The physical model relates to an individual’s ability to function independently in the community. Both physical and mental measurements are being used in state and federal laws to govern eligibility requirements in long-term care insurance.
Physical Assessment
Activities of daily living of ADLs as they are referred to, are often used by health care experts to determine whether a person is capable of living independently.
Stanley Katz classified standard ADLs in a 1963 study 2 that became the basis of physical impairment research.
ADLs are used to predict the length of hospital stays, use of services, the need for health and supportive care among the elderly residing in their homes and charting changes in health status.
ADLs are excellent measures to assess a person’s need for nursing home, home health or other health related services.
Since the 80’s ADL impairment had become the preferred method for assessing the functional status of older populations living in the community. 3 ADLs have also been used by clinicians to estimate the type of care needed.
Studies generally examine from five to seven ADLs. Most researchers agree that the following six core ADLs best describe functional impairment.
• Bathing: Meaning cleaning the body using a tub, shower or sponge bath, including getting a basin of water, managing faucets, getting in and out of tub or shower, reaching head and body parts for soaping, rinsing, and drying.
• Dressing: Meaning putting on and taking off, fastening and unfastening garments and undergarments and special devices such as back or leg braces, corsets, elastic stocking/garments and artificial limbs or splints.
• Toileting: Meaning getting on and off a toilet or commode and emptying a commode, managing clothing and wiping and cleaning the body after toileting, and using and emptying a bedpan and urinal.
• Continence: Meaning the ability to control bowel and bladder as well as use ostomy and/or catheter receptacles, and apply diapers and disposable barrier pads.
• Transferring: Meaning moving from one sitting or lying position to another sitting or lying position; e.g., from bed to or from a wheelchair, or sofa, coming to a standing position and/or repositioning to promote circulation and prevent skin breakdown.
• Eating: Meaning reaching for, picking up, grasping a utensil and cup; getting food on a utensil, bringing food, utensil and cup to mouth; manipulating food on a plate; and cleaning face and hands as necessary following meals.
In addition, some studies have examined other ADLs, including:
• Ambulating: Meaning the ability to move about both inside and outside your residence. *This ADL is not part of the Federal (TQ) product.
The developers of the original Katz ADL scale that included bathing, dressing, toileting, transferring, continence and eating considered these items hierarchical.
That is, these abilities tended to be lost in a certain order the reverse order from that in which one acquires them as a child.
A person with increasing impairment could be expected to lose independence in dressing and bathing first, then transferring and toileting, continence and feeding last.
A person dependent in all his/her ADLs would tend to regain independence in feeding and continence first, transferring and toileting second, and dressing and bathing last.
2 S. Katz, A.B. Ford, R.W. Moskowitz, B.A. Jackson, and M.W. Jaffee, “Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psychological Function. “Journal of the American Medical Association 185 (1963):94 ff.
3 Kovar, M. G. and Lawson, M. P. 1994. “Functional Disability: Activities and Instrumental Activities of Daily Living.” Annual Review of Gerontology and Geriatrics 14: 57-75.
