Activities of Daily Living

The activities of daily living (ADLs) is a term used to collectively describe fundamental skills that are required to independently care for oneself such as eating, bathing, and mobility. The term activities of daily living was first coined by Sidney Katz in 1950. ADL is used as an indicator of a person’s functional status. The inability to perform ADLs results in the dependence of other individuals and/or mechanical devices. The inability to accomplish essential activities of daily living may lead to unsafe conditions and poor quality of life. Measurement of an individual’s ADL is important as these are predictors of admission to nursing homes, need for alternative living arrangements, hospitalization and use of paid home care. The outcome of a treatment program can also be assessed by reviewing a patient’s ADLs. Nurses are often the first to note when patients\u27 functionality declines during hospitalization; therefore, routine screening of ADLs is imperative and nursing assessment of ADL\u27s is performed on all hospitalized patients. Hospitalization for an acute or chronic illness may influence a person’s ability to meet personal goals and sustain independent living. Chronic illnesses progress over time, resulting in a physical decline that may lead to a loss of ability to perform ADL\u27s. In 2011, the United States National Health Interview Survey determined that 20.7% of adults aged 85 or older, 7% of those aged 75 to 84 and 3.4% of those aged 65 to 74 needed help with ADLs

Identifying longitudinal sustainable hierarchies in activities of daily living

© 2017 Elsevier B.V. Activities of daily living serve as an indicator of progression in disability and rehabilitation. It is know that some of the measurement scales used show hierarchical properties indicating that activities of daily living are lost and gained in a consistent pattern. Few studies have investigated the extent to which these patterns are sustained across time and across a range of disability. The study aimed to investigate the hierarchical properties of the activity of daily living items in the ValGraf functional ability scale, to establish if there is a hierarchy of items in the scale and to study the sustainability of the hierarchy over time. Secondary analysis of a retrospective database from 13,113 people over 65 years in 105 nursing homes in northern Italy, between 2008 and 2013 was conducted. Data were gathered 6-monthly and analysed using Mokken scaling to identify a hierarchy of items in the scale and if this was sustainable over time. A sustainable hierarchy of items was observed running in difficulty from urinary incontinence to feeding. The hierarchical structure of the activities of daily living observed in the present study is stable over time meaning that changes in total score for these items can be compared meaningfully across time

The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment

Background: The notion of "minimal impairment in instrumental activities of daily living (i-ADL)" is important in the diagnosis of mild cognitive impairment (MCI), but is presently not adequately operationalized. ADL is stratified according to difficulty, complexity, and also to vulnerability to early cognitive changes in a threefold hierarchy: basic activities of daily living (b-ADL), i-ADL, and advanced activities of daily living (a-ADL). This study aims to gain a deeper understanding of the functional decline in the process of MCI. Methods: In a qualitative design, 37 consecutive patients diagnosed with amnestic (a)-MCI and their proxies were interviewed at two geriatric day hospitals. Constant comparative analysis was used for the analysis. Results: The a-ADL-concept emerged as important in the diagnosis of MCI. All participants were engaged in a wide range of activities, which could be clustered according to the International Classification of Functioning, Disability and Health (ICF). Participants reported subtle difficulties in performance. A process of functional decline was identified in which adaptation and coping mechanisms interacted with the process of reduced skills, leading to an activity disruption and an insufficiency in functioning. Conclusion: This study asserts the inclusion of an evaluation of a-ADL in the assessment of older persons. When evaluating ADL at three levels (b-ADL, i-ADL, and a-ADL), all the activities one can perform in daily living are covered

Promoting Independence Through Effective Interventions For Adults With ALS

PICO Question What are effective occupational therapy interventions for adults with ALS to improve participation in ADLs/IADLs? Objectives Define amyotrophic lateral sclerosis (ALS) and recognize the prevalence Identify and describe evidence-based interventions to promote independence for individuals with ALS in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) Discuss how the current literature on the effective interventions impacts occupational performance and treatment of adults with AL

Exploring Patterns of Activities of Daily Living in the Home Environment

Background: Senior citizens tend to live longer and longer independently. Judging whether a senior person is still capable of living on his own is often based on the occurrence of incidents, with all consequences thereof. In the specific case of early dementia, the symptoms are not immediately apparent and the occurrence and severity of incidents progress gradually over time. In this case, the children or grandchildren are burdened by the question whether or not the elderly adult can still live safely and independently in his or her own home. This decision is only based on input obtained through incidental visits. We believe that the capability of independent living can only be objectively judged, by a health professional, if long term objective information on the elderly person's daily activities of living (ADL) is available

The simulation of action disorganisation in complex activities of daily living

Action selection in everyday goal-directed tasks of moderate complexity is known to be subject to breakdown following extensive frontal brain injury. A model of action selection in such tasks is presented and used to explore three hypotheses concerning the origins of action disorganisation: that it is a consequence of reduced top-down excitation within a hierarchical action schema network coupled with increased bottom-up triggering of schemas from environmental sources, that it is a more general disturbance of schema activation modelled by excessive noise in the schema network, and that it results from a general disturbance of the triggering of schemas by object representations. Results suggest that the action disorganisation syndrome is best accounted for by a general disturbance to schema activation, while altering the balance between top-down and bottom-up activation provides an account of a related disorder - utilisation behaviour. It is further suggested that ideational apraxia (which may result from lesions to left temporoparietal areas and which has similar behavioural consequences to action disorganisation syndrome on tasks of moderate complexity) is a consequence of a generalised disturbance of the triggering of schemas by object representations. Several predictions regarding differences between action disorganisation syndrome and ideational apraxia that follow from this interpretation are detailed

Pronounced impairment of activities of daily living in posterior cortical atrophy

Introduction : The impact of several dementia syndromes on activities of daily living (ADLs) has been well documented, but no study has yet investigated functional ability in posterior cortical atrophy (PCA). The primarily visual nature of deficits in this condition is likely to have a pronounced impact on ADLs. Objective : The aim of this study was to profile functional change in PCA and identify predictors of change. Method : Twenty-nine PCA patients and 25 patients with typical Alzheimer’s disease (AD) and their caregivers were included in this cross-sectional study. ADLs were assessed using the Disability Assessment for Dementia (DAD), administered to caregivers, assessing basic ADLs (e.g., eating, dressing) and instrumental ADLs (e.g., managing finances, meal preparation). The predictive utility of cognitive domains (Addenbrooke’s Cognitive Examination), behavioural impairment (Cambridge Behavioural Inventory-Revised) and demographic variables on ADL ability was also examined. Results : PCA patients showed significantly reduced total ADL scores compared to AD patients (medium effect size, d = –0.7; p 0.05). A model combining patient mood, disinhibition, apathy, symptom duration, and memory and attention/orientation scores explained the variance of scores in functional decline (61.2%), but the key factor predicting ADL scores was attention/orientation (p = 0.048). Conclusion : This study shows the profound impact of PCA on ADLs and factors underpinning patients’ disability. Attention/orientation deficits were found to correlate and contribute to variance in ADL scores. Future work to develop tailored interventions to manage ADL impairment in PCA should take these findings into account

Sharing of hand kinematic synergies across subjects in daily living activities

The motor system is hypothesised to use kinematic synergies to simplify hand control. Recent studies suggest that there is a large set of synergies, sparse in degrees of freedom, shared across subjects, so that each subject performs each action with a sparse combination of synergies. Identifying how synergies are shared across subjects can help in prostheses design, in clinical decision-making or in rehabilitation. Subject-specific synergies of healthy subjects performing a wide number of representative daily living activities were obtained through principal component analysis. To make synergies comparable between subjects and tasks, the hand kinematics data were scaled using normative range of motion data. To obtain synergies sparse in degrees of freedom a rotation method that maximizes the sum of the variances of the squared loadings was applied. Resulting synergies were clustered and each cluster was characterized by a core synergy and different indexes (prevalence, relevance for function and within-cluster synergy similarity), substantiating the sparsity of synergies. The first two core synergies represent finger flexion and were present in all subjects. The remaining core synergies represent coordination of the thumb joints, thumb-index joints, palmar arching or fingers adduction, and were employed by subjects in different combinations, thus revealing different subject-specific strategies

Measuring unmet need for social care among older people

Recent spending cuts in the area of adult social care raise policy concerns about the proportion of older people whose need for social care is not met. Such concerns are emphasised in the context of population ageing and other demographic changes. This briefing summarises research published in Population Trends no. 145 which explores the concept of ‘unmet need’ for Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), using data on the receipt of support (informal, state or privately paid for). The results show that each of the three different support sectors tend to provide help for different kinds of need, and that worryingly, there is a significant level of ‘unmet need’ for certain activities