Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Summary

During acute medical problems, older people may lose independence in activities of daily living (ADL). Assessment of baseline ADL and ADL on admission can guide personalized treatment plans aimed at preventing nosocomial dependence and ensuring better functional outcomes.

Abstract

During an acute medical problem, older people may lose functional independence. ADL scales are used to assess this loss of independence. The simplest and most convenient ADL scale is the Katz Index, which measures six ADL: bathing, dressing, toileting, transferring, continence, and feeding. A lower ADL score indicates greater loss of functional independence. The ADL score prior to the acute medical problem (baseline) is estimated by questioning the patient or the caregivers, and this score is then compared with that on hospital admission. The ADL score should be monitored from hospital admission until discharge to allow early detection of changes in functional independence. Identifying any loss of functional independence before and during hospitalization provides information to caregivers regarding the risk of short-term mortality risk and complications, and the prognosis after hospitalization.

Introduction

Medical problems can cause older people to lose functional independence, rendering them unable to carry out activities of daily living (ADL) without assistance from others. This loss of independence, which often results from cardiovascular comorbidities¹, cognitive impairment^2,3, and visual impairment⁴, impacts patient quality of life⁵ and life expectancy⁶, and increases healthcare costs⁷. Functional independence may progressively deteriorate, or be lost completely, with more severe comorbidi....

Protocol

The protocol has been approved by the human research ethics committee of the University Hospital of Bordeaux.

NOTE: The protocol described in this section involves evaluation of ADL dependence using the Katz ADL. The six activities assessed are described above¹⁸. The Katz ADL is administered at the Bordeaux University Hospital, on admission and discharge, to all patients over 75 years of age, i.e., all those in acute geriatric medicine wards. Inpatients in geriatric units present with numerous comorbidities and it is recommended that staff assess all such patients. In theory, the Katz ADL could be administered to all....

Results

Here, we consider two example cases after completion of the protocol: one with full recovery of the baseline level of ADL function at discharge, and one with no or partial recovery.

Discharged with baseline level of ADL function
In this group of patients, two ADL function trajectories were possible, as shown in Figure 1: patients who maintained their ADL score throughout hospitalization (Trajectory A) and those whose score at hospitalization w.......

Discussion

The protocol is not appropriate in all situations
Our protocol was designed for patients who have been hospitalized for an acute medical problem. However, other tools, such as the Barthel Index, should be used in rehabilitation centers. The original Katz ADL scale scores functional ability only on a 7-point scale (scores of 0–6); subtle fluctuations in functional dependence may therefore be overlooked. The Barthel Index, which is generally comparable to the Katz ADL, yields weighted and summe.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Clothing and underwear	Any
Hospital Bathroom with toilet
Meal Tray
Medical Bed	Any
Medical Chair	Any
Papers
Pens
Table Bed	Any