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Index of Activities of Daily Living (ADLs)

The Index of Activities of Daily Living is based on an evaluation of the functional independence or dependence of patients in bathing, dressing, going to the toilet, transferring, continence, and feeding. Specific definitions of functional independence and dependence appear below the index. (These definitions can be used to convert the data recorded in the evaluation form into an Index of ADL grade.)

Evaluation Form

Name _____________________________________________
Day and Date of Evaluation _____________________, __/__/__

For each area of functioning listed below, check description that applies. (The word "assistance" means supervision, direction, or personal assistance.)

Bathing (either sponge bath, tub bath, or shower)
__Receives no assistance (gets in and out of tub by self if tub is usual means of bathing)
__Receives assistance in bathing only one part of the body (such as back or a 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, including braces if worn)
__Gets clothes and gets completely dressed without assistance
__Gets clothes and gets dressed without assistance except for assistance in tying shoes
__Receives assistance in getting clothes or in getting dressed, or stays partially or completely undressed

Toileting (going to the "toilet room" for bowel 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 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 room termed "toilet" for the elimination process

Transfer
 __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)
__Moves in and out of bed or chair with assistance
__Doesn't get out of bed

Continence
 __Controls urination and bowel movement completely by self
__Has occasional "accidents"
__Supervision helps keep urine or bowel control; catheter is used, or is incontinent

Feeding
 __Feeds self without assistance
__Feeds self except for getting assistance in cutting meat or buttering bread
__Receives assistance in feeding or is fed partly or completely by using tubes or intravenous fluids

After filling out the form, convert the data collected into an ADL grade by using the definitions provided below.

Grading

  1. Independent in feeding, continence, transferring, going to the toilet, dressing, and bathing.
  2. Independent in all but one of these functions.
  3. Independent in all but bathing and one additional function.
  4. Independent in all but bathing, dressing, and one additional function.
  5. Independent in all but bathing, dressing, going to the toilet, and one additional function.
  6. Independent in all but bathing, dressing, going to the toilet, transferring, and one additional function.
  7. Dependent in all six functions.
  8. Other: Dependent in at least two functions, but not classifiable as C, D, E, or F.

Independence means without supervision, direction, or active personal assistance, except as specifically noted below. This is based on actual status and not on ability. A patient who refuses to perform a function is considered as not performing the function, even though he or she is deemed able.

Bathing (Sponge, Shower, or Tub)
Independent: assistance only in bathing a single part (such as back or disabled extremity) or bathes self completely
Dependent: assistance in bathing more than one part of body; assistance in getting in or out of tub or does not bathe self

Dressing
 Independent: gets clothes from closets and drawers; puts on clothes, outer garments, braces; manages fasteners; act of tying shoes is excluded
Dependent: does not dress self or remains partly undressed

Going to Toilet
 Independent: gets to toilet; gets on and off toilet; arranges clothes; cleans organs of excretion; (may manage own bedpan used at night only and may or may not be using mechanical supports)
Dependent: uses bedpan or commode or receives assistance in getting to and using toilet

Transfer
 Independent: moves in and out of bed independently and moves in and out of chair independently (may or may not be using mechanical supports)
Dependent: assistance in moving in or out of bed and/or chair; does not perform one or more transfers

Continence
 Independent: urination and defecation entirely self-controlled
Dependent: partial or total incontinence in urination or defecation, partial or total control by enemas, catheters, or regulated use of urinals and/or bedpans

Feeding
 Independent: gets food from plate or its equivalent into mouth (precutting of meat and preparation of food, as buttering bread, are excluded from evaluation)
Dependent: assistance in act of feeding (see above); does not eat at all or parenteral feeding

Source: Katz, S.; Ford, A.B.; Moskowitz, R.W.; et al. Studies of illness in the aged. The Index of ADL: A standardized measure of biological and psychosocial function. JAMA 1963, 185:914-919.

References

  1. Katz, S.; Downs, T.D.; Cash, H.R.; et al. Progress in development of the Index of ADL. Gerontologist 1970, 10(1):20-30.
  2. Katz, S., and Akpom, C.A. Index of ADL. Medical Care 1976, 14(suppl. 5):116-118.
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