Functional Status
Intrinsic capacity (IC) is the combination of all the
physical and mental capabilities of an individual. Functional ability is
dependent on the IC (of the person himself/herself), the environment (external things
which help improve function, Eg: spectacles, hearing aid, walker, wheelchair
etc.) and the interactions between the two. This model proposed by the World
Health Organization can modify how clinical practice is currently conducted, shifting
from disease-centred towards function-centred paradigms.
Measurement of functional status is an essential part of the
evaluation of an older person. A person's capability to perform functional
tasks can be considered as a comprehensive measure of the overall impact of age-related
impairment and health conditions. Functional status is a powerful prognostic factor
and an essential indicator of the quality of life.
Many tools have been proposed and used to assess functional
status in older adults, some are objective measures, and others are
self-reported. Self-report measures are based on questionnaires asking how
people function in their environment to evaluate their ability to remain independent.
Using the self-report tool, functional status can be assessed at different
levels: basic activities of daily living (BADL), instrumental activities of
daily living (IADL) and advanced activities of daily living (AADL). The latter
is seldom used in routine clinical practice.
Basic activities of daily living (BADL)
Basic activities of daily living include fundamental skills
typically needed to manage basic physical needs. They have the following categories:
·
Ambulation: the extent of a persons ability to
move from one position to another and walk independently.
·
Feeding: the ability of a person to feed oneself.
·
Dressing: the ability to select appropriate clothes
and to put the clothes on.
·
Personal hygiene: the ability to bathe and groom
oneself and maintain dental hygiene, nail and hair care.
·
Continence: the ability to control bladder and
bowel function.
· Toileting: the ability to get to and from the toilet, using it appropriately, and cleaning oneself.
The Katz index of independence and the Barthel index is
commonly used for BADL evaluation. The Katz index ranks performance in the six
functions. A score of 6 indicates full function, 4 indicates moderate impairment,
two or less indicates severe functional impairment. The Barthel index assesses ten
activities. The total score ranges from 0 to 100 points, with higher scores
indicating better performance.
Instrumental activities of daily living (IADL)
The instrumental ADLs are those that require more complex
thinking skills, including organizational skills. IADLs are those activities
that allow an individual to live independently in a community. The Lawton IADL
scale includes eight domains:
· Using the telephone
· Shopping
· Preparing food
· Housekeeping
· Laundry
· Mode of transportation
· Responsibility for their medications
· Ability to handle finances
The scoring should be individualized, as not everyone
performs all the above eight activities. Hence a more appropriate scoring method
would be first asking if the person performed an activity and has he/she stopped
doing it recently.
Advanced activities of daily living (AADL)
AADL is based on intentional conducts involving the physical,
mental and social functioning that allow the individual to develop multiple
social roles and maintain good mental health and quality of life. It is also of
interest in establishing the diagnosis of Alzheimer's disease in an earlier stage,
as these activities require high cognitive functioning and are responsive to
subtle changes. Common AADLs are:
· Participating in a meeting
· Giving advice to family
· Reading a newspaper
· Shopping on special occasions
· Socializing with others
· Taking a walk
· Care of a grandchild
Objective measures of physical function might be superior to
self-report tools in people who are in general healthy. The measure includes
short physical performance battery (SPPB), gait speed or 400 m walking test or
6- minute walk test. This is the best strategy to detect early limitations and
stratify the risk of future health outcomes in otherwise fully independent
people. Learning how each ADL affects an individual to care for themselves can help
determine whether a patient would need daily assistance.
With the advancement in technology, we can provide support
to people with impaired ADLs. Assistive devices are external devices that are
designed to assist a person in performing a particular task. With the use of
appropriate devices of good-quality, it is possible to improve the quality of
life by enabling a person to participate in life at home, work, and the community.
