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.
ADL is also part of the MOST score.
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.