Activities of daily living

Activities of daily living (ADLs or ADL) is a term used in healthcare to refer to people's daily self care activities. The concept of ADLs was originally proposed in the 1950s by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, OH and has been added to and refined by a variety of researchers since that time.^[1] Health professionals often use a person's ability or inability to perform ADLs as a measurement of their functional status, particularly in regard to people post injury, with disabilities and the elderly.^[2] Younger children often require help from adults to perform ADLs, as they have not yet developed the skills necessary to perform them independently.

ADLs are defined as "the things we normally do... such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure."^[3] A number of national surveys collect data on the ADL status of the U.S. population.^[4] While basic definitions of ADLs have been suggested, what specifically constitutes a particular ADL for each individual may vary. Adaptive equipment and devices may be used to enhance and increase independence in performing ADLs.

Basic

Basic ADLs consist of self-care tasks that include, but are not limited to:^[5]

• Bathing and showering
• Personal hygiene and grooming (including brushing/combing/styling hair)
• Dressing
• Toilet hygiene (getting to the toilet, cleaning oneself, and getting back up)
• Functional mobility, often referred to as "transferring", as measured by the ability to walk, get in and out of bed, and get into and out of a chair; the broader definition (moving from one place to another while performing activities) is useful for people with different physical abilities who are still able to get around independently.
• Self-feeding (not including cooking or chewing and swallowing)

One way to think about basic ADLs is that they are the things many people do when they get up in the morning and get ready to go out of the house: get out of bed, go to the toilet, bathe, dress, groom, and eat.

There is a hierarchy to the ADLs:" ... the early loss function is hygiene, the mid-loss functions are toilet use and locomotion, and the late loss function is eating. When there is only one remaining area in which the person is independent, there is a 62.9% chance that it is eating and only a 3.5% chance that it is hygiene." ^[6]

Although not in wide general use, a mnemonic that some find useful is DEATH: dressing/bathing, eating, ambulating (walking), toileting, hygiene.^[7]

Instrumental

Instrumental activities of daily living (IADLs) are not necessary for fundamental functioning, but they let an individual live independently in a community:^[8][9]

• Cleaning and maintaining the house
• Managing money
• Moving within the community
• Preparing meals
• Shopping for groceries and necessities
• Taking prescribed medications
• Using the telephone or other form of communication

A useful mnemonic is SHAFT: shopping, housekeeping, accounting, food preparation/meds, telephone/transportation.

Occupational therapists often evaluate IADLs when completing patient assessments. The American Occupational Therapy Association identifies 12 types of IADLs that may be performed as a co-occupation with others:^[10]

• Care of others (including selecting and supervising caregivers)
• Care of pets
• Child rearing
• Communication management
• Community mobility
• Financial management
• Health management and maintenance
• Home establishment and maintenance
• Meal preparation and cleanup
• Religious observances
• Safety procedures and emergency responses
• Shopping

Role of occupational therapy

Occupational therapists use exercises to assist patients in maintaining and gaining independence in ADLs. The exercise program is based on what components patients are lacking such as walking speed, strength, balance, and coordination. Slow walking speed is associated with increased risk of falls. Exercise enhances walking speed, allowing for safer and more functional ambulation capabilities. After initiating an exercise program it is important to maintain the routine otherwise the benefits will be lost.^[11] Exercise for patients who are frail is essential for preserving functional independence and avoiding the necessity for care from others or placement in a long term care facility.^[12]

Assistance

Assisting in activities of daily living are skills required in nursing and as well as other professions such as nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed. For hygiene, this often involves bed baths and assisting with urinary and bowel elimination.

Evaluation

There are several evaluation tools, such as the Katz ADL scale,^[13] the Older Americans Resources and Services (OARS) ADL/IADL scale, the Lawton IADL scale and the Bristol Activities of Daily Living Scale.

Most models of health care service use ADL evaluations in their practice, including the medical (or institutional) models, such as the Roper-Logan-Tierney model of nursing, and the resident-centered models, such as the Program of All-Inclusive Care for the Elderly (PACE).

Research

ADL evaluations are used increasingly in epidemiological studies as an assessment of health in later-life that does not necessarily involve specific ailments. Studies using ADL differ from those investigating specific disease outcomes, as they are sensitive to a broader spectrum of health effects, at lower-levels of impact. ADL is measured on a continuous scale, making the process of investigation fairly straightforward.

Sidney Katz initially studied 64 hip fracture patients over an 18-month period. Comprehensive data on treatments, patient progression, and outcomes were collected during this study. After analyzing the study data, the researchers discovered that the patients they viewed as being most independent could perform a set of basic activities – ranging from the most complex bathing activity, to the least complex feeding activity. From these data, Katz developed a scale to assess patients' ability to live independently.^[14] This was first published in the 1963 in the Journal of the American Medical Association; the paper has since been cited over 1,000 times.^[15]

Although the scale offers a standardized measure for psychological and biological function, the process of arriving at this assumption has been criticised. Specifically, Porter has argued for a phenomenological approach noting that:

Katz et al. (1963) made a claim that became the basis for the ontological assumptions of the ADL research tradition. In their suggestion that there was an "ordered regression [in skills] as part of the natural process of aging" (p. 918), there was an implicit generalization, from their sample of older persons with fractured hips, to all older persons.^[16]

Porter emphasizes the possible disease-specific nature of ADLs (being derived from hip-fracture patients), the need for objective definition of ADLs, and the possible value of adding additional functional measures.^[16]

A systematic review examined the effectiveness of imparting activities of daily life skills programmes for people with chronic mental illnesses:

See also

References

External links

• The Thin Edge of Dignity Moving presentation about one man's experience in an assisted living facility.