ADL General Collection Information

Activities of Daily Living (ADL) refers to daily self-care activities within an individual's place of residence, in outdoor environments, or both. The evaluation tool used by Medicine is the Katz ADL and is used for all Medicine patients.

Specifically, the Katz ADL tool is used to:

• Assess a patient's functional status as a measurement of their ability to perform activities of daily living independently.
• Rank adequacy of performance in six functions: bathing, dressing, toileting, transferring, continence, and feeding.

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

Activities

Activity	Description	Unassisted	Minor Assistance	Major Assistance
Bathing	Either sponge bath, tub bath, or shower	Receives no assistance (gets in and out of tub if tub is the usual means of bathing)	Receives assistance in bathing only one part of the body (such as the back or leg)	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, e.g., for braces	Gets clothes and gets completely dressed without assistance	Gets their clothes and gets dressed without assistance except in tying shoes or buttoning or zipping up items	Receives assistance in getting clothes or in getting dressed or stays partly or completely undressed
Toileting	Going to the "toilet room" for bowel movement and urine elimination; cleaning self after elimination, and arranging clothes	Goes to "toilet room", cleans self, and arranges clothes without assistance; may use object for support such as cane, walker, or wheelchair and may manage night bedpan or commode, emptying same in the morning	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	Doesn't go to "toilet room" for elimination process
Transferring	Moving from one place to another while performing activities	Moves in and out of bed as well as in and out of chair without assistance; may use object for support such as cane or walker	Moves in and out of bed or chair with assistance	Doesn't get out of bed
Continence	Control of urination and bowel movements	Controls urination and bowel movement completely by self, including patients with chronic renal failure; manages Foley at home on own (Foley is inserted solely to keep track of fluid output)	Has occasional "accidents"	Supervision helps keep urine or bowel control; catheter is used, or patient is incontinent; Foley is used because patient is unable to control bladder function (if it cannot be determined if the patient would be continent without a foley and the patient has a Foley, then score as major)
Feeding	Preparing and eating food	Feeds self without assistance; NPO due to pre-OP, tests or procedures or GI bleeding	Feeds self except for getting assistance in cutting meat or buttering bread	Receives assistance in feeding of is fed partly or completely by using tubes or intravenous fluids; dysphagia

Assessment guidelines

An ADL assessment is conducted by the attending physician during the first 24 hours after arrival of the patient to a Medicine unit. The ADL assesses a patient's capability to perform a certain activity irrespective of any subsequent medical intervention. Moreover, restrictions on a patient's activities should not be assessed as requiring assistance. If the patient would be able to perform the activity if allowed then they are to be assessed accordingly. An ADL assessment should also occur prior to surgery.

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)

References

• 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.