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Katz Index of Independence in Activities of Daily Living (ADL)

Issue Number 2, Revised 2007 Series Editor: Marie Boltz, PhD, APRN, BC, GNPM anaging Editor: Sherry A. Greenberg, MSN, APRN, BC, GNPNew York University College of NursingKatz Index of Independence in Activities of Daily Living (ADL)By: Meredith Wallace, PhD, APRN, BC, Fairfield University School of Nursing, andMary Shelkey, PhD, ARNP, Virginia Mason Medical CenterWHY:Normal aging changes and health problems frequently show themselves as declines in the functional status ofolder adults. Decline may place the older adult on a spiral of iatrogenesis leading to further health problems. One of thebest ways to evaluate the health status of older adults is through functional assessment which provides objective datathat may indicate future decline or improvement in health status, allowing the nurse to intervene TOOL:The Katz Index of Independence in Activities of Daily Living , commonly referred to as the Katz ADL, is themost appropriate instrument to assess functional status as a measurement of the client s ability to

housework, shopping, managing finances and telephoning. Although the Katz ADL Index is sensitive to changes in declining health status, it is limited in its ability to measure small increments of change seen in the rehabilitation of older adults. A full comprehensive geriatric assessment should follow when appropriate. The Katz ADL Index is very

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Transcription of Katz Index of Independence in Activities of Daily Living (ADL)

1 Issue Number 2, Revised 2007 Series Editor: Marie Boltz, PhD, APRN, BC, GNPM anaging Editor: Sherry A. Greenberg, MSN, APRN, BC, GNPNew York University College of NursingKatz Index of Independence in Activities of Daily Living (ADL)By: Meredith Wallace, PhD, APRN, BC, Fairfield University School of Nursing, andMary Shelkey, PhD, ARNP, Virginia Mason Medical CenterWHY:Normal aging changes and health problems frequently show themselves as declines in the functional status ofolder adults. Decline may place the older adult on a spiral of iatrogenesis leading to further health problems. One of thebest ways to evaluate the health status of older adults is through functional assessment which provides objective datathat may indicate future decline or improvement in health status, allowing the nurse to intervene TOOL:The Katz Index of Independence in Activities of Daily Living , commonly referred to as the Katz ADL, is themost appropriate instrument to assess functional status as a measurement of the client s ability to perform Activities ofdaily Living independently.

2 Clinicians typically use the tool to detect problems in performing Activities of Daily Living andto plan care accordingly. The Index ranks adequacy of performance in the six functions of bathing, dressing, toileting,transferring, continence, and feeding. Clients are scored yes/no for Independence in each of the six functions. A score of6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional POPULATION:The instrument is most effectively used among older adults in a variety of care settings, whenbaseline measurements, taken when the client is well, are compared to periodic or subsequent AND RELIABILITY:In the thirty-five years since the instrument has been developed, it has been modifiedand simplified and different approaches to scoring have been used.

3 However, it has consistently demonstrated its utilityin evaluating functional status in the elderly population. Although no formal reliability and validity reports could befound in the literature, the tool is used extensively as a flag signaling functional capabilities of older adults in clinical andhome AND LIMITATIONS:The Katz ADL Index assesses basic Activities of Daily Living . It does not assess moreadvanced Activities of Daily Living . Katz developed another scale for instrumental Activities of Daily Living such as heavyhousework, shopping , managing finances and telephoning. Although the Katz ADL Index is sensitive to changes indeclining health status, it is limited in its ability to measure small increments of change seen in the rehabilitation ofolder adults.

4 A full comprehensive geriatric assessment should follow when appropriate. The Katz ADL Index is veryuseful in creating a common language about patient function for all practitioners involved in overall care planning anddischarge ON THE TOPIC:Best practice information on care of older adults: , C. (2006). Functional decline in hospitalized older adults. AJN, 106(1), , S., Down, , Cash, , & Grotz, (1970) Progress in the development of the Index of ADL. The Gerontologist, 10(1), , S. (1983). Assessing self-maintenance: Activities of Daily Living , mobility and instrumental Activities of Daily Living . JAGS, 31(12), , , & Mezey, M. (2003). Assessment of function. In M. Mezey, T.

5 Fulmer, I. Abraham (Eds.), D. Zwicker (Managing Ed.), Geriatric nursingprotocols for best practice(2nd ed., pp 31-46). NY: Springer Publishing Co., Inc. Mick, , & Ackerman, (2004, Sept). Critical care nursing for older adults: Pathophysiological and functional considerations. Nursing Clinics ofNorth America, 39(3), 473-93. Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety onlyfor not-for-profit educational purposes only, provided thatThe Hartford Institute for Geriatric Nursing, College of Nursing, New York University is cited as the source. This material may be downloaded and/or distributed in electronicformat, including PDA format.

6 Available on the internet at E-mail notification of usage to: 2008tVol. 108, No. 467 ACTIVITIESPOINTS (1 OR 0) Independence :(1 POINT)NOsupervision, direction or personalassistanceDEPENDENCE:(0 POINTS)WITH supervision, direction, personalassistance or total careBATHINGPOINTS:_____(1 POINT)Bathes self completely orneeds help in bathing only a singlepart of the body such as the back,genital area or disabled extremity.(0 POINTS)Needs help with bathingmore than one part of the body,getting in or out of the tub or total :_____(1 POINT)Gets clothes from closetsand drawers and puts on clothes andouter garments complete withfasteners. May have help tying shoes.(0 POINTS)Needs help with dressingself or needs to be :_____(1 POINT)Goes to toilet, gets on andoff, arranges clothes, cleans genitalarea without help.

7 (0 POINTS)Needs help transferring to the toilet, cleaning self or usesbedpan or :_____(1 POINT)Moves in and out of bed orchair unassisted. Mechanicaltransferring aides are acceptable.(0 POINTS)Needs help in movingfrom bed to chair or requires acomplete :_____(1 POINT)Exercises complete selfcontrol over urination and defecation.(0 POINTS)Is partially or totallyincontinent of bowel or :_____(1 POINT)Gets food from plate intomouth without help. Preparation offood may be done by another person.(0 POINTS)Needs partial or total helpwith feeding or requires POINTS= _____ 6 = High (patient independent)0=Low (patient very dependent)Slightly adapted from Katz, S., Down, , Cash, , & Grotz, (1970) Progress in the development of the Index of Gerontologist,10(1), The Gerontological Society of America.

8 Reproduced [Adapted] by permission of the Index of Independence in Activities of Daily LivingA SERIES PROVIDED BYThe Hartford Institute for Geriatric NursingEMAIL: INSTITUTE WEBSITE: WEBSITE: #68 AJNtApril 2008tVol. 108, No. 2008tVol. 108, No. 469encourage older adults to remain as independent aspossible. Using the Katz Index in acute care settingsmay require a new institutional emphasis on thenursing staff s responsibility to support patients functional Independence . (To view the section of theonline video discussing assessment, interpretation,and discharge planning, go to )COMMUNICATING THE KATZ Index RESULTSThe results of a functional assessment using theKatz Index should be shared with the clinical team,the patient, and family members; they all have rolesto play in improving function.

9 Patients and familymembers in particular need a clear explanation ofwhat the score means and what work the patientmust do to achieve Independence or, if that s not pos-sible, to make good use of assistance. This usuallyrequires an explanation of the categories assessed for example, explaining remaining continentas controlling your bladder and bowels or transfer-ringas getting in and out of bed or up from a chairby yourself. It s also important to explain howfunctional status relates to Living independently andhow the plan of care aims to restore plan of care will likely involve ongoing nursingassessment and care to restore function and preventfurther decline, as well as referral to physical andoccupational therapists, if necessary.

10 Explaining Katz Index scores to patients mayrequire extra effort when particular barriers are pres-ent: insufficient fluency in English, hearing or othersensory impairment, aphasia, delirium, or the patient, using pencil and paper or com-puter printouts, asking the patient to repeat whatwas said, and being alert for nonverbal indicators ofcomprehension may help to ensure that the Katzindex results have been successfully communicated. Nurses should be vigilant about ensuring that anychanges in a patient s functional status are commu-nicated to the clinical team and that the plan of careis modified as the patient s abilities improve ordecline.


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