Activities of daily living evaluation

Definition

An activities of daily living (ADL) evaluation is an assessment of an individual's physical and sometimes mental skills. In the area of physical or occupational therapy, it reflects how well a disabled individual or someone recovering from disease or accident can function in daily life. It is also used to determine how well individuals relate to and participate in their environment.

Purpose

ADL evaluations help practitioners determine how independent patients are and what activities they can perform on their own, as well as to gauge how independent each individual can become after intervention by a health professional. The goal of practitioners performing ADL evaluations is to help patients become as independent as possible, using appropriate adaptations if needed.

Description

Many ADL indexes exist, such as the Katz Index, Revised Kenny Self-Care Evaluation, and the Barthel Index. These indexes typically evaluate patients on their self-care skills and rate each individual according to how functional they are. Scoring is based on how independently a task can be performed and whether supervision or assistance is needed in performing the task.

Basic ADL versus instrumental ADL

Basic activities of daily living are those skills needed in typical daily self care. An evaluation consists basic activities such as bathing, dressing, feeding, and toileting. The evaluator examines various activities in each category to determine the patient's skill. Afterward it can be determined what, if any, changes will be necessary to allow the patient to function as independently as possible.

Instrumental activities of daily living refer to skills beyond basic self care that evaluate how individuals function within their homes, workplaces, and social environments. Instrumental ADLs may include typical domestic tasks, such as driving, cleaning, cooking, and shopping, as well as other less physically demanding tasks such as operating electronic appliances and handling budgets. In the work environment, an ADL evaluation assesses the qualities necessary to perform a job, such as strength, endurance, manual dexterity, and pain management . The instrumental activities of daily living may vary from individual to individual as different patients have

different requirements for independent functioning, based on what type of employment he or she has, what the home living situation is like, what kinds of other activities he or she regularly participates in, and others environment-specific factors.

Whether individuals being treated following an injury or disorder diagnosis need an intervention depends upon how severely functional ability has been affected. If an individual's ADL function is not restored, a health care professional will perform an intervention. This entails helping the individual adapt to permanent dysfunction or regain meaningful function. How well an individual must perform various tasks depends on the living setting he or she is returning to, for example, whether it is a full custodial facility, assisted living community, or living at home independently.

Preparation

No specific preparations are required for this procedure.

Aftercare

No specific aftercare is required following this procedure. It may be beneficial to discuss the outcome of evaluation with the patient and explain what kinds of therapy or interventions may help to improve functional abilities.

Complications

There are no complications expected from an activities of daily living evaluation. However, complications may arise from treatment received after the evaluation.

Results

The activities of daily living evaluation will provide all health care professionals involved in treating the patient with a better understanding of that patient's abilities and limitations. This information can then be used to help develop a plan for intervention if it is indicated. Interventions that may be implemented to increase function include adaptations and home modification. Adaptations are devices that enhance the usability of everyday items for individuals who have a limited range of motion. Home modification involves the process of making one's living environment more functional for ADL.

KEY TERMS

Adaptation —Altering a tool used in performing a task so that the individual is better able to function independently or with minimal assistance.

Dressing stick —A long rod with a hook attached to the end that a patient uses in place of the hands. Typically a dressing rod would be used to pull on a pair of pants or socks.

Home modification —Altering the physical environment of the home so as to remove hazards and provide an environment that is more functional for the individual. Examples of home modification include installing grab bars and no-slip foot mats in the bathroom to prevent falls.

Adaptations

There are several ways that adaptations can be used to make common household items more functional. For example, patients who have a weakened grasp insufficient to hold heavy or small objects may use enhancements such as easily gripped handles that are added to small objects, such as eating utensils or personal grooming items. Other adaptations may involve the use of unique tools to facilitate tasks, such as a long rod with a hook at one end, known as a dressing stick, to pull on pants or socks. Adaptations may involve altering the environment to aid in other tasks, such as providing adequate lighting or magnifying lenses to compensate for a vision impairment.

Home modifications

Home modification has become a focus of occupational therapists. In order for patients to return home or go to a group setting, the physical environment of the house or facility may have to be altered to make ADL function better. Common examples of home modifications include the installation of grab bars in the shower, toilet area and hallways; lower kitchen counters for easier access to wheelchair-bound individuals; and the elimination of potential trip points, such as loose throw rugs and slight changes in floor elevation.

Caregiver concerns

Occupational therapists and physical therapists are the two primary disciplines most qualified to assess ADL function and recommend the appropriate interventions and modifications in the home and work environment. Physical therapists might focus primarily on a patient's mobility and ambulation, while the occupational therapist might focus on more specific tasks described above.

Resources

BOOKS

Emlet, Charles A., Jeffrey L. Crabtree, and Victoria Ann Condon, eds. In-Home Assessment of Older Adults: an Interdisciplinary approach, 2nd ed. Austin, TX: Pro-Ed, 2006.

Gallo, Joseph J., et al., ed. Handbook of Geriatric Assessment, 4th ed. Sudbury, MA: Jones and Bartlett Publishers, 2006.

Levine, Carol, ed. Family Caregivers on the Job: Moving Beyond ADLs and IADLs. New York: United Hospital Fund of New York, 2004.

PERIODICALS

Lynch, Scott M., Scott Brown, and Katherine G. Harmsen. “The Effect of Altering ADL Thresholds on Active Life Expectancy Estimates for Older Persons.” The Journals of Gerontology, Series B58 (May 2003): 171–179.

Ponzetto, Maria, et al. “Risk Factors for Early and Late Mortality in Hospitalized Older Patients: the Continuing Importance of Functional Status.” The Journals of Gerontology, Series A58 (November 2003):1049–1054.

ORGANIZATIONS

The American Occupational Therapy Association, 4720 Montgomery Lane, Bethesda, MD, 20824, (301) 652-2682, http://www.aota.org.

The American Physical Therapy Association, 1111 North Fairfax Street, Alexandria, VA, 22314-1488, (703) 684-2782, http://www.apta.org.

Meghan M. Gourley

Tish Davidson A.M.