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RESEARCH ARTICLE |
MU Sinclair School of Nursing, University of Missouri–Columbia.
Address correspondence to Dr. Eileen J. Porter, MU Sinclair School of Nursing, University of Missouri–Columbia, Columbia, MO 65211. E-mail: PorterEJ{at}missouri.edu
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Abstract |
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Methods. This was a qualitative study with a quantitative component. During open-ended interviews about living alone with help, participants rated difficulty with tasks on a 1-to-5 scale and talked about difficulty relative to tasks. I estimated concordance of the first two ratings and used a descriptive phenomenological method to discern how participants understood difficulty.
Results. Concordance was satisfactory for all tasks other than climbing stairs. Six elements of the life-world of older women were descriptive of difficulty relative to tasks, including pinpointing my biggest/hardest job and having difficulty rating difficulty. Whether reporting difficulty or not, some women spoke of taking extra time, extra effort, or both.
Discussion. The findings suggest a counterview to functional limitation models. Difficulty was posed as a theoretical construct, and the concept of subliminal difficulty was introduced. Various facets of difficulty warrant further descriptive work. Incorporating an opportunity to talk about difficulty, as well as to rate it, would be valuable in large-scale studies.
MANY gerontological studies incorporate questions about difficulty with activities of daily living (ADLs) and instrumental ADLs (IADLs). Difficulty is a key construct in frameworks such as "the iceberg of disability" (Verbrugge, 1990
, p. 55) and subclinical functional limitation (Fried et al., 1996; Wolinsky, Miller, Andresen, Malmstrom, & Miller, 2005). If ADL is the "lingua franca of geriatrics" (Kane, 1993, p. 30), then difficulty, "the dimension to be measured" (Verbrugge, 1990, p. 69), is the lingua franca of ADLs/IADLs. However, researchers use ADL/IADL tools to rate difficulty while ostensibly measuring more theoretical constructs, such as functional decline (Fried et al., 1996) and disability (Simonsick et al., 2001). From the standpoint of empirical validity that approach is questionable, because the original ADL tool was not designed to measure difficulty but rather independence in six activities (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963), and the underlying construct of IADLs (Lawton & Brody, 1969) is not always specified (Coster et al., 2004). These validity issues are especially critical, because there are few useful definitions of difficulty. Fried and colleagues (1996) identified "task difficulty" from self-reports of "difficulty, inability, and/or dependency in task performance" (p. M208)—a definition that is in part tautological.
Studies about daily activities have been grounded in the assumption that researchers and participants understand difficulty in the same way. The assumption that older persons view difficulty with ADL/IADL tasks as relevant to their daily lives has not been subject to an empirical test. Many scholars have asked older persons to rate difficulty, but few have invited comments about it in prospective, descriptive studies. Questions about the nature of difficulty with daily tasks remain unresolved. Yet there are compelling reasons to explore the perceptions of older women about difficulty with tasks. Compared to older men, older women live longer, have greater burdens from chronic illness (Fried & Guralnik, 1997), and endure more limitations in functional capability (Atchley & Scala, 1998). Noting that the "current approach to disability statistics is likely to miss a great deal," Verbrugge (1990) called for "a broader social science perspective" (p. 73). To tap the broader context of difficulty, scholars should explore daily routines and the home and social environments (Kane, 1993; Leveille, Fried, McMullen, & Guralnik, 2004; Melzer, Lan, Tom, Deeg, & Guralnik, 2004). During a longitudinal study of the home care experience among 25 older women, I asked participants to rate difficulty with 20 ADLs/IADLs, because ADL/IADL difficulty is to be tapped at each interview in prospective studies with older persons (Verbrugge, 1990). However, I also encouraged participants to talk about their activities. After estimating concordance of difficulty ratings, I used a phenomenological approach to describe how participants understood difficulty relative to their tasks.
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) deemed exempt from review by the University of Missouri Health Sciences Institutional Review Board, because data are maintained without identifiers. This was a qualitative study with a quantitative component. It involved a descriptive phenomenological analysis of qualitative data reported in conjunction with difficulty ratings for ADLs/IADLs and a concordance analysis of two sets of difficulty ratings. As shown in the notes to Table 1, I selected the 20 ADLs/IADLs from various sources, modifying some task descriptors for specific reasons.
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, 1995, 1998) earlier from Husserl's (1913/1962) philosophy. Using this approach, I obtained data about an experience and its personal–social context, or life-world (Porter, 1995), during a series of in-depth interviews with persons who met criteria relevant to the experience. Sampling was done using convenience, purposive, and quota strategies sequentially (Porter, 1999). I recruited women living in central Missouri chiefly through social service agencies. Participants had to meet the following criteria linked to home care use: (a) being age 80 or older (Jenkins & Laditka, 2003), (b) living alone at home (Schlenker, Powell, & Goodrich, 2002), and (c) reporting self-rated health as less than excellent (Jette, 1996). I used quota sampling to bolster representation of Black women and rural women. Of the 25 women (aged 81–96, M = 87.6 years), 19 were White and 6 were Black; 13 lived in cities and 12 lived in towns of fewer than 2,500 persons (Porter, 2005a). Although not required to do so by the institutional review board, I secured informed written consent prior to Interview 1. In this article, I identify each woman in findings by an initial that does not correspond to her surname.
Data Gathering
Over 3 years, each woman was to have 7 tape-recorded interviews in her home. Of the 165 interviews, I conducted all but 7 (these 7 interviews were done by trained research assistants). I started each interview with open-ended questions about living alone while needing, seeking, and having help; some women spontaneously talked about daily tasks. I finished each interview by asking structured questions to elicit a difficulty rating for each ADL/IADL, giving ample opportunity for spontaneous comments about tasks and difficulty. To establish rapport and to allow for concordance checks on ratings, Interview 2 occurred 2 weeks after Interview 1. Interview 3 took place 3 months later; thereafter, Interviews 4 through 7 occurred at 6-month intervals. Staff telephoned the women monthly to keep in touch and sought an extra interview if home care use had changed. Ten women had at least one extra interview. The 15 women who completed the 3-year study had eight interviews each on average (range 7–11). The 10 women who did not continue (due to relocation, severe illness, or death) had an average of 5 interviews each (range 3–8). I used all data regardless of duration of participation. Interviews averaged 70 min in length. I used QSR, a qualitative software program, to manage interview data and Microsoft Excel to document ratings.
I asked the following question about each ADL/IADL shown in Table 1: "Do you have difficulty with [task]?" I did not specify response options. Some women said "yes" or "no" before elaborating; when women simply talked about the task, I asked about difficulty again. I probed the interface of task and difficulty by asking (a) if "extra effort" was required and, if so, what it involved; and (b) if "extra time" was needed and, if so, why. I asked if the women had changed how they did a task to reduce difficulty or if they had to rest before completing a task (Clark, Stump, & Wolinsky, 1997). When a woman reported having difficulty, I asked for a 1-to-5 rating, defining only the poles (1 = a little difficulty and 5 = a great deal of difficulty). Validity can be compromised by imprecise category definitions (Guralnik, Branch, Cummings, & Curb, 1989), but I did not intend to create a scale or to assess construct validity. Rather than yes/no options, I offered the 1-to-5 range to tap more diversity (Lawrence & Jette, 1996) and to reveal variations over time (Avlund, 1997).
Data Analysis
I did not estimate test–retest reliability for ADLs/IADLs, because I had not defined all five rating categories. To appraise consistency in question content (Avlund, 1997), I calculated concordance on difficulty ratings for each task at Interviews 1 and 2 (Myers, 1992). As shown in Table 1, agreement was greater than 90% for 11 tasks and satisfactory (78%–89%) for 8 tasks. Due to low concordance on stair climbing (62.5%), I do not report interview data about it.
My purpose was to describe how the women understood difficulty relative to ADL/IADL tasks. I assumed that their perceptions about tasks and difficulty were contextual facets of the home care experience. As described elsewhere (Porter, 1995), I view the context of experience as life-world—"a reality which we modify through our acts and which ... modifies our actions" (Schutz & Luckmann, 1973, p. 6). My phenomenological method involves discerning common patterns in data by juxtaposing similarities and differences in each participant's data and across the sample (Porter, 1995, 1998). To grasp life-world elements, or basic structures of context, I reviewed each woman's narrative data and difficulty ratings, highlighting phrases that pointed to ways in which she understood difficulty. For instance, Ms. F said this about meal preparation: "Well, that's my biggest problem." Reflection on those data and similar data from other women yielded the element pinpointing my biggest/hardest job. I sought feedback from the women about such insights, and I talked with a coinvestigator at length about each interview.
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RESULTS |
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Thinking That Difficulty Is Not the Best Word for It
Some women rejected the idea that difficulty applied to a particular task; they described it instead as irksome, time-consuming, unhandy, bothersome, or tedious. Ms. C had minimal vision. When asked about difficulty with meal preparation, she said, "Oh, I wouldn't say it was difficult. [Tell me how you would describe it then.] Unhandy." Having denied having difficulty, some women explained that a task took extra effort, extra time, or both. For Ms. F, who also had minimal vision, laundry was "‘bout as hard as anything I do." Yet she denied having difficulty:
I get along alright, but I got a little portable washin' machine that's sometimes a little bit of trouble. [Do you have difficulty?] Not really, if I just go at it kind of easy. It's hard to get it always connected [to the sink]. [Does it take extra effort to get it done?] Yeah. It sometimes takes me three or four times tryin' to get it connected. [So it takes some extra time, then]. Yeah. I think that's due to not seein'. [Is it zero for no difficulty, or do you have difficulty?] No. Just write zero.
Ms. C said that moving around outdoors was not difficult in and of itself. "It ain't the moving; it's just that I can't handle very much of it. [So difficulty doesn't apply?] No." Ms. H also denied having difficulty with moving outdoors, but unlike Ms. C, she did not leave her house alone:
My sister is there at the door to help me to the car. [Do you have difficulty moving to the car?] No. Well, I guess I'm conscious of the fact, but I don't think anything about it. I don't have any trouble with it.
Often two women's narratives about a task were more similar than their difficulty ratings.
[Do you have difficulty getting up out of your favorite chair, Ms. P?] Yes, I do. I have to grab onto the arms. Sometimes I try to get up, and I'll fall back. And then I can get up again. But I do have trouble.[Ms. Q, with getting up out of your chair here, do you have difficulty?] Well, now, that is not what I call "hard." When I get ready to get up, if I feel like I'm going to have a problem, I give myself a bounce, sort of like that. And, about on the second or anyway, the third, see, I'll get up.
In this case, Ms. P rated difficulty as 3, whereas Ms. Q denied having difficulty. Ms. P reported having "trouble" in a general sense, but Ms. Q spoke of occasions when she anticipated "a problem." Such responses might have reflected unique interpretations of the idea of difficulty. When asked about difficulty, several women spoke of competence in carrying out the task. I asked Ms. O about difficulty with laundry, and she detailed elaborate procedures for washing bedding, hanging it out, bringing it in, and folding it. Then she said, "I know how to do it."
Thinking of X as More Important Than Difficulty
Other elements of life-world were more central than having difficulty with some tasks. In Interview 1, Ms. R talked about getting dressed:
As far as getting dressed, it's a little more problem, getting my socks on, getting pantyhose on. That's a problem in itself. I just do it a little at a time. I get dressed and get ready to go out. I'm always dressed. They [her family] pick me up every place they go practically, and I'm always ready to go if I know I'm going.
She corroborated those remarks later, rating difficulty with dressing as 1, as she did at Interview 4. At other interviews, she mentioned pantyhose or socks, but denied having difficulty with dressing. Having difficulty with dressing was less important than being ready to go out with the family.
For Ms. O the joy of sitting in her chair outweighed her trouble in getting up from it:
[Do you have difficulty getting out of your chair?] Yeah. I kind of struggle, but I had my walker here, or I can get up with the cane. [If we were to say from 1 to 5, how difficult it is to get up?] Well, probably ‘bout 5. Hard to get up, but it's a nice comfortable chair. I love to set in it. [So there's a little trade-off there?] Yeah.
Finally, difficulty was not always as pertinent to the women as the risk of what could happen if they did a task. Ms. F could not see, but she occasionally ventured down her front steps with her walker. "[Do you have difficulty moving around outdoors?] Well, more or less. I don't know whether I really have difficulty or not. I think I'm more or less afraid I'll fall."
Knowing That Difficulty Varies From Time to Time
The variability inherent in the task affected the degree of difficulty perceived. About getting out of her chair, Ms. G said, "Some days I can get out easy, and some days, I don't." The degree of difficulty perceived while initiating some tasks influenced decisions about how to do them. While getting up from her chair, Ms. G decided if she needed the cane, the walker, or neither one:
[How would you rate that on a 1-to-5 scale?] Well, I would not say "very difficult," because I can do it. I can even do it without one of those things [cane or walker], but sometimes I can't. I didn't do too bad today. Let's make it 4.
At Interview 3, Ms. B had returned home after a week in the hospital. She felt weaker than she had before the hospitalization, and she wanted to compare current perceptions of difficulty with her earlier ratings. When I introduced the rating questions, she said:
Tell me what I said before, and I'll compare it to now. [Difficulty moving about in the house? You said "no" last time.] Oh no, put a 2, because I see so poorly, and then, I'm a little on the weak side. Now next week I may have a different story.
The recognition of fluctuation in difficulty from the recent past to the present and the anticipated flux in the near future were both elements of her life-world.
There is insufficient space to present variations in difficulty ratings over time for each woman. However, I address that briefly in two ways. First I present a case to consider the parameters of extra time and extra effort relative to variations in difficulty ratings. Then I suggest that the concordance analysis of difficulty ratings reveals a relationship between the life-world elements of knowing that difficulty varies from time to time and having difficulty rating difficulty.
At her six interviews, Ms. W gave different ratings for difficulty with meal preparation. She spoke of time in terms of the speed that her mind worked and how long it took to prepare a meal. She referred to effort relative to concentrating while cooking, dealing with fatigue, doing a job that was not enjoyable, cooking for an extra person, and moving around her kitchen. At Interview 1 she denied having difficulty, but she said, "Oh, just my mind doesn't work fast enough. [In what respect?] I don't remember things. In the kitchen I do better by myself than I do with somebody else, because they're asking you this and that." At Interview 2, she denied having difficulty but continued talking: "I get tired. I'm getting so I just don't like to [cook]. Beth [her daughter] comes quite often at lunch, and I try to fix something she likes. Other than that, I never did like to cook." With that remark I asked again about difficulty: "It's a little harder, because I'm not as agile to get around, and you do have to move around a kitchen." Having denied having difficulty earlier, she then rated difficulty as 1. In Interview 5, she said, "I have a tough time remembering. I have to stay in the kitchen, and then I'm usually there all morning. If I'm on my feet very long, I can't take it." She rated difficulty as 3. Thus, whether or not Ms. W reported having difficulty, she spoke of cooking in terms of taking extra time and effort. Her data highlight changes in ratings over time for one woman with one task.
In contrast, the concordance analysis (see Table 1) is an overview of variability in difficulty ratings for the sample at Interviews 1 and 2. Most women gave identical ratings at both interviews for most tasks. Just as identical ratings might have meant no change in difficulty, some discrepant ratings might have reflected perceived changes. Eight of the 24 women (33%) who responded to yes/no questions about difficulty gave different ratings for 3 or more tasks, including Ms. T, Ms. D, and Ms. G, who gave different ratings for 6, 9, and 10 tasks, respectively. After all, the women who experienced difficulty took its variable nature for granted. However, rating discrepancies might have occurred because some women reported having difficulty with rating difficulty.
Having Difficulty Rating Difficulty
The women varied in their interest in rating difficulty. Ms. S bypassed all requests for ratings, but she clearly explained her own criteria for judging difficulty with certain tasks: "I used to walk from the bedroom through the kitchen to the bathroom and back 15 times; I can't walk it 3 times now." Several women forthrightly said that the idea of rating difficulty made little sense or that they did not know how to assign a number. When asked to rate difficulty moving outdoors, Ms. F said, "I don't know how to give it a number, but I have a little trouble ‘a-walkin’ and seein' where to go."
Many women were quite creative with rating difficulty. Of the 25 women, 13 (52%) created their own ranges within the scale, perhaps because difficulty varied from time to time, three of five scale categories had not been defined, or both. Ms. U rated difficulty with managing property as 3
. Ms. G gauged difficulty with shopping as "at least 2." For getting out of the chair, Ms. D said, "It's got to be between 2 and 4, because I have a hard time sometimes. [It varies, then?] Yes." Several women used the either/or approach: Ms. T rated difficulty moving in bed as "maybe 2 or 3." Ms. G chose a rating in part because she had not used that number. She rated moving indoors as 3. Then she said this about moving outdoors: "That's more difficult, ‘cause you can't tell when a hole might come up ahead of time. At least make it a 4. Might make it a 5. I haven't made anything a 5."
Ms. B, who deeply regretted that she could no longer see to drive, revealed some factors she considered as she tried to rate her difficulty with transportation:
Like I would go on my own and go shopping if I could, but I can't. And I guess that's a transportation difficulty. But if I want to go to the oculist, I call a taxi. [So how would you rate that difficulty on a 1-to-5 scale?] Oh, I'd like to say a 5, but that's not true. That's frustration. Oh, maybe a 2. Because I really don't need to do all the things I would do impulsively.
To hone her rating, Ms. B differentiated her frustration over the lost opportunity to transport herself from her difficulty ensuring that she got where she needed to go.
Pinpointing My Biggest/Hardest Job
This topic often arose when I asked if it was necessary to rest during any task. Ms. P said, "Making a bed. That sounds silly, but when I make up my bed clean." Other women differentiated the difficulty of making up a clean bed from that of making the bed daily. The former involved walking around the bed while manipulating bedding; the latter could involve "throwing up the covers" or leaving the bed as it was. Some women told of having difficulty with other tasks that were not on the ADL/IADL list. Ms. O liked to eat meals in the front room near the TV. "The hardest thing I have is walkin’ and carryin' a plate." For Ms. U, the hardest job was "doing nothing":
[Tell me a little more about that.] Well, I'll see something. I think, "I should fix that." [Your hardest job is seeing what needs to be done...?] Uh-huh. And just not able to do it. It bothers me. I've always been able to do everything.
Wondering What Difficulty Really Is
Several women raised insightful questions about the nature of difficulty. Uncertain about the meaning of a word in a question about difficulty, Ms. C redefined the term and compared the difficulty involved in two similar tasks:
[What about difficulty moving around outdoors?] Depends what they mean by moving. I'm going to be like Clinton here. [She smiles.] I'd say it's not the moving, but it's harder to walk outdoors than in the house. I don't know if it's the ground, if it's spongy, but it ain't like a solid floor. The least little raise, it don't take much of a slope to get the best of me. It's alright if I do it slow enough.
Ms. R talked about getting dressed, explaining difficulty in terms of being slower and wondering aloud whether the task was harder because she did it slowly:
I have a little more difficulty in getting dressed. [What's it like?] I'm slower. [So, is it a speed thing?] Yeah. [Is it harder?] Well, it's probably harder because I go slower. I watch television; I get dressed.
When I asked Ms. B if she had difficulty getting out of her favorite chair, she said this:
Some days I'm stiff, and some days I'm not very stiff. What is difficulty? I usually have to take the second hitch before I get out. I'm accustomed to that. It doesn't seem like a difficulty. It's just Reba getting out of the chair.
"What is difficulty?" As I discuss the findings of this study, I explain why various types of research are needed to explore aspects of this provocative question.
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), thereby enhancing data validity. In large-scale studies, thresholds for reporting difficulty have not varied due to race or education (Melzer et al., 2004). Important variations among older persons, although surely disguised in large-scale studies (Porter, 2000), were quite evident within this small sample. Indeed, revealing that uniqueness is one key aim of the method, along with drawing out similarities in experiences across the sample. However, the method does not enable attribution of individual variations to specific demographic factors. For that reason, I did not appraise difficulty ratings in a demographic context. Although a phenomenological method does not yield generalizable data, findings are evidence of the benefits of treating difficulty as a topic of conversation rather than as a dichotomous variable. Unlike numerical difficulty ratings, the rich interview data suggest new ideas about difficulty with daily tasks. The variety of life-world elements associated with difficulty for these older women is as an empirical counterpoint to both extant scholarly perspectives about difficulty and methods designed to measure that construct.
A Counterview to Extant Perspectives About Difficulty
Some researchers view the notion of difficulty with tasks as particularly important. For some women, difficulty was less pertinent for certain tasks than other parameters, such as being fearful of doing a task. More information is needed about the context of those individualized parameters that older adults consider cogent to their daily lives. Scholars must explore varying views about the relevance of difficulty to each task across diverse samples of older persons.
Findings are a challenge to the idea that, by definition, taking more time to do a task is problematic and, furthermore, that it is evidence of subclinical disability (Fried et al., 1996). For Ms. G and Ms. W, having to take extra time to make a meal was a hardship, but if it was laundry for Ms. O or bathing for Ms. H, the time involved was of little consequence. "I love to warsh," Ms. O intoned; "I have nothing else to do," Ms. H said flatly. Allowing a task to fill time might be consistent with "having my own time" (Porter, 1995, p. 37) to do what has to be done or "finding ways to keep busy" (Porter, 2005b, p. 97) while savoring the satisfactions of living alone.
Researchers have differentiated persons who report having difficulty from those who deny having difficulty while reporting that they take extra time or extra effort (Fried et al., 1996). That distinction might not be empirically grounded. In this study, women who reported having difficulty and those who denied it said that they took extra time, extra effort, or both. For some persons, those indicators might be more basic than having difficulty with some tasks. To ascertain the extent of the empirical relationships among these key constructs, the experiences of taking extra time and taking extra effort should be described concurrently with further studies on the nature of difficulty. The speculations of older persons about the nature of difficulty (such as whether a task is more difficult because it is done slowly) could be a basic data source for such studies.
Women who referred to a task as unhandy or tedious implied that something about the task was troublesome, even if it was not difficult. Furthermore, some women made similar remarks about a task over a period of 3 years, reporting having difficulty at some interviews but not at others. Both findings underscore the conclusion that if subclinical disability is a focal construct for the population, then perhaps subliminal difficulty is a focal concept at the level of the individual. Descriptive work is needed to reveal what it is like for older persons when underlying perceptions bordering on having difficulty with a task start to scratch at the surface of the consciousness.
By spontaneously talking about their hardest or biggest jobs, the women suggested a fertile field for exploratory study, especially with regard to tasks rarely included on ADL/IADL lists. Because they tap gender- and culture-specific variations of this life-world element, variations in the hardest job could be detailed over time at the individual level. Researchers might find it more useful to ask about the hardest job rather than to solicit difficulty ratings for discrete tasks. If each person is asked to name the hardest job, then researchers need not adopt the potentially erroneous assumption that the task with the highest rating is the most difficult. Practitioners might begin an assessment of tasks by asking clients about their hardest tasks.
A Counterview to Typical Methods of Measuring Difficulty
To streamline epidemiological measurement of constructs like functional impairment, researchers have used difficulty as the operational construct and measured it with ADL/IADL tools. They have done this without sufficient consideration of the subjective nature of difficulty. For participants in this study, difficulty was indeed a "subjective perception" (Reuben et al., 2004, p. 1060). I recommend that researchers who conduct epidemiological studies define the term difficulty. That recommendation is not antithetical to the position that difficulty is a subjective perception, if in fact researchers (a) draw upon findings of rigorous qualitative studies about the nature of difficulty rather than using standardized, scholarly definitions; and (b) offer the opportunity for participants to share their own perspectives about the nature of difficulty.
Thus, in ongoing efforts to measure difficulty, the field needs a new perspective that gives credence to the wisdom of older persons about the essence of their experience and, at the same time, allows and welcomes the opportunity for dialogue about the "thing" that is being measured. Researchers working with various methods (and across methods) must interface (a) to discuss how to decide what counts as denial (or acknowledgment) of difficulty and (b) to consider whether that criterion should vary with the design or method. Some women rated difficulty, talked about the task, and then offered another rating, suggesting that the identification of subclinical disability from a one-time response might not be valid. Studies should involve multiple data points; if older women understand difficulty as variable, repeated measures are necessary. Participants could be asked to base a rating on a former rating and to talk about reasons for changes. Researchers should consider potential adverse affects of question content upon respondents. To ask if a woman has difficulty might be to imply that she does not know how to do the task. It might be better to ask, "Is it hard to do X? If so, how hard is it on this scale?"
These findings suggest the need for compatible changes in difficulty frameworks and in methods used to study difficulty. Self-reports are needed not only to capture "experiences that shift the individual's perception from ‘no difficulty’ to having ‘difficulty’ in a task" (Gregory & Fried, 2003, p. 14), but to explore the range of perceptions about difficulty. Difficulty could be envisioned as a dialectic as well as a dichotomy, and large panel studies could accommodate both perspectives. A subsample in the National Long-Term Care Survey could be asked to talk about task difficulty as they rate it. Frequencies of life-world elements associated with difficulty could be counted, and new elements could be discerned. Because persons might mention a new perception about a task several times in as many sentences while denying having difficulty, scholars could peruse qualitative data for meaningful quantitative inferences. Variability in elements could be explored in demographic context. Elements revealed in studies with old persons could be compared to those of younger-old participants in the Health and Retirement Study.
My aim here was not to explore how older women defined difficulty, but rather to describe how they understood it relative to tasks. Difficulty has been an indicator of other constructs, but as Uhlenberg (1995) observed, "theoretically relevant variables [should be differentiated] from the operational indicators of those variables" (p. 549). Perhaps difficulty is a pertinent variable in its own right. To continue exploring its inherent complexity, researchers could ask participants the question raised by Ms. B: "What is difficulty?" Ongoing conversations on that topic with older persons could broaden the understanding of difficulty and stimulate essential questions about the validity of extant measures of the construct.
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Received for publication April 10, 2006. Accepted for publication October 18, 2006.
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