Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. (Katz, 1983)

Katz, S. (1983). Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31(12), 721-727.

Abstract: The aging of the population of the United States and a concern for the well-being of older people have hastened the emergence of measures of functional health. Among these, measures of basic activities of daily living, mobility, and instrumental activities of daily living have been particularly useful and are now widely available. Many are defined in similar terms and are built into available comprehensive instruments. Although studies of reliability and validity continue to be needed, especially of predictive validity, there is documented evidence that these measures of self-maintaining function can be reliably used in clinical evaluations as well as in program evaluations and in planning. Current scientific evidence indicates that evaluation by these measures helps to identify problems that require treatment or care. Such evaluation also produces useful information about prognosis and is important in monitoring the health and illness of elderly people.

http://www.ncbi.nlm.nih.gov/pubmed/6418786

My notes:

Interesting historical facts…..

1. Late 1800s to early 1900s: information reported was often in terms of days of sickness and sick day
2. 1940: Hierarchically ordered classifications of disability were used
3. 1950 in a Canadian Survey, a disability ratio was introduced (e.g, days of hospitalization per 100 days)
4. 1959-1980: the range of available measures of physical, mental, and social functions have expanded

For Lawton, activities of daily living covered self-maintenance functions from multiple domains. His model also includes the ordered hierarchy of six functions of Katz (bathing, dressing, toileting, transfer, continence, and feeding). The construct validity of the measure was established by observing the recovering patients passing through stages parallel to the ordinary developmental stages faced by children.

Lawton considered IADL to be more complex than IADL. The IADL functions are concerned with people's ability to cope with their environment and to adapt to the tasks that they have to perform. These including shopping, cooking, housekeeping, laundry, use of transportation, managing money, managing medication and using telephone.

(In Lawton, M.P. Assessing the competence of older people, in Kent D. Kastenbaum R, Sherwood S (EDS.): Research Planning and Action for the Elderly, New York, Behavioral Publications, 1972, PP. 122-143.)

The domain of ADL could be considered as including three self-maintenance components:

• basic ADL
• mobility
• IADL.

Some evaluation systems include all three components while others include more than one component.

Katz and his associate (1981) conducted an evaluation study checking the compatibility of 24 assessing instruments. Higher degree of compatibility is found between the basic ADL and mobility. IADL is only acceptably compatible with others.

1. The reliability and validity
   
   1. Reliability: internal consistency (relationship between items and the total scale), observer consistency (inter and intra rater) and respondent consistency (test-retest reliability)
2. Usefulness
1. Some studies found the ADL instruments useful. These are studies which purpose is to evaluate the effectiveness of interventions and to document the longitudinal projection of illness. Information provided by these studies further established the validity of the given ADL instruments.

A fairly MDS perspective concerning the 3 self-maintenance components including ADL: basic ADL, mobility and IADL…