activities of daily living
TRANSCRIPT
Activites of daily living
Roger WatsonProfessor of Nursing
Symposium: Medicine for the elderlyRoyal College of Physicians of Edinburgh
12 April 2013
ADL
The activities usually performed in the course of a normal day in a person's life, such as:
• Eating
• Toileting
• Dressing
• Bathing
• Brushing the teeth.
ADL
• The ability to perform ADL may be compromised by a variety of causes, including chronic illnesses and accidents.
• The limitation may be temporary or permanent; rehabilitation may involve relearning the skills or learning new ways to accomplish ADL.
• .
What do we want from an ADL scale?
• Utility
• Meaningful scoring system
• Predictive ability
Townsend Functional Ability Scale
1) Cut toe nails
2) Shop with bags
3) Up and down stairs
4) Get on bus
5) Reach overhead
6) Wash or bathe
7) Tie a knot
8) Prepare a meal
9) Heavy housework
No difficulty = 0With difficulty = 1Unable to do = 2
Fieo R, Watson R, Deary IJ, Starr JM (2009) A revised activities of daily living instrument increases interpretive power: theoretical applications for functional tasks exercise Gerontology 56: 483-490
Watson R, van der Ark LA, Lin L-C, Fieo R Deary IJ Meier R (2011) Item response theory: How Mokken scaling can be used in clinicalpracticeJournal of Clinical Nursing 21: 2736-2746
Utility
KISS = Keep it Short and Simple
In the Townsend Functional Ability Scale 6 items form a reliable hierarchy using item response theory (Fieo et al 2009)
Townsend Functional Ability Scale
Mean
1) Cut toe nails 0.72
3) Up and down stairs 0.36
4) Get on bus 0.22
4) Reach overhead 0.16
5) Wash or bathe 0.09
6) Tie a knot 0.04
n=548 Community dwelling older people
Fieo R, Watson R, Deary IJ, Starr JM (2009) A revised activities of daily living instrument increases interpretive power: theoretical applications for functional tasks exercise Gerontology 56: 483-490
Meaningful scoring system
Obtained if the items in the ADL scale are ordered along the disability trait
In the Townsend Functional Ability Scale the 6 items are ordered for every person at all levels of disability (Watson et al 2011)
Invariant item ordering
P
Disability
Cut toe nails
Tie a knot
Watson R, van der Ark LA, Lin L-C, Fieo R Deary IJ Meier R (2011) Item response theory: How Mokken scaling can be used in clinical practice Journal of Clinical Nursing 21: 2736-2746
Meaningful scoring system
What does a non-meaningful scoring system look like?
Townsend Functional Ability Scale
Does the patient ever: None Some Unable
1) Cut toe nails2) Up and down stairs3) Get on bus4) Reach overhead5) Wash or bathe6) Tie a knot
Total score = No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 0No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 12No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 6No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 6No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 6No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 6No difficulty = 0With difficulty = 1Unable to do = 2
Meaningful scoring system
What does a meaningful scoring system look like?
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 0No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 1No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 2No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 3No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 4No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 5No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 6No difficulty = 0With difficulty = 1Unable to do = 2
Townsend Functional Ability Scale
Does the patient ever:None Some Unable
1) Cut toe nails 2) Up and down stairs 3) Reach overhead 4) Get on bus 5) Wash or bathe 6) Tie a knot
Total score = 7No difficulty = 0With difficulty = 1Unable to do = 2
Predictive ability
Picks up disability early
The Townsend Functional Ability Scale
1) Cut toe nails
2) Up and down stairs
3) Reach overhead
4) Get on bus
5) Wash or bathe
6) Tie a knot
What do we want from an ADL scale?
• Utility
• Meaningful scoring system
• Predictive ability
