ADL General Collection Information

Activities of Daily Living (ADL) refers to daily self-care activities.

Collection Instructions

The ADL assesses a patient's capability to perform a certain activity. Enter the status into the ADL dropdown boxes in the ADL tab in CCMDB.mdb.

Timeframe

An ADL assessment is usually done within 24 hours of admission (done by allied health or nurses). The ADL assessment we utilize is the patient's state of activity on admission (not at home prior to admission). It takes into consideration acute medical issues that resulted in admission to the hospital.

Directed Restrictions

Directed restrictions on a patient's activities should not be assessed as requiring assistance. For example, if a pt is on bedrest restrictions, it does not mean that they are unable physically to get out of bed. If the patient would be able to perform the activity if allowed then they are to be assessed accordingly.

Where to get data

Data to evaluate ADL can be obtained from the following sources:

• OT/PT initial assessment
• Nursing activity flow sheets (if used)
• Nursing database or primary care patient record
• Integrated progress notes
• Risk assessment for falls form (if used)

Specific Activities collected

See the following for specific coding instructions for the different activities.

• ADL Bathing
• ADL Dressing
• ADL Toiletting
• ADL Transfering
• ADL Continence
• ADL Feeding

Scoring

The field is driven by S_ADLOptions table.

score used by Template:Discussion by what, created_variables_common_maker query, created_variables_CC_maker query?? Ttenbergen 16:14, 2017 February 6 (CST)

Performance of each of the activities is evaluated as unassisted (0 points), minor assistance (3 points), or major assistance (6 points).

Total ADL Score is the sum of points of all the six activities.

ADL is also part of the MOST score.

in CCMDB.mdb

In CCMDB the ADLs are stored as their full words rather than scores, e.g. "ADL_Bathing" might have a value of "unassisted". The values are entered via dropdown list, which is driven by the S_ADLOptions table. In that table there is a column "sorter" with numbers used to change the order the values appear in the dropdown list. The column is not a score and not used for anything beyond sorting.

In TMSX

As per email from Julie 2013-12-17:

Ed’s database assigns the points 1, 3, 6 to unassisted, minor and major respectively.

But in calculating the MOST Score, the point for unassisted has zero point instead of one.

So maybe you have to change the S_ADL options from 2,4,6 not to 1,3,6 but 0,3,6.

Presumably Ed assigns the score upon importing the True/false columns and processing them.

If we were to change the numbers to 0, 3, 6, then do we use ADL score anywhere other than MOST, where this would mess with data?

For now I will add "ADL_Score" and "MOST_Score" columns to the S_ADLOptions table with the values as described.

References/Background

The evaluation tool used for all Medicine patients is the Katz ADL.

• S Katz et al. Studies of illness in the aged: the index of ADL. American Medical Association, 1963.
• S Katz, SD Downs, HR Cash, RC Grotz. Index of daily living. The Gerontologist 1:20-301.