Normal aging changes and health problems frequently show themselves as declines in the functional status of older adults. Decline may place older adults 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 nurses to 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 clients' ability to perform ADLs independently. Clinicians typically use the tool to detect problems in performing ADLs 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 scored yes or no for independence in each of the six functions. A score of 6 indicates full function; 4 indicates moderate impairment; and 2 or less indicates severe functional impairment.
The instrument is most effectively used among older adults in a variety of care settings, when baseline measurements, taken when clients are well, are compared to periodic or subsequent measures.
In the 35 years since the instrument has been developed, it has been modified and simplified, and different approaches to scoring have been used. However, it has consistently demonstrated its utility in evaluating functional status in the elderly population. Although no formal reliability and validity reports could be found in the literature, the tool is used extensively as a flag signaling functional capabilities of older adults in clinical and home environments.
STRENGTHS AND LIMITATIONS
The Katz ADL tool assesses basic ADLs. It does not assess more advanced ADLs. Katz (1983) developed another scale for instrumental ADLs such as heavy housework, shopping, managing finances, and telephoning. Although the Katz ADL index is sensitive to changes in declining health status, the tool 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 index is very useful in creating a common language about client function for all practitioners involved in overall care planning and discharge planning.
MORE ON THE TOPIC
Abrams, W.B., Beers., M.H., & Berkow, R (1995). The Merck manual of geriatrics. Whitehouse Station, NJ: Merck Research Laboratories.
Kane, R.L., Ouslander, J.G., & Abrass, LB. (1994). Essentiah of amicai geriatria (3rd ed.). New York: McGraw Hill.
Katz, S., Down, T.D., Cash, HiL, et al. (1970). Progress in the development of the index of ADL. The Gerontobgist, 10, 20-30.
Katz, S. (1983). Assessing self-maintenance: Activities of daily living, mobility and instrumental activities of daily living. Journal of the American Geriatrics Society, 37, 267-271.
Lueckenotte, A.G. (1990). Pocket guide to gerontologic assessment. Philadelphia: Mosby.
The following instrument represents an effective quantitative method to gather information on ADLs.
KATZ INDEX OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING*