This document contains an evaluation form and scoring system called the Katz Index of Activities of Daily Living (ADL). It assesses independence in 6 functions: bathing, dressing, toileting, transferring, continence, and feeding. A patient's level of independence is scored from A to G, with A being fully independent and G being dependent in all 6 functions. The form provides definitions of independence and dependence for each function.
This document contains an evaluation form and scoring system called the Katz Index of Activities of Daily Living (ADL). It assesses independence in 6 functions: bathing, dressing, toileting, transferring, continence, and feeding. A patient's level of independence is scored from A to G, with A being fully independent and G being dependent in all 6 functions. The form provides definitions of independence and dependence for each function.
This document contains an evaluation form and scoring system called the Katz Index of Activities of Daily Living (ADL). It assesses independence in 6 functions: bathing, dressing, toileting, transferring, continence, and feeding. A patient's level of independence is scored from A to G, with A being fully independent and G being dependent in all 6 functions. The form provides definitions of independence and dependence for each function.
College of Arts and Sciences Nursing and Health Sciences Department Naval, Biliran
EVALUATION FORM FOR KATZ INDEX OF ADL
EVALUATION FORM
Name___________________________________ Date of Evaluation ____________________________
For each area of functioning below, check description that applies. (The word assistance means supervision, direction or personal assistance.)
Bathing either sponge bath, tub bath or shower _ Receives no assistance (gets in _ Receives assistance in bathing _ Receives assistance in bathing and out of tub by self if tub is only one part of body (such as more than one part of body (or usual means of bathing) back or leg) does not bathe self)
Dressing gets clothes from closets and drawers; puts on clothes, including underclothes, other garments; manages fasteners (including braces, if worn) _ Gets clothes and gets _ Gets clothes and gets dressed _ Receives assistance in getting completely dressed without without assistance except for clothes or in getting dressed or assistance tying shoes stays partly or completely
Toileting going to the toilet room for bowel and urine elimination; cleaning self after elimination and arranging clothes _ Goes to toilet room, cleans self, _ Receives assistance in going _ Does not go to room termed and arranges clothes without to toilet room or cleansing self toilet for the elimination process assistance (may object for or in arranging clothes after support such as cane, walker or elimination or in use of night wheelchair and manage night bed bedpan or commode pan or commode, emptying same in morning)
Transfer _ Moves in and out of chair _ Moves in and out of bed or chair _ Does not get out of bed without assistance (may use with assistance object for support such as cane or walker)
Continence _ Controls urination and bowel _ Has occasional accidents _ Supervision helps keep urine or movement completely by self bowel control; catheter is used or is incontinent
Feeding _ Feeds self without assistance _ Feeds self except for getting _ Receives assistance in feeding assistance in cutting meat or or is fed partly or completely by buttering bread tubes or intravenous fluids
Republic of the Philippines NAVAL STATE UNIVERSITY College of Arts and Sciences Nursing and Health Sciences Department Naval, Biliran
Nursing Care of the Chronically-Ill and the Older Person
KATZ INDEX OF ACTIVITIES OF DAILY LIVING Index Independence in Activities of Daily Living
The Index of Independence in Activities of Daily Living is based on an evaluation of functional independence or dependence of patients in bathing, dressing, going to the toilet, transferring, continence, and feeding. Specific definitions of functional independence and dependence appear below the index.
A. Independent in feeding, continence, transferring, going to toilet, dressing and bathing B. Independent in all but one of this functions C. Independent in all but bathing and one additional function D. Independent in all but bathing, dressing and one additional function E. Independent in all but bathing, dressing, going to toilet, and one additional function F. Independent in all but bathing, dressing, going to toilet, transferring, and one additional function G. Dependent in all six functions Other: Dependent in at least two functions, but not classifiable as C, D, E, or F
Independence means without supervision, direction or active personal assistance, except as specifically noted below. This is based on actual status and not on ability. A patient who refuses to perform on a function is considered as not performing the function, even though he is deemed able. BATHING (Sponge, shower or tub) Independent: