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Purpose. Measure independence in activities of daily living (ADL).
Age-related changes and health problems frequently show themselves as declines in the functional status of older adults. This decline often places the older adult on a downwards health spiral. An effective way to evaluate the health status of older adults is through their functional ability. An objective assessment which provides objective data helps indicate decline or improvement in health status, allowing the physiotherapist to plan and intervene appropriately
Older adults and individuals with chronic diseases.
Method of Use
The Katz Index of Independence in Activities of Daily Living (Katz ADL), is an appropriate tool to assess functional status when measuring the client’s ability to perform activities of daily living independently. It takes less than 5 minutes to perform and requires no training.
Physiotherapists use the tool when assessing function and detect problems in performing ADL and formulate a plan care. The Index ranks adequacy of performance in six functions of bathing, dressing, toileting, transferring, continence, and feeding. 1 point is independent, 0 points is with supervision, direction, personal assistance or total care
(1 POINT) Bathes self completely or
needs help in bathing only a single part
of the body such as the back, genital
area or disabled extremity.
(0 POINTS) Need help with
bathing more than one part of the
body, getting in or out of the tub or
shower. Requires total bathing
(1 POINT) Get clothes from closets
and drawers and puts on clothes and
outer garments complete with fasteners.
May have help tying shoes.
(0 POINTS) Needs help with
dressing self or needs to be
(1 POINT) Goes to toilet, gets on and
off, arranges clothes, cleans genital area
(0 POINTS) Needs help
transferring to the toilet, cleaning
self or uses bedpan or commode.
(1 POINT) Moves in and out of bed or
chair unassisted. Mechanical transfer
aids are acceptable
(0 POINTS) Needs help in moving
from bed to chair or requires a
(1 POINT) Exercises complete self
control over urination and defecation.
(0 POINTS) Is partially or totally
incontinent of bowel or bladder
(1 POINT) Gets food from plate into
mouth without help. Preparation of food
may be done by another person.
(0 POINTS) Needs partial or total
help with feeding or requires
TOTAL POINTS: ________ SCORING: 6 = High (patient independent) 0 = Low (patient very dependent)
The interrater reliability is 0.95 or better after training (1,4). The coefficient of reproducibility, (a measure of the internal consistency of an ordered measure), is 0.96 – 0.99
The Katz tool was originally developed in the late 1950s and has consistently demonstrated its utility in evaluating functional status in the elderly population.It is used extensively as a flag signalling functional capabilities of older adults in clinical and home environments.
Construct validity. Scores on the Katz ADL Index are correlated with scores on the Barthel index (r 0.78, kappa 0.77).
Predictive validity. Correlation with mobility dysfunction (0.50) and house confinement (0.39) among older adult patients 2 years later.
Sensitivity/responsiveness to change. This scale has a significant floor effect, in that it is relatively insensitive to variations at low levels of disability
This occurs as it does not assess more advanced activities of daily living and it is limited in its ability to measure small increments of change seen in the rehabilitation of older adults. A comprehensive geriatric assessment should follow when appropriate. The Katz ADL Index is very useful in that is in a simple form all involved in a care plan can interpret.
- Donna McCabe, DNP, APRN-BC, GNP. Katz Index of Independence in Activities of Daily Living (ADL). Best Practices in Nursing Care to Older Adults. Issue Number 2, Revised 2019. Available from: https://consultgeri.org/try-this/general-assessment/issue-2.pdf (last accessed 5.5.2019)
- Describing occupation. Katz ADL. Available from: https://www.youtube.com/watch?v=ekwu49fH5QM (last accessed 5.5.2019)
- Arthritis & Rheumatism (Arthritis Care & Research) Vol. 49, No. 5S, October 15, 2003, pp S15–S27 DOI 10.1002/art.11415 © 2003, American College of Rheumatology Measures of Adult general function. Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.11415 (last accessed 5.5.2019)