ADL Functional Assessment Tools
Key Points
- Functional assessment quantifies independence in BADLs and IADLs and supports safer care planning.
- Common tools include the Katz ADL Index, Lawton-Brody IADL Scale, and Barthel Index.
- Tool choice depends on purpose: quick dependency screening, IADL complexity, or rehabilitation progress tracking.
- Repeated scoring is most useful when compared with the same tool over time.
Pathophysiology
Functional assessments do not diagnose disease directly; they measure impact of disease, aging, cognition, and environment on real-world task performance. Declining scores can be early evidence of physiologic deterioration, neurocognitive change, frailty progression, or unsafe discharge readiness.
Because ADL function is dynamic, serial measurements are more informative than one-time scores. Trends support triage for home support, rehabilitation intensity, or long-term-care eligibility.
Classification
- Katz ADL Index: Six BADLs; binary scoring per item (independent vs requires help).
- Lawton-Brody IADL Scale: Eight IADL domains for community-living complexity.
- Barthel Index: Expanded BADL-related items with more nuanced dependence gradation (0-100).
- Use context: Acute discharge planning, rehab trajectory tracking, payer eligibility, or baseline primary-care screening.
Nursing Assessment
NCLEX Focus
Priority questions often test which tool best fits the clinical goal and how to interpret trend changes rather than isolated numbers.
- Assess reason for measurement (discharge safety, rehab progress, long-term placement, or service eligibility).
- Assess who provides data (patient self-report, caregiver report, direct observation) and possible reliability limits.
- Assess for changes from baseline rather than only absolute score category.
- Assess whether score changes align with cognition, mobility, medication burden, and acute illness findings.
- Assess need for same-tool follow-up intervals to evaluate intervention response.
Nursing Interventions
- Select the instrument matched to care goal and setting before collecting data.
- Use consistent scoring method and document item-level deficits, not only total score.
- Communicate results to interdisciplinary teams to align PT/OT, nursing, and social-work planning.
- Use findings to determine supervision level, caregiver education, and home-safety supports.
- Repeat assessments at transitions (admission, discharge, post-acute follow-up) to detect decline early.
Score-Only Error
Relying on a total score without task-level interpretation can miss high-risk deficits such as medication management or toileting safety.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| sedatives | Benzodiazepines, hypnotics | Can lower functional scores by causing confusion and gait instability; interpret trends with medication timing in mind. |
| analgesics | Opioids, adjunct pain therapies | Untreated pain and over-sedation both alter ADL performance; balance comfort and function when interpreting results. |
Clinical Judgment Application
Clinical Scenario
A patient in short-term rehabilitation improves from total-assist transfers to supervised transfers, but still cannot manage medications independently.
Recognize Cues: Mixed recovery pattern across BADLs and IADLs. Analyze Cues: Mobility gains do not guarantee safe independent discharge. Prioritize Hypotheses: Priority is preventing medication-related harm after transition home. Generate Solutions: Pair Barthel progress review with Lawton IADL scoring and caregiver planning. Take Action: Arrange medication-management supports and targeted discharge teaching. Evaluate Outcomes: Functional plan matches real-world capabilities and reduces readmission risk.
Related Concepts
- activities-of-daily-living - Defines BADL and IADL domains measured by these tools.
- promoting-independence-during-adls - Functional scores guide independence-preserving interventions.
- geriatric-assessment-and-polypharmacy-safety - Functional tools complement comprehensive geriatric assessment.
- patient-care-coordination-interdisciplinary-referrals-and-case-management - Scores help align team roles and transitions.
- documenting-and-reporting-data - Trend documentation is essential for safe handoff and planning.
Self-Check
- When is the Barthel Index more useful than the Katz ADL Index?
- Why should ADL tool interpretation include medication and cognition context?
- Which transition points need repeat functional assessment most urgently?