Assessing Needs of Older Adults

Despite being a natural and inevitable part of human life, aging is viewed negatively. That aging exposes individuals to a wide range of health issues is among the reasons why this process is regarded with dread and deep concern. Research has identified aging as among the risk factors for illness (Niccoli & Partridge, 2012). Older adults tend to experience difficulties that have adverse impacts on the quality of life. While it is true that aging comes with health challenges, there are steps that can be taken to enhance the experiences of the elderly. In addition to providing treatment to these individuals, society also needs to acknowledge their contribution, offer support services and eliminate barriers to health. 

Description of Subject 

As part of this assignment, it was required that an older adult should be interviewed. The purpose of the interview was to gain a deeper understanding of the unique challenges that the elderly face and the values that enable them to face these challenges. A 75 year old white woman was interviewed. The woman was selected because of her age and her medical history. For the better part of her older adult life, she has suffered a number of illnesses that have seen her hospitalized and require care and support. The responses that the lady provided represent the experiences of the larger elderly population. 

Cultural Implications 

When delivering care to older adults, it is important to account for their cultural backgrounds (Chettih, 2012). This is the essence of cultural competence. The values, beliefs and perspectives that elderly patients hold are among the cultural issues for which providers of care need to account. For the lady interview, there are a number of cultural implications. One of the questions posed concerned traditions and practices that she has adopted in an effort to enhance her health. She shared that her family places immense focus on healthy diet. The implication of this cultural practice cannot be overstated. For elderly adults, nutritious food plays a critical role in promoting their wellbeing (Leslie & Hankey, 2015). Therefore, it can be expected that as she continues to eat healthy food, the lady will witness an improvement in her health outcomes. Another cultural implication concerns attitudes toward conventional medicine. It has been observed that some cultures mistrust the medical profession and discourage their members against seeking medical care (Ohana, 2015). On the question of her perspective regarding health, the lady acknowledged that she believes that conventional medicine holds the key to wellbeing. This belief is important as it indicates that she trusts medical professionals. By entrusting medical practitioners with her health, the lady essentially sets the stage for the delivery of proper care. Overall, the lady’s cultural background, beliefs and practices have a positive effect on her health. 

Results of Assessment 

The assessment that was conducted was as extensive as it was thorough. It revealed that the lady attempts to remain independent, thereby minimizing the amount of care and support that she requires. For example, she is able to walk with minimal support and bathe without much help. Furthermore, the assessment indicated that the lady is able to move out of bed without requiring help. While the lady has demonstrated a desire to maintain her autonomy, there are some hazards and challenges that introduce difficulties into her life. These include the lack of railing on the stairs leading to her bedroom and the presence of objects which could cause her to trip and fall. Moreover, the lady holds perspectives and beliefs that could be detrimental to her health. For instance, she feels that she has become a burden and suffers isolation. Overall, while it is vital to encourage the lady to remain independent, it is important to modify her environment so as to allow for easy movement and a general improvement in her quality of life. 

Age-related Changes 

Aging is usually accompanied by a number of significant changes. For older adults to maintain their comfort and fulfilment with their lives, they need to adjust to these changes. During the assessment, it was observed that there are a number of changes that the lady had undergone as a result of her aging. Isolation and depression are among these changes. Researchers have observed that the health, social and economic challenges that older adults face leave them feeling isolated and depressed (Singh & Misra, 2009). Their difficulties are compounded by the lack of social and moral support. As the assessments attached in the appendix show, the lady stated that she has become depressed as she feels that she is a burden on society. Difficulty in staying mobile is yet another change that results from aging. As one ages, their body becomes frail and unable to keep up with the demands of daily routines (Manini, 2013). Moreover, the illnesses that many elderly people suffer further limit their mobility. After observing the lady’s movements, it was observed that while she is able to move without much help, she has lost her agility and strength. It is unfortunate that her situation is not isolated since many older adults require assistance to move. Overall, as one ages, their health declines and they become increasingly dependent on others. The lady interviewed is an embodiment of these changes. Her changes are in line with literature concerning the experiences of older adults. 

Preliminary Issues 

After a review of the assessment, a number of preliminary issues became clear. The cost of attending to the needs of older adults is among these issues. In the United States and across the globe, families incur huge costs as they address the demands of their older members. The costs include expenses for treatment and the lost productivity as family members are forced to abandon their personal pursuits and care for the elderly. The lady said that her daughter is her sole provider of care. As such, the daughter is under immense pressure to attend to her needs while dedicating time and resources to her (daughter’s) personal matters. It can therefore be expected that the daughter is likely to suffer exhaustion and frustration. When they are overwhelmed by the demands of providing care, family caregivers tend to experience fatigue and burnout (Lynch, 2008). Another issue that became clear from the assessment is that the values that an older adult holds determine the quality of life. For example, to survive the wide range of challenges that they encounter, older adults need to be resilient and cling on to their independence (MacLeod et al., 2016). The lady interviewed shared that her positive attitude, resilience and autonomy have been crucial in promoting her wellbeing. 

The need to align the environment with the needs of elderly adults and the importance of offering support to elderly adults are other preliminary issues that emerged from the assessment. Since they encounter difficulties with mobility, it is important to adapt the environment to facilitate seamless and unhindered movement. For example, it was noted that the lady struggles to get to her bedroom since the stairs lack railing. The lady also indicated that her daughter is her only source of support. This leaves her feeling isolated and that she imposes a burden on the daughter. To improve the lady’s outcomes, there is need for other parties to become involved in providing support. 

Proposed Alterations 

The assessment of the lady’s condition and environment showed that there are various issues which erode her wellbeing. There is a need to implement alterations with the goal of improving her situation. The first alteration concerns changing her mindset. It was noted that she has an unhealthy mindset which keeps her from celebrating her life and the impact that she has had on her family. By challenging her to be more positive, the lady will feel less depressed and will experience a general improvement in her health. Ridding her environment of hazards is another alteration that should be implemented. Such objects as carpets and electrical cables pose a threat as she could trip and fall. To minimize the risk of falls, these dangerous objects should be placed in safe locations. Another alteration that promises to improve the lady’s health is encouraging her family to play a more active role in delivering care. 

Interventions 

Thanks to the assessment, it was revealed that there are a number of problems that require intervention. These problems include depression, limited mobility and low social support. Various interventions have been developed to help older adults grappling with depression. Home visits by nurses and other medical practitioners are among the interventions that have proven effective (Nguyen, & Wu, 2013). It is therefore recommended that the practitioners who treat the lady should arrange for visits. In addition to helping the lady overcome her depression, the visits will also lessen the burden borne by her daughter. Social activity and interaction is another intervention that has yielded positive outcomes for older adults with depression (Nguyen & Wu, 2013). There is need for the lady to leave her house and engage in social activities within her community. This will restore her sense of purpose and bring her joy. Another intervention adopted for depressed older adults is challenging the adults to abandon unhelpful and unhealthy mindsets (Nguyen & Wu, 2013). It was observed that the lady feels that she is a burden and this mindset is partly to blame for her depression. If she is to overcome the depression, she needs to be reminded of her contribution and that she is deeply loved. 

Limited mobility is another problem that the lady exhibits. To solve this problem, resistance exercises are commonly applied. These exercises are designed to strengthen lower extremities so as to improve the walking, posture and gait of older adults (Brach & VanSwearingen, 2013). Another intervention that yields success is progressive ambulation training. This intervention is intended to enable adults to recognize and correct actions that hinder mobility. Aerobic conditioning is yet another intervention that helps older adults with mobility programs. Essentially, this measure is concerned with increasing oxygen supply to body parts involved in walking. By applying these three interventions, it can be expected that the interviewed lady will be able to walk with much ease. 

Low levels of social support are another issue that the lady faces. Left unaddressed, this problem could significantly erode her satisfaction and quality of life levels. To address the problem, it is suggested that counseling, home visits and encouraging the lady to join social groups should be implemented. Research shows that these three interventions have significantly positive effects on the wellbeing of older adults who are socially isolated (Dickens et al., 2011). Combined with the measures described above, these interventions will go a long way in restoring the sense of worth of the lady. 

In conclusion, older adults constitute a population that has been neglected. As a result, they experience challenges which adversely affect their health. The assessment that was conducted revealed that it is indeed true that old age presents challenges. Social isolation, ill health and depression are just some of these challenges. There is a need for all stakeholders to play their role in enhancing the lives of the elderly. It is particularly important for families, communities and medical practitioners to deliver care and support. Moreover, interventions that have proven to be effective should be implemented. The implementation of these interventions will have an enhancing effect on the lives of the elderly. 

References 

Brach, J. S., & VanSwearingen, J. M. (2013). Interventions to improve walking in older adults. Current Transnational Geriatrics and Experimental Gerontology Reports, 2 (4). DOI: 10.1007/s13670-013-0059-0 

Chettih, M. (2012). Turning the lens inward: cultural competence and providers’ values in health Care decision making. The Gerontologist, 52 (6), 739-747. 

Dickens, A. P., Richards, S. H., Greaves, C. J., & Campbell, J. L. (2011). Interventions Targeting social isolation in older people: a systematic review. BMC Public Health. DOI: 10.1186/1471-2458-11-647 

Leslie, W., & Hankey, C. (2015). Aging, nutritional status and health. Healthcare, 3 (3), 648-56. 

Lynch, S. H. (2018). Looking at compassion fatigue differently: application to family Caregivers. American Journal of Health Education, 49 (1), 9-11. 

MacLeod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of Resilience among older adults. Geriatric Nursing, 37 (4), 266-272. 

Manini, T. M. (2013). Mobility decline in old age: a time to intervene. Exercise and Sport Sciences Reviews, 41 (1), 2. 

Nguyen, D., & Wu, C. M. (2013). Current depression interventions for older adults: a review of Service delivery approaches in primary care, home-based, and community-based Settings. Current Transnational Geriatrics and Experimental Gerontology Reports, 2 (1), 37-44. 

Niccoli, T., & Partridge, L. (2012). Aging as a risk factor for disease. Current Biology, 22 (17), R741-R752. 

Ohana, S., & Mash, R. (2015). Physician and patient perceptions of cultural competency and Medical compliance. Health Education Research, 30 (6), 923-34. 

Singh, A., & Misra, N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry Journal, 18 (1), 51-5. 

Appendix 

Home Safety Checklist 

Name of Home Owner/Renter: 

Name of Person Completing the Assessment: 

Check the Box that Applies for Each Question 

Room in House/Questions	Yes	No	Don’t know/Doesn’t apply
Living Room  Can you turn on a light without of having to walk into a dark room?  Are all lamp, extension, phone cords out of the current of foot traffic?  Are passageways in this room free from objects and clutter (papers, furniture)?  Are curtains and furniture approximately 36 inches from baseboard Heaters or portable heaters?  Do your carpets lie flat?  Do small rugs and runners stay put when you push them with your foot?	Yes  Yes  Yes	No  No  No
Kitchen  Are stove controls easy to use?  Do you keep loose fitting clothing, towels, and curtains that could Catch fire away from the burners and oven?  Can you get to frequently used items without climbing to reach them?  Do you have a step stool that is strong and in good repair		No  No  No  No
Bedrooms  Do you have a working smoke detectors?  Can you turn on a light without assistance?  Is the light within a range of your bed?  Is a phone within easy range of your bed?  Is there a light left on at night between the bed and the toilet?	Yes  Yes  Yes  Yes	No
Bathroom  Does the shower have a non-skid surface?  Is there a sturdy grab bar?  Is the hot water temperature set to around 120 degrees?  Does your floor have a non-slip surface?  Are you able to use the toilet without difficulties	Yes	No  No  No  No
Hallways/Passageways  Do small rugs and runners stay put when you push them with your foot?  Do your carpets lie flat?  Are any electrical cords, furniture or items on the floor in the way?	Yes  Yes	No
Front and Back Entrances  Do the entrances to the home have safety lights?  Are walkways to your entry free from cracks and holes?		No  No
Throughout Your House  An emergency exit plan has been created?  Do you have a list of emergency contacts?  Are there other hazards found? If so, list what they are here:  To get to her bedroom, she has to use steep stairs that lack railing.	Yes  Yes	No

Provided by: California Department of Aging, Senior Housing Information and Support Center 

Adapted from: Home Safety Checklist Summary, developed by the Community and Home Injury 

Prevention Project for Seniors (CHIPPS) 

Sponsored by: Community Health Education Section, San Francisco Department of Public Health 

THE BARTHEL INDEX	Patient Name : Rater Name:  Date:	August 1, 2018
Activity		Score
FEEDING

0 = unable

5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent

BATHING

0 = dependent

5 = independent (or in shower) 

GROOMING

0 = needs to help with personal care 

5 = independent face/hair/teeth/shaving (implements provided)

DRESSING

0 = dependent

5 = needs help but can do about half unaided 

10 = independent (including buttons, zips, laces, etc.)

BOWELS

0 = incontinent (or needs to be given enemas) 5 = occasional accident 

10 = continent

BLADDER

0 = incontinent, or catheterized and unable to manage alone 5 = occasional accident 

10 = continent

TOILET USE

0 = dependent

5 = needs some help, but can do something alone 10 = independent (on and off, dressing, wiping)

TRANSFERS (BED TO CHAIR AND BACK)

0 = unable, no sitting balance

5 = major help (one or two people, physical), can sit 10 = minor help (verbal or physical) 

15 = independent

MOBILITY (ON LEVEL SURFACES)

0 = immobile or < 50 yards

5 = wheelchair independent, including corners, > 50 yards

10 = walks with help of one person (verbal or physical) > 50 yards 

15 = independent (but may use any aid; for example, stick) > 50 yards

STAIRS

0 = unable

5 = needs help (verbal, physical, carrying aid) 10 = independent

TOTAL (0–100): 55 

The Barthel ADL Index: Guidelines 

The index should be used as a record of what a patient does, not as a record of what a patient could do. 

The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason. 

The need for supervision renders the patient not independent. 

A patient's performance should be established using the best available evidence. Asking the patient, friends/relatives and nurses are the usual sources, but direct observation and common sense are also important. However direct testing is not needed. 

Usually the patient's performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant. 

Middle categories imply that the patient supplies over 50 per cent of the effort. 

Use of aids to be independent is allowed. 

Interpreting Scores 

“ The original Index is a three-item ordinal rating scale completed by a therapist or other observer in 2-5 minutes. Each item is rated in terms of whether the patient can perform the task independently, with some assistance, or is dependent on help based on observation (0=unable, 1=needs help, 2=independent). 

An overall score is formed by adding scores on each rating. Scores range from 0 to 100, in steps of 5, with higher scores indicating greater independence. Items are weighted and include instructions for assessing the time it takes a subject to perform a task as a dimension of ability. 

Scoring of the Barthel is done through assignment of different values to different activities. Individuals are scored on 10/15 activities which are summed to give a score of 0 (totally dependent) to 100 (fully independent). The scores are designed to reflect the amount of time and assistance a patient requires. However, the scoring method is inconsistent in that changes by a given number of points do not reflect equivalent changes in disability across different activities. 

Several authors have proposed guidelines for interpreting Barthel scores. Shah et al. suggested that scores of 0-20 indicate “total” dependency, 21-60 indicate “severe” dependency, 61-90 indicate “moderate” dependency, and 91-99 indicates “slight” dependency. 2  Most studies apply the 60/61 cutting point, with the stipulation that the Barthel Index should not be used alone for predicting outcomes.” (Lewis, 2008). Para 3. 

References

Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” 

Maryland State Medical Journal 1965;14:56-61. Used with permission. 

Lewis, C. (2008). The original Barthel index of ADLs. Rehab Insider: Advanced Healthcare Network . 

Retrieved from http://rehab-insider.advanceweb.com/the-original-barthel-index-of-adls/ 

Loewen SC, Anderson BA., (1990). Predictors of stroke outcome using objective measurement scales. 

Stroke, 21. 78-81. 

Gresham GE, Phillips TF, Labi ML., (1980). ADL status in stroke: relative merits of three standard indexes. 

Archives of Physical Medical Rehabilitation, 61. 355-358. 

Collin C, Wade DT, Davies S, Horne V., (1988). The Barthel ADL Index: a reliability study. 

International Disability Study , 10 . 61-63. 

Copyright Information

The Maryland State Medical Society holds the copyright for the Barthel Index. It may be used freely for non- commercial purposes with the following citation:

Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.”

Maryland State Med Journal 1965;14:56-61. Used with permission. 

Permission is required to modify the Barthel Index or to use it for commercial purposes.

TINETTI BALANCE ASSESSMENT TOOL 

Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on number of chronic dis- abilities. Am J Med 1986:80:429-434 

PATIENTS NAME 

D.o.b. 4/5/1943 

Ward 

BALANCE SECTION

Patient is seated in hard, armless chair;

	Date
Sitting Balance	Leans or slides in chair Steady, safe	= 0  = 1	0
Rises from chair	Unable to without help Able, uses arms to help	= 0  = 1	1
	Able without use of arms	= 2
Attempts to rise	Unable to without help Able, requires > 1 attempt	= 0  = 1	1
	Able to rise, 1 attempt	= 2
Immediate standing Balance (first 5 seconds)	Unsteady (staggers, moves feet, trunk sway) Steady but uses walker or other support Steady without walker or other support	= 0  = 1  = 2	1
Standing balance	Unsteady  Steady but wide stance and uses support	= 0  = 1	1
	Narrow stance without support	= 2
Nudged	Begins to fall  Staggers, grabs, catches self	= 0  = 1	1
	Steady	= 2
Eyes closed	Unsteady Steady	= 0  = 1	0
	Discontinuous steps	= 0	0
Turning 360 degrees	Continuous	= 1
	Unsteady (grabs, staggers)	= 0	0
	Steady	= 1
Sitting down	Unsafe (misjudged distance, falls into chair) Uses arms or not a smooth motion	= 0  = 1	1
	Safe, smooth motion	= 2
	Balance score		6/16	6/16

P.T.O.

TINETTI BALANCE ASSESSMENT TOOL 

GAIT SECTION

Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace.

	Date
Indication of gait  (Immediately after told to ‘go’.)	Any hesitancy or multiple attempts No hesitancy	= 0  = 1	0
Step length and height	Step to  Step through R	= 0  = 1	1
	Step through L	= 1
Foot clearance	Foot drop  L foot clears floor	= 0  = 1	0
	R foot clears floor	= 1
Step symmetry	Right and left step length not equal Right and left step length appear equal	= 0  = 1	0
Step continuity	Stopping or discontinuity between steps Steps appear continuous	= 0  = 1	0
Path	Marked deviation  Mild/moderate deviation or uses w. aid	= 0  = 1	1
	Straight without w. aid	= 2
	Marked sway or uses w. aid	= 0	1
Trunk	No sway but flex. knees or back or uses arms for stability	= 1
	No sway, flex., use of arms or w. aid	= 2
Walking time	Heels apart  Heels almost touching while walking	= 0  = 1	0
	Gait score		3/12	3/12
Balance score carried forward			/16	/16
Total Score = Balance + Gait score			9/28	9/28

Risk Indicators:

Tinetti Tool Score Risk of Falls 

≤18 High

19-23 Moderate

≥24 Low

Patient Questionnaire 

INTERVIEW OF CHOSEN ELDER ADULT 

Name: ­­­­­­­­­­­­­­­­­­­­­________________________________ Age: ­­­­­­­­­­­­­­­75______________ 

Brief Introduction (Background information): 

The patient is a white woman who has a long history of heart disease and Diabetes. She stays alone but receives care from her daughter who lives nearby. Previous assessments have revealed that there are various risks that need to be addressed. The risks include high likelihood of falls and the absence of reliable care providers. Little action has been taken to address these risks. The lady relies entirely on her pension payments for sustenance. She has expressed a desire to die as she feels that her illness has reduced her to a burden on her daughter and society. Physical activity is limited and it has been observed that her diet is poor. ________________________________________________________________ 

1. Philosophy on living a long life 

She believes that love and support from family hold the key to longevity. The patient also feels that proper treatment and care from competent providers are vital for a long life. ________________________________________________________________ 

2. Thoughts about when a person is considered “too old” 

Patient feels that when individuals are considered “too old”, they should take steps to gain greater independence. If these steps prove ineffective, the individual should be sent to a nursing home where they will be less of a burden on their family and society. ________________________________________________________________ 

3. Opinion on the status and treatment of older adults 

She thinks that older adults possess value. However, the fact that they are no longer productive erodes their value. Moreover, patient is convinced that older adults are a burden who cost their families and their society. She feels that most older adults are not offered proper care and that society is abandoning them. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

4. Beliefs about health and illness 

Regarding health and illness, patient understands that the mere absence of a malady does not necessarily mean that one is well. Health is realized when one is free of illness and is living in a supportive and accepting environment. She thinks that illness limits the quality of one’s life and strips them of dignity. ________________________________________________________________ 

5. Health promotion activities he or she participates in 

Strict adherence to medication instructions is one of the activities. The patient also attempts to engage in light physical activity and upholds a balanced diet. ________________________________________________________________ 

6. Something special that helped the person live so long 

The patient found fulfilment and a sense of meaning from her work as a high school teacher. She also attributes her long life to the love and support from her family. ________________________________________________________________ 

7. Life span of other family members 

The patient has two brothers and sisters, all of whom are at least 65 years old. It appears that members of her family have long life spans. ________________________________________________________________ 

8. Special dietary traditions in patient’s culture attributed with aiding long life 

The lady’s culture places emphasis on low-fat foods which are believed to prolong life and promote health. ________________________________________________________________ 

9. Any remedies/medications that have been handed down in family/group. If yes, describe. 

None. The family relies entirely on conventional medicine. ________________________________________________________________ 

10. Patient’s description of current and past health status 

The lady has a long history of health issues. She has been hospitalized with such conditions as Diabetes and hypertension. She still ails from these conditions currently. ________________________________________________________________ 

11. The values that guided life so far 

Resilience, belief in family and community, autonomy and faith in conventional medicine are the main values that have driven the patient’s life. ________________________________________________________________ 

Additional Questions 

1. Sources of care and support 

Her daughter is the primary and only provider of care and support. She laments that society has abandoned its elderly members. ________________________________________________________________ 

2. Funding for treatment 

Most of the funding for her treatment and care has been from Medicaid. However, she feels that Medicaid and other government insurance programs do not go far enough in meeting the needs of elderly patients. ________________________________________________________________ 

3. Social support 

Most of the lady’s days are spent in isolation. She expressed a desire for company from her family and peers. ________________________________________________________________ 

Summary 

Overall, the patient has a healthy perspective regarding health. However, society’s failures have adversely impacted her wellbeing. Whereas she appreciates the support that her daughter provides, she wishes that such stakeholders as the government would do more. Her belief that elder adults are burdensome is unhealthy and could expose her to the risk of depression and stress. Urgent action is needed to alter her perception of old age. ________________________________________________________________ 

Contrast of client’s responses with findings in current literature 

The patient’s responses are in line with literature. Literature has established that the elderly experience feelings of worthlessness and suffer isolation. Moreover, literature has shown that society appears to have abandoned the elderly. ______________________________________________________________________________________________________________________ 

Literature indicates that more concerted effort is needed to adequately address the needs of the elderly. This is an endorsement of the lady’s concerns that the government and other stakeholders have failed the elderly. ______________________________________________________________________________________________________________________ 

It is understood that such behaviors as physical exercise and healthy diets promote health. This insight is in line with the lady’s assertion that her long life is the result of her diet and light physical activity. ______________________________________________________________________________________________________________________ 

Katz Index of Independence in Activities of Daily Living
Activities  Points (1 or 0)	Independence  (1 Point)  NO supervision, direction or personal assistance.	Dependence  (0 Points)  WITH supervision, direction, personal assistance or total care.
BATHING  Points: 1	(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
DRESSING  Points: 0	(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 completely dressed.
TOILETING  Points: 0	(1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help.	(0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode.
TRANSFERRING  Points: 1	(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 complete transfer.
CONTINENCE  Points: 1	(1 POINT) Exercises complete self control over urination and defecation.	(0 POINTS) Is partially or totally incontinent of bowel or bladder
FEEDING  Points: 1	(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 parenteral feeding.
TOTAL POINTS: 4 SCORING: 6 = High ( patient independent ) 0 = Low ( patient very dependent

LAWTON - BRODY  INSTRUMENTAL ACTIVITIES OF DAILY LIVING SCALE (I.A.D.L.)
Scoring: For each category, circle the item description that most closely resembles the client’s highest functional level (either 0 or 1).
A. Ability to Use Telephone		E. Laundry
Operates telephone on own initiative-looks up and dials numbers, etc.  Dials a few well-known numbers  Answers telephone but does not dial  Does not use telephone at all	1  1  1  0	Does personal laundry completely  Launders small items-rinses stockings, etc.  All laundry must be done by others
B. Shopping		F. Mode of Transportation
Takes care of all shopping needs independently  Shops independently for small purchases  Needs to be accompanied on any shopping trip  Completely unable to shop	1	Travels independently on public transportation or drives own car  Arranges own travel via taxi, but does not otherwise use public transportation  Travels on public transportation when accompanied by another  Travel limited to taxi or automobile with assistance of another  Does not travel at all
	0
	0
	0
C. Food Preparation		G. Responsibility for Own Medications
Plans, prepares and serves adequate meals independently  Prepares adequate meals if supplied with ingredients  Heats, serves and prepares meals, or prepares meals, or prepares meals but does not maintain adequate diet  Needs to have meals prepared and served	1	Is responsible for taking medication in correct dosages at correct time  Takes responsibility if medication is prepared in advance in separate dosage  Is not capable of dispensing own medication
	0
	0
	0
D. Housekeeping		H. Ability to Handle Finances
Maintains house alone or with occasional assistance (e.g. "heavy work domestic help")  Performs light daily tasks such as dish washing, bed making  Performs light daily tasks but cannot maintain acceptable level of cleanliness  Needs help with all home maintenance tasks  Does not participate in any housekeeping tasks	1	Manages financial matters independently (budgets, writes checks, pays rent, bills, goes to bank), collects and keeps track of income  Manages day-to-day purchases, but needs help with banking, major purchases, etc .  Incapable of handling money
	1
	1
	1
	0
Score	2	Score
Total score 3  A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women and 0 through 5 for men to avoid potential gender bias.