The contribution of chronic diseases to the disability burden differs by gender, age, and disability severity level. Although reporting any difficulty in performing an ADL is considered a severe limitation, as ADLs are defined as basic tasks of daily life required for survival [26], longitudinal studies have shown that information on difficulty and dependence in performing ADLs are complementary. Thus, if both difficulty and dependence are assessed, they can better represent the continuum of disability than if severity level is ignored [36, 37]. Also, it has been demonstrated that a large proportion of the elderly individuals who report ADL is not homogenous, reinforcing the importance of assessing both, difficulty and dependence, to better understand this heterogeneity [37].