Activities of daily living Study Guide

📖 Core Concepts Activities of Daily Living (ADL) – everyday self‑care tasks (e.g., bathing, dressing, feeding). Instrumental ADL (IADL) – more complex tasks that support independent living (e.g., managing money, using the phone). Functional status – a person’s ability to perform ADL/IADL; used by clinicians to gauge independence. Katz ADL scale – the original tool (1950s) that measures basic self‑care. Lawton IADL scale – added in 1969 to capture community‑based tasks. Functional Independence Measure (FIM) – 0‑7 rating for each activity; higher scores = more independence. Repositioning – moving immobile patients at least every 2 h to prevent pressure injury and DVT. --- 📌 Must Remember Katz (1950s) introduced basic ADL; Lawton & Brody (1969) added IADL. Basic ADL list: bathing/showering, hygiene/grooming, dressing, toileting, functional mobility/transferring, self‑feeding. IADL list (core): house cleaning, money management, community mobility, meal prep, shopping, medication management, telephone use. FIM scoring: 7 = complete independence; 6 = modified independence (equipment only); 5 = supervision/setup; 4 = minimal assistance; 3 = moderate assistance; 2 = maximal assistance; 1 = total assistance; 0 = activity does not occur. Repositioning interval: ≥ every 2 hours for immobile patients. Exercise in frail older adults preserves functional independence and reduces institutionalization. --- 🔄 Key Processes ADL Assessment with FIM Observe the patient performing the activity. Rate from 0–7 based on amount of assistance/equipment needed. Document score; repeat for each ADL/IADL domain. Repositioning Protocol Identify immobile patient → set 2‑hour alarm. Turn to a new position (e.g., side, supine, prone). Check skin for pressure signs; document. Occupational Therapy Evaluation Interview patient → list IADL tasks. Perform performance‑based tests → note deficits. Develop intervention plan (skill‑training, adaptive equipment). Physical Therapy Exercise Design Assess strength, balance, gait speed. Prescribe progressive walking, resistance, balance drills. Provide home program; emphasize adherence. --- 🔍 Key Comparisons Basic ADL vs. Instrumental ADL Basic: personal care (bath, dress, feed). Instrumental: community/management tasks (money, meds, shopping). FIM vs. Katz Scale FIM: 0‑7 granular rating for each activity. Katz: binary (independent vs. dependent) for basic self‑care only. Score 5 (FIM) vs. Independence Score 5: supervision/setup required → not independent. Score 7: true independence. --- ⚠️ Common Misunderstandings ADL = IADL – they are distinct; mixing them leads to inaccurate functional ratings. Score 5 = independent – actually indicates need for supervision or set‑up. Repositioning only prevents pressure ulcers – also reduces DVT risk and functional decline. All ADL tools are interchangeable – each has a different focus (basic vs. instrumental vs. detailed gradation). --- 🧠 Mental Models / Intuition ADL Ladder – imagine a 7‑step ladder (FIM); each rung adds a bit less assistance. “Home‑Base vs. Out‑and‑About” – basic ADL = tasks done at home on the body; IADL = tasks that let you function in the community. Repositioning Clock – picture a clock face; every “2‑hour” tick you turn the patient to a new position. --- 🚩 Exceptions & Edge Cases FIM score of 0 – means the activity does not occur (not simply “unable”). Original Katz scale may reflect disease‑specific abilities rather than universal function. Spinal Cord Injury – use the Spinal Cord Independence Measure instead of generic ADL scales. --- 📍 When to Use Which Katz ADL scale – quick screen of basic self‑care in geriatric or acute settings. Lawton IADL scale – assess community living skills (e.g., before discharge planning). FIM – detailed inpatient rehab tracking; needed when gradations of assistance matter. Older Americans Resources and Services (OARS) – evaluate both basic and instrumental tasks together. Spinal Cord Independence Measure – only for patients with spinal cord injury. --- 👀 Patterns to Recognize Lists of tasks – basic ADL always includes the six core items; IADL always includes money, meds, phone, shopping, meals, housekeeping, community mobility. Score gradients – as the numeric FIM score drops, the type of assistance moves from “equipment only” → “supervision” → “minimal” → “moderate” → “maximal” → “total”. Repositioning cue – any immobile patient description → look for “every 2 h” in the question. --- 🗂️ Exam Traps Distractor: “A FIM score of 5 indicates complete independence.” – Wrong; 5 = supervision/setup. Distractor: “Instrumental ADL includes bathing.” – Wrong; bathing is a basic ADL. Distractor: “Repositioning should be done every hour.” – Wrong; guideline is ≥ every 2 hours. Distractor: “Katz scale measures community tasks.” – Wrong; Katz only covers basic self‑care. Distractor: “All ADL tools have the same scoring range.” – Wrong; only FIM uses 0‑7; others are binary or categorical.