ADL

The KATZ Index of Independence in Activities of Daily Living commonly referred to as the Katz ADL, is collected on all patients accepted to the Medicine service.

• KATZ ADL is used to assess functional status as a measurement of a patient's ability to perform activities of daily living independently.
• KATZ ADL ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence and feeding.
• Adequacy of performance scoring: Unassisted (Independant) (0 points), Minor assistance (3 points), Major Assistance (6 points).
• The ADL is also being used as a component of the "MOST" Score (Medical Outcome Strafitication and Triage". MOST is a locally tested and validated risk stratification assessment which is made at the time of acceptance to Medicine Service).

It is not the question if a patient is not allowed to perform an activity, or if there are no facilities for the patient to be independent. If patient would be able to do the activity, they should be scored as "unassisted".

General Considerations

• ADL - assess functional status during the first 24 hours once accepted to medicine service.TOstryzniuk 17:31, 20 June 2008 (CDT) & Dan Roberts

• NOTE: ADL assesses a patient "capability" to perform a certain activity if allowed. A patient who is order by a physician or restricted by hospital policy not to do a certain activity should not be assessed as physically disabled.

Bathing

Either sponge bath, tub bath or shower.

Unassisted

• receives no assistance (gets in and out of tub if tub is the usual means of bathing)

Minor

• receives assistance in bathing only one part of the body (such as the back or leg)

Major

• receives assistance in bathing more than one part of the body (or not bathed)

Dressing

Gets clothes from closets and drawers - including underclothes, outer garments and using fasteners (including braces if worn)

Unassisted

• gets clothes and gets completely dressed without assistance

Minor

• gets their clothes and gets dressed without assistance except in tying shoes or buttoning or zipping up items--JHutton 10:08, 11 June 2008 (CDT)TOstryzniuk 17:33, 20 June 2008 (CDT)

Major

• receives assistance in getting clothes or in getting dressed or stays partly or completely undressed

Toiletting

Going to the "toilet room" for bowel movement and urine elimination; cleaning self after elimination, and arranging clothes

Unassisted

• goes to "toilet room", cleans self, and arranges clothes without assistance (may use object for support such as cane, walker, or wheelchair and my manage night bedpan or commode, emptying same in the morning.

• NOTE: if there is a hospital policy that restricts a patient to bed rest, thought patient may be able to go to the bathroom on his own if allowed, document this as unassisted.

Minor

• receives assistance in going to "toilet room" or in cleansing self or in arranging clothes after elimination or in use of night bedpan or commode.

Major

• doesn't go to "toilet room" for elimination process

Transfer

Unassisted

• moves in and out of bed as well as in and out of chair without assistance (may be using object for support such as cane or walker)
• NOTE: if there is a hospital policy that restricts a patient to bed rest, thought patient would be able to move in and out of bed on his on his own if allowed, document this as unassisted.

Minor

• moves in and out of bed or chair with assistance

Major

• doesn't get out of bed

Continence

Unassisted

• controls urination and bowel movement completely by self.
  • Chronic Renal Failure (CRF) receiving regular dialysis- if patient can access and use a toilet by themselves and can control bowel function - unassisted.
  • If patient manages foley at home on his own - unassisted
  • If foley is inserted to keep track of fluid output - unassisted

Minor

• has occasional "accidents"

Major

• supervision helps keep urine or bowel control; catheter is used, or is incontinent

Discussion

• does the use of a foley from home or within the first 24 hours qualify as Dependant. The KATZ states "Dependant as assistance; incontinent or cathether used (as with the use of a foley).
  • If patient manages foley at home on his own - unassisted
  • If foley is inserted to keep track of fluid output - unassisted
  • If foley inserted because patient is unable to control urination - Major assistance.TOstryzniuk 17:51, 20 June 2008 (CDT)& Dan Roberts.

Feeding

Unassisted

• feeds self without assistance

Minor

• feeds self except for getting assistance in cutting meat or buttering bread

Major

• receives assistance in feeding of is fed partly of completely by using tubes or intravenous fluids.
• E.G. DysphagiaTOstryzniuk 17:59, 20 June 2008 (CDT)

Discussion

• when a person arrives to the unit within the first 24 hours NPO either for a test or for GI Bleed does this qualify as Dependant? The KATZ says 'Dependant is assistance to eat; does not eat (I interpret this to include NPO); must be fed; fed partly or completely by NG or IV.

• • NO - ADL assesses a patient "capability" to perform a certain activity if allowed. A patient who is order by a physician or restricted by hospital policy not to do a certain activity should not be assessed as physically disabled. This includes NPO due to PRE-OP, Test or GI bleeding. If the patient was allowed to each he could. TOstryzniuk 17:57, 20 June 2008 (CDT)

Discussion

• we want to get back to the way it was done before the confusion of instructions.

Current

• Grace: gets what they can off ER sheet, then use ward records
• Vic: go through ER, then as close as possible on Ward, OT/PT does good job usually within 24hr (MOST patients are assessed). Lots of nursing home placements are why this is done
• StB: ER assessment for falls assessment / risk sheet / prevention program; sometimes filled by ward nurses, then you have physio and OT and home care, latter usually for elderly patients only.

• what values are used
  • Worst in some locations
  • most likely accurate in other location
  • some use pre-admission ADL, some use ony after WARD admission
  • "how they are normally"
  • some changed from "usual" pre-2007 to "worst" after
  • sedated patient is coded as if they were unassisted

--- Dr. Roberts says: Code what they are like within the first 24 hr after admission. In cases where the current ADL is induced solely by medical intervention, consider ADL if we did not intervene.

• NPO before procedure = unassisted
• NPO due to pt aphasic = major
• Foley to measure output = unassisted
• Foley because unable to self-serve = major

---

Example: changes via a stroke.

Reference

• Studies of Illness in the Aged: The Index of ADL; a standardized measure of ...ological and Psychological functioning. by Katz S, et al.. Copyright 1963 by the American Medical Association. Reprinted with permission of AMA via the Copyright Clearance Center.

• http://classes.kumc.edu/som/amed900/ExposureSkills/Katz_Index_ADL.htm

• S Katz, TD Downs, HR Cash, RC Grotz, (1970). Index of Activities of Daily Living, The Gerontologist, 1:20-301.