F. Didn’t do regularly, but can do normally now should they have to.

7. Keep track of current events, either in the neighborhood or nationally

• _____ A. Pays no attention to, or doesn’t remember outside happenings.
• _____ B. Some idea about major events (for example, comments on presidential election, major events in the news or major sporting events).
• _____ C. Somewhat less attention to, or knowledge of, current events than formerly.
• _____ D. As aware of current events as ever was.
• _____ E. Never paid much attention to current events, and would find quite difficult to start now.
• _____ F. Never paid much attention, but can do as well as anyone now when they try.

8. Pay attention to, understand, and discuss the plot or theme of a one-hour television program; get something out of a book or magazine

• _____ A. Doesn’t remember, or seems confused by, what they have watched or read.
• _____ B. Aware of the general idea, characters, or nature while they watch or read, but may not recall later; may not grasp theme or have opinion about what they saw.
• _____ C. Less attention, or less memory than before, less likely to catch humor, points which are made quickly, or subtle points.
• _____ D. Grasps as quickly as ever.
• _____ E. Never paid much attention to or commented on T.V., never read much and would probably find very difficult to start now.
• _____ F. Never read or watched T.V. much, but read or watch as much as ever and get as much out of it as ever.

9. Remember appointments, plans, household tasks, car repairs, family occasions (such as birthdays or anniversaries), holidays, medications

• _____ A. Someone else has recently taken this over.
• _____ B. Has to be reminded some of the time (more than in the past or more than most people).
• _____ C. Manages without reminders but has to rely heavily on notes, calendars, schemes.
• _____ D. Remembers appointments, plans, occasions, etc. as well as they ever did.
• _____ E. Never had to keep track of appointments, medications or family occasions, and would probably find very difficult to start now.
• _____ F. Didn’t have to keep track of these things in the past, but can do as well as anyone when they try.

10. Travel out of neighborhood; driving, walking, arranging to take or change buses and trains, planes

• _____ A. Someone else has taken this over completely or almost completely.
• _____ B. Can get around in own neighborhood but gets lost out of neighborhood.
• _____ C. Has more problems getting around than used to (for example, occasionally lost, loss of confidence, can’t find car, etc.) but usually O.K.
• _____ D. Gets around as well as ever.
• _____ E. Rarely did much driving or had to get around alone and would find quite difficult to learn bus routes or make similar arrangements now.
• _____ F. Didn’t have to get around alone much in past, but can do as well as ever when has to.

Scoring Key: Dependent = 3, Requires assistance = 2, Has difficulty but does by self = 1, Normal = 0, Never did [the activity] but could do now = 0, Never did and would have difficulty now = 1