II. Epidemiology

  1. Incidence ADL loss in community dwelling elderly: 10%

III. ADL Examples

  1. Bathing
  2. Dressing
  3. Transferring from bed or chair
  4. Walking
  5. Eating
  6. Toilet use
  7. Grooming

IV. Clinical Predictors of Decline

  1. Timed tests to evaluate risk of ADL loss
    1. Foot taps
    2. Chair stands
    3. Turn a full 360 degrees
    4. Bend over
    5. Rapid gait
    6. Hand signature
  2. Interpretation
    1. Trouble performing these tests predicts decline
    2. Risk of decline increased by 30-50%
  3. Reference
    1. Gill (1995) J Am Geriatr Soc 43:603-9 [PubMed]

V. Evaluation: Clinic Assessment

  1. Activities of Daily Living Scale
  2. Instrumental Activities of Daily Living
  3. Vision
  4. Hearing
  5. Polypharmacy
  6. Safety of home environment
    1. Home lighting
    2. Shoes
    3. Uneven flooring
  7. Balance and gait
    1. Timed tests (e.g. Get-Up and Go Test)
    2. One-leg balance test for 5 seconds

VI. Management

  1. Consider balance and Strength Training referral
  2. Consider home health evaluation for safety

VII. Prognosis: Loss of ADLs reflects greater risk

  1. Increased hospitalizations
  2. Increased Nursing Home placement
  3. Predictors of higher mortality rate
    1. Male gender (2 points)
    2. Age 75-80 (1 point)
    3. Age >80 (2 points)
    4. Dependent bathing (1 point)
    5. Dependent shopping (2 points)
    6. Difficult walking (2 points)
    7. Difficulty moving heavy items (1 point)
    8. Carey (2004) J Gen Intern Med 19:1027 [PubMed]

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