Katz Index of Independence in Activities of Daily Living

The Index of Activities of Daily Living (ADL) encompasses six basic human functions:
bathing, dressing, toileting, transfer, continence, and feeding. It provides an objective method of
classifying heterogeneous groups of people with chronic illnesses, disabilities and impairments, and
of describing their health needs and outcomes.
Katz Index of Independence in Activities of Daily Living (ADL)
ACTIVITIES
Points (1 or 0)

INDEPENDENCE: (1 POINT)
NO supervision, direction or personal

WITH supervision, direction, personal

assistance

assistance or total care

(1 POINT) Bathes self completely or needs

BATHING

DEPENDENCE: (0 POINTS)

(0 POINTS) Needs help with bathing

help in bathing only a single part of the body

more than one part of the body, getting in

such as the back, genital area or disabled

or out of the tub or shower. Requires total

extremity.

bathing.

(1 POINT) Gets clothes from closets and

DRESSING

drawers and puts on clothes and outer

garments complete with fasteners. May have

(0 POINTS) Needs help with dressing

self or needs to be completely dressed.

help tying shoes.

(1 POINT) Goes to toilet, gets on and off,
TOILETING

arranges clothes, cleans genital area without

the toilet, cleaning self or uses bedpan or

help.

commode.

(1 POINT) Moves in and out of bed or chair

TRANSFERRING unassisted. Mechanical transferring aides are
acceptable.

CONTINENCE

(1 POINT) Exercises complete self control

over urination and defecation.
(1 POINT) Gets food from plate into mouth

FEEDING

(0 POINTS) Needs help transferring to

(0 POINTS) Needs help in moving from

bed to chair or requires a complete
transfer.
(0 POINTS) Is partially or totally
incontinent of bowel or bladder.
(0 POINTS) Needs partial or total help

without help. Preparation of food may be done with feeding or requires parenteral
by another person.

feeding.

Interpretation:
6 = High (patient independent) Full function
4 = Moderate impairment
2 or below = Low (patient very dependent) severe functional impairment

Reaction:
Change is inevitable and one of the changes that will occur in our life is aging.
Normal aging changes and health problems frequently show themselves as declines in the
functional status of older adults. Decline may place the older adult on a spiral of
iatrogenesis leading to further health problems. One of the best ways to evaluate the
health status of older adults is through functional assessment which provides objective
data that may indicate future decline or improvement in health status, allowing us nurses
to plan and intervene appropriately.
The Katz Index of Independence in Activities of Daily Living, commonly referred to
as the Katz ADL, is the most appropriate instrument to assess functional status as a
measurement of the clients ability to perform activities of daily living independently.
Clinicians typically use this tool to detect problems in performing activities of daily living
and to plan care accordingly. The Index ranks adequacy of performance in the six
functions of bathing, dressing, toileting, transferring, continence, and feeding. Clients are
score dyes/no for independence in each of the six functions. A score of 6 indicates full
function, 4 indicate moderate impairment, and 2 or less indicates severe functional
impairment.
This instrument is most effectively used among older adults in a variety of care
settings, when baseline measurements, taken when the client is well, are compared to
periodic or subsequent measures.
The Katz ADL Index assesses basic activities of daily living. It does not assess
more advanced activities of daily living. Katz developed another scale for instrumental
activities of daily living such as heavy 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 useful in creating a common language about
patient function for all practitioners involved in overall care planning and discharge
planning.

Timed Up and Go (TUG) Test

The Timed Up and Go test (TUG) is a simple test used to assess a person's mobility and
requires both static and dynamic balance.
It uses the time that a person takes to rise from a chair, walk three meters, turn around,
walk back to the chair, and sit down. During the test, the person is expected to wear their regular
footwear and use any mobility aids that they would normally require. The TUG is used frequently in
the elderly population, as it is easy to administer and can generally be completed by most older
adults.
1. Equipment: arm chair, tape measure, tape, stop watch.
2. Begin the test with the subject sitting correctly in a chair with arms, the subjects back should
resting on the back of the chair. The chair should be stableand positioned such that
it will not move when the subject moves from sitting to standing.
3. Place a piece of tape or other marker on the floor 3 meters away from the chair so
that it is easily seen by the subject.
4. Instructions : On the word GO you will stand up, walk to the line on
around and walk back to the chair and sit down. Walk at your regular pace.

the

floor, turn

5. Start timing on the word GO and stop timing when the subject is seated again correctly in the
chair with their back resting on the back of the chair.
6. The
subject wears their regular
footwear, may use
any gait aid that they normally
during ambulation, but may not be assisted by another person. There is no time

use

limit. They may stop and rest (but not sit down) if they need to.
7. Normal healthy elderly usually complete the task in ten seconds or less. Very
frail or weak elderly with poor mobility may take 2 minutes or more.
8. The subject should be given a practice trial that is not timed before testing.
9. Results correlate with
follow change over time.

gait speed, balance, functional level,the

ability to go

out, and

10. Interpretation
< 10 seconds = normal
< 20 seconds = good mobility, can go out alone, mobile without a gait aid.
< 30 seconds = problems, cannot go outside alone, requires a gait aid.
A score of more than or equal to fourteen seconds has been shown to indicate high risk of falls.

can

REACTION:

We all know that elderly clients are prone to falls and any other related staff. And
The Timed Up and Go test (TUG) is the one being used to assess mobility of the elderly.
The Timed up and Go Test (TUG) is recommended as a screening tool for fall risk in older
people. It is assumed that this general mobility test is underpinned by physiological
factors such as strength, coordination and balance. However, no studies have examined the
range of physiological and psychological factors which influence performance on this test.
On my opinion, this test is needed to prevent further accident to elderly client.
According to research, The TUG appears to be an appropriate tool for clinical assessment
of functional mobility even in healthy older adults. It does not suffer from ceiling effect
limitations, is normally distributed and is apparently related to executive function. The
BBT and the DGI do not share these beneficial properties. Perhaps the transferring and
turning components of the TUG help to convert this relatively simple motor task into a
more complex measure that also depends on cognitive resources.

Assessment Tool
For
Elderly Patient
Demetrio Ferrer III BSN 4A