II. Epidemiology
- Incidence ADL loss in community dwelling elderly: 10%
III. ADL Examples
- Bathing
- Dressing
- Transferring from bed or chair
- Walking
- Eating
- Toilet use
- Grooming
IV. Clinical Predictors of Decline
- Timed tests to evaluate risk of ADL loss
- Foot taps
- Chair stands
- Turn a full 360 degrees
- Bend over
- Rapid gait
- Hand signature
- Interpretation
- Trouble performing these tests predicts decline
- Risk of decline increased by 30-50%
- Reference
V. Evaluation: Clinic Assessment
- Activities of Daily Living Scale
- Instrumental Activities of Daily Living
- Vision
- Hearing
- Polypharmacy
- Safety of home environment
- Home lighting
- Shoes
- Uneven flooring
- Balance and gait
- Timed tests (e.g. Get-Up and Go Test)
- One-leg balance test for 5 seconds
VI. Management
- Consider balance and Strength Training referral
- Consider home health evaluation for safety
VII. Prognosis: Loss of ADLs reflects greater risk
- Increased hospitalizations
- Increased Nursing Home placement
- Predictors of higher mortality rate
- Male gender (2 points)
- Age 75-80 (1 point)
- Age >80 (2 points)
- Dependent bathing (1 point)
- Dependent shopping (2 points)
- Difficult walking (2 points)
- Difficulty moving heavy items (1 point)
- Carey (2004) J Gen Intern Med 19:1027 [PubMed]