LAWTON SCALE FOR INSTRUMENTAL ACTIVITIES OF DAILY LIVING

The Lawton scale evaluates more sophisticated functions than the Katz index. Patients or caregivers can complete the form in a few minutes. The first answer in each case—except for 8a—indicates independence, the second indicates capability with assistance, and the third indicates dependence. In this version, the maximum score is 29, although scores have meaning only for an individual patient, as when declining scores over time reveal deterioration. Questions 4 to 7 tend to be gender-specific; modify them as necessary.

1. Can you use the telephone?   without help â‘¢ with some help 2 completely unable 1 2. Can you get to places beyond walking distance?   without help â‘¢ with some help 2 not without special arrangements 1 3. Can you go shopping for groceries?   without help â‘¢ with some help 2 completely unable 1 4. Can you prepare your own meals?   without help â‘¢ with some help 2 completely unable 1 5. Can you do your own housework?   without help 3 with some help â‘¡ completely unable 1 6. Can you do your own handyman work?   without help 3 with some help â‘¡ completely unable 1 7. Can you do your own laundry?   without help â‘¢ with some help 2 completely unable 1 8a. Do you take medicines or use any medications?   Yes (If yes, answer Question 8b.)‘ â‘  No (If no, answer Question 8c.) 2 8b. Do you take your own medicine?   without help (in the right doses at the right times) â‘¢ with some help (if someone prepares it for you and/or reminds you to take it) 2 completely unable 1 8c. If you had to take medicine, could you do it?   without help (in the right doses at the right time) â‘¢ with some help (if someone prepared it for you and reminded you to take it) 2 completely unable 1 9. Can you manage your own money?   without help â‘¢ with some help 2 completely unable 1 Adapted with permission

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Tools for Assessment of Geriatric Care

Numerous tools are available to help you perform a methodical functional assessment. Some widely used methods are discussed here.

A functional assessment is used to evaluate the older adult's overall well-being and self-care abilities. It will help you identify individual needs and care deficits, provide a basis for developing a plan of care that enhances the abilities of the older adult with coexisting disease and chronic illness, and provide feedback about treatment and rehabilitation. You can use the information to identify and match the older adult's needs with such services as housekeeping, home health care, and day care to help the patient maintain independence.

 

Katz index

The Katz Index of Activities of Daily Living is a widely used tool for evaluating a person's ability to perform six daily personal care activities: bathing, dressing, toileting, transfer, continence, and feeding. It describes his functional level at a specific point in time and objectively scores his performance. (See Katz Index of Activities of Daily Living, pages 804 and 805.)

 

Lawton scale

Another widely used tool, the Lawton Scale for Instrumental Activities of Daily Living, evaluates the ability to perform more complex personal care activities. It addresses the activities needed to support independent living, such as the ability to use the telephone, cook, shop, do laundry, manage finances, take medications, and prepare meals. The activities are rated on a three-point scale, ranging from independence to needing some help to complete disability. (See Lawton Scale for Instrumental Activities of Daily Living, page 806.)

 

Barthel index and scale

The Barthel Index evaluates the following 10 self-care functions: feeding, moving from wheelchair to bed and returning, performing personal toilet, getting on and off the toilet, bathing, walking on a level surface or propelling a wheelchair, going up and down stairs, dressing and undressing, maintaining bowel continence, and controlling the bladder. Each item is scored according to the degree of assistance needed; over time, results reveal improvement or decline.

A similar scale—called the Barthel Self-Care Rating Scale—is a more detailed scale to evaluate function. Both tools provide information to help you determine the type of assistance needed.

 

OARS Social Resource Scale

The Older Americans Research and Service Center (OARS) Social Resource Scale is an assessment tool developed at Duke University in 1978. A multidimensional tool, it evaluates level of function in the following five areas:

• social resources
• economic resources
• physical health
• mental health
• activities of daily living.

The primary activities of daily living (ADLs) include mobility, dressing, personal hygiene, eating, and toileting or continence factors. However, ADLs may be expanded to include instrumental activities (shopping, household maintenance, using the telephone, paying bills, administering medications, cooking and laundry) and advanced activities (voluntary social activities, occupational activities, and recreational activities).

Each area is scored on a scale of 1 to 6. At the end of the assessment, a cumulative impairment score is determined. The lower the score, the less the degree of impairment.

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