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Assess functional independence using the Katz Index for Basic Activities of Daily Living (ADL) and the Lawton Scale for Instrumental Activities of Daily Living (IADL).
Rate each activity: 1 = Independent, 0 = Needs Assistance
Rate each activity: 1 = Independent, 0 = Needs Assistance
Basic ADL Score (Katz Index)
0 / 6
Instrumental ADL Score (Lawton Scale)
0 / 8
Care Recommendations:
Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are standardized assessments used to evaluate functional independence. The Katz Index, developed in 1963, measures basic self-care abilities, while the Lawton Scale assesses more complex activities necessary for independent community living.
The Katz Index evaluates six fundamental personal care activities: bathing, dressing, toileting, transferring, continence, and feeding. These activities are hierarchical, with feeding typically being the last function lost and the first regained during recovery. A score of 6 indicates full independence, while lower scores suggest increasing need for assistance.
The Lawton Scale measures eight complex activities required for independent living in the community: telephone use, shopping, food preparation, housekeeping, laundry, transportation, medication management, and financial management. IADL impairment typically precedes basic ADL decline and may indicate early cognitive or physical decline.
ADL and IADL assessments guide care planning, determine eligibility for services, monitor disease progression, and evaluate treatment effectiveness. Regular reassessment helps identify declining function early, allowing for timely interventions such as home modifications, assistive devices, or increased support services.
Basic ADLs are fundamental self-care activities essential for daily living (bathing, dressing, eating), while IADLs are more complex activities needed for independent community living (managing finances, using transportation, shopping). IADL impairment typically occurs before ADL impairment in progressive conditions.
Initial assessment should occur during comprehensive geriatric evaluation, hospital admission, or when enrolling in care services. Reassessment is recommended every 6-12 months for stable patients, more frequently (monthly to quarterly) for those with progressive conditions, and immediately following any significant health event or hospitalization.
Any trained healthcare professional can conduct ADL/IADL assessments, including nurses, social workers, occupational therapists, and physicians. Occupational therapists provide the most comprehensive functional assessments and can recommend specific interventions and adaptive equipment to maximize independence.
Eligibility varies by insurance and program. Medicare typically requires dependence in at least 2-3 ADLs for home health aide services. Medicaid and long-term care insurance have varying thresholds. Documentation must show skilled nursing or therapy need, homebound status, and that care is medically necessary and reasonable.
Yes, particularly when decline is due to acute illness, surgery, or reversible conditions. Rehabilitation, physical/occupational therapy, treatment of underlying conditions, proper nutrition, and appropriate assistive devices can restore function. However, progressive conditions like dementia typically show continued functional decline despite interventions.
Common devices include grab bars, shower chairs, raised toilet seats, long-handled reachers, dressing aids, adaptive utensils, medication organizers, and mobility aids. Occupational therapy evaluation ensures proper equipment selection, fitting, and training. Many devices are covered by insurance with appropriate documentation.
Cognitive impairment typically affects IADLs first (finances, medications, complex tasks), followed by basic ADLs as the condition progresses. Safety concerns may necessitate supervision even when physical ability is intact. Assessment should distinguish between physical inability and cognitive impairment requiring cueing or supervision.
ADL dependence is a strong predictor of mortality, particularly in older adults. Each additional ADL dependency increases mortality risk by approximately 10-20%. ADL assessment helps with prognostication, advance care planning, and determining appropriate levels of care. Rapid functional decline often indicates serious underlying illness requiring evaluation.
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