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Activities of daily living

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Improving measurement of ADLs

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Activities of daily living

  1. 1. Activites of daily living Roger Watson Professor of Nursing Symposium: Medicine for the elderly Royal College of Physicians of Edinburgh 12 April 2013
  2. 2. 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.
  3. 3. 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.
  4. 4. • .
  5. 5. What do we want from an ADL scale? • Utility • Meaningful scoring system • Predictive ability
  6. 6. 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 = 0 With difficulty = 1 Unable 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 clinical practiceJournal of Clinical Nursing 21: 2736-2746
  7. 7. 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)
  8. 8. 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
  9. 9. 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)
  10. 10. 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
  11. 11. Meaningful scoring system What does a non-meaningful scoring system look like?
  12. 12. Townsend Functional Ability Scale Does the patient ever: None Some Unable 1) Cut toe nails 2) Up and down stairs 3) Get on bus 4) Reach overhead 5) Wash or bathe 6) Tie a knot Total score = No difficulty = 0 With difficulty = 1 Unable to do = 2
  13. 13. 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 = 0 No difficulty = 0 With difficulty = 1 Unable to do = 2
  14. 14. 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 = 12 No difficulty = 0 With difficulty = 1 Unable to do = 2
  15. 15. 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 = 6 No difficulty = 0 With difficulty = 1 Unable to do = 2
  16. 16. 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 = 6 No difficulty = 0 With difficulty = 1 Unable to do = 2
  17. 17. 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 = 6 No difficulty = 0 With difficulty = 1 Unable to do = 2
  18. 18. 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 = 6 No difficulty = 0 With difficulty = 1 Unable to do = 2
  19. 19. Meaningful scoring system What does a meaningful scoring system look like?
  20. 20. 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 = 0 No difficulty = 0 With difficulty = 1 Unable to do = 2
  21. 21. 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 = 1 No difficulty = 0 With difficulty = 1 Unable to do = 2
  22. 22. 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 = 2 No difficulty = 0 With difficulty = 1 Unable to do = 2
  23. 23. 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 = 3 No difficulty = 0 With difficulty = 1 Unable to do = 2
  24. 24. 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 = 4 No difficulty = 0 With difficulty = 1 Unable to do = 2
  25. 25. 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 = 5 No difficulty = 0 With difficulty = 1 Unable to do = 2
  26. 26. 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 = 6 No difficulty = 0 With difficulty = 1 Unable to do = 2
  27. 27. 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 = 7 No difficulty = 0 With difficulty = 1 Unable to do = 2
  28. 28. 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
  29. 29. What do we want from an ADL scale? • Utility • Meaningful scoring system • Predictive ability
  30. 30. r.watson@hull.ac.uk @rwatson1955

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