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 for all Medicine patients is the Katz ADL.

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.

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 usually done within 24 hours of admission (done by allied health or nurses). The ADL assesses a patient's capability to perform a certain activity. 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. 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. --LKolesar 15:10, 2013 May 30 (EDT)

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)

Scoring

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 table s_ADLOptions. 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.

on sending from CCMDB.mdb to TMSX

When exporting to TMSX ADLs are encoded by setting one of three columns per value to "TRUE" and the rest to "FALSE"; no score is included.

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 s_ADLOptions with the values as described.

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.