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 (independent) (0 points), minor assistance (3 points), major assistance (6 points).
• The ADL is also being used as a component of the "MOST" Score

General Considerations

• ADL - assess functional status during the first 24 hours after the patient has been "accepted" to medicine service by a medicine service attending physician.
• Where a non-independent ADL is induced solely by medical intervention, estimate the ADL without intervention.
• ADL assesses a patient "capability" to perform a certain activity if allowed. Patients who are ordered not to do a certain activity should not be assessed as requiring assistance. If patient would be able to perform the activity if allowed then they are to be assessed as "unassisted".

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

Major

• 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

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.

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)

Minor

• moves in and out of bed or chair with assistance

Major

• doesn't get out of bed

Continence

Following discussion with Dr. Dan Roberts and due to the way we use our data, our definition of "continence" differs somewhat from the Katz definition in our take on Foley catheters. In our definition a Foley catheter is to be scored as "unassisted" or as "major" depending on circumstances.

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
  • If patient manages Foley at home on his own
  • If Foley is inserted solely to keep track of fluid output

Minor

• has occasional "accidents"

Major

• supervision helps keep urine or bowel control; catheter is used, or is incontinent
• if Foley inserted because patient is unable to control bladder function

Feeding

Unassisted

• feeds self without assistance
• NPO due to pre-OP, tests or procedures or GI bleeding

Minor

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

Major

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

Discussion

• Needs to include where this data is to be gathered from, and where not, i.e. physio discharge notes are inappropriate etc. Yes, the instruction that data should be during the first 24hrs may already say that, but maybe not for patients discharged after less than a day. Ttenbergen 15:02, 21 August 2008 (CDT)

• Where and how should this information be collected? There are differences in how the hospital work, but we should have a common starting direction at least.

According to team meeting,

• Grace gets what they can off ER sheet, then use ward records; This may not be "within first 24 hrs of admission" - is it good enough?

• 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 - does OT/PT use the same criteria as us? If not, this likely is not appropriate.
  • The OT/PT notes include functional status prior to admission and a current functional status at the time of the assessment. These notes are very detailed. We have also been seeing more and more detailed home care reports on the patient's charts regarding functional status and services that are in place prior to admission.TAngell 09:53, 20 November 2008 (CST)

• 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. - as above, are those who fill out other ADLs using the same criteria as us?

We have addressed that status during first 24 hrs is what should be collected. Should it really be worst status during the first 24 hrs?

• • Worst in some locations
  • most likely accurate in other location
  • some use pre-admission ADL, some use only 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" - not true if the patient requires assistance when not sedated. Our definition above is clearer than this, so we should get rid of this.

• NPO due to pt aphasic = major (I suspect disphagic was intended here, or do we also have patients NPO because they can't talk? )

• • • I have a patient who came in with independent ADLs then went to the cath lab and had a coronary angio complicated by an embolic stroke.Now he is a complete in bathing and major in mobility .So I guess I can only change my adls if the stroke occurred within 24 hours .Is this correct?

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
  • This is a dead end link that doesn't provide any information, therefore should be taken out.

TOstryzniuk 13:06, 19 November 2008 (CST)

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