Activities of daily living
Activities of daily living is a term used in healthcare to refer to an individual's daily self-care activities. Health professionals often use a person's ability or inability to perform ADLs as a measure of their functional status. The concept of ADLs was originally proposed in the 1950s by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, Ohio. Since then, numerous researchers have expanded on the concept of ADLs. For instance, many indexes that assess ADLs incorporate measures of mobility.
In 1969, Lawton and Brody developed the concept of Instrumental Activities of Daily Living to capture the range of activities that support independent living. These are often utilized in caring for individuals with disabilities, injuries, and the elderly. Younger children often require help from adults to perform ADLs, as they have not yet developed the skills necessary to perform them independently. Aging and disabilities, affecting individuals across different age groups, can significantly alter a person's daily life. Such changes must be carefully managed to maintain health and well-being.
Common activities of daily living include feeding oneself, bathing, dressing, grooming, working, homemaking, and managing personal hygiene after using the toilet. A number of national surveys have collected data on the ADL status of the U.S. population. Although basic definitions of ADLs are established, what specifically constitutes a particular ADL can vary for each individual. Cultural background and education level are among the factors that can influence a person's perception of their functional abilities.
ADLs are categorized into basic self-care tasks or instrumental tasks generally learned throughout adolescence. A person who cannot perform essential ADLs may have a poorer quality of life or be unsafe in their current living conditions; therefore, they may require the help of other individuals and/or mechanical devices. Examples of mechanical devices to aid in ADLs include electric lifting chairs, bathtub transfer benches and ramps to replace stairs.
Basic
Basic ADLs consist of self-care tasks that include:- Bathing and showering
- Personal hygiene and grooming, which encompasses brushing, combing, and styling hair
- Dressing
- Toilet hygiene, which involves getting to the toilet, cleaning oneself, and getting back up
- Functional mobility, often referred to as "transferring." This includes the ability to walk, get in and out of bed, and get into and out of a chair. The broader definition covers moving from one place to another while performing activities and is useful for people with varying physical abilities who can still move around independently.
- Self-feeding, which is limited to the act of eating itself, as opposed to assisted feeding
The specific breakdown of the scale is shown below:
7 - Complete Independence
6 - Modified Independence
5 - Supervision or Setup
4 - Minimal Assistance
3 - Moderate Assistance
2 - Maximal Assistance
1 - Total Assistance
0 - Activity Does Not Occur
Instrumental
Instrumental activities of daily living are not essential for basic day-to-day functioning, but they enable an individual to maintain a level of independence in a community.- Cleaning and maintaining the house
- Managing money
- Moving within the community
- Preparing meals
- Shopping for groceries and other necessities
- Taking prescribed medications
- Using the telephone or other forms of communication
- Care of others
- Care of pets
- Child rearing
- Communication management
- Community mobility
- Financial management
- Health management and maintenance
- Home establishment and maintenance
- Meal preparation and cleanup
- Religious observances
- Safety procedures and emergency responses
- Shopping
Therapy
Physical therapists employ exercises to help patients maintain and improve independence in ADLs. The exercise program is tailored to the patient's specific deficits, which may include walking speed, strength, balance, and coordination. A slow walking speed has been linked to an increased risk of falls; thus, exercises that enhance walking speed are crucial for safer and more functional ambulation. After initiating an exercise program, it is important to maintain the routine. Otherwise, the benefits will be lost. For frail patients, regular exercise is vital in preserving functional independence and preventing the need for external assistance or placement in a long-term care facility.
Assistance
Skills in assisting with ADLs are required in nursing and other professions, such as nursing assistants in hospitals, nursing homes, assisted living facilities, and other long-term care settings. This includes assisting in patient mobility, such as repositioning an activity-intolerant patient in bed. Hygiene assistance may involve giving bed baths and helping with urinary and bowel elimination. Personal care assistants are required to adhere to established standards of care. Personal assistance is defined as wagered support of 20 or more hours a week for people with impairments. A 2008 review suggested that personal assistance may offer benefits to some elderly individuals and their informal caretakers. Further research is required to evaluate the efficiency of different personal assistance models and their overall costs.Caretaker requirements
In community residential care settings, it is essential for personal assistants, doctors, and nurses to recognize that illness can alter a patient's mental state, affecting their reactions to change and possibly leading to behaviors such as fussiness or capriciousness. Providing care with patience, tact, concentration, discipline, and compassion is crucial to building trust with patients, maintaining their confidence, and supporting the success of their treatment and recovery.Because nursing care requires a great deal of attention and energy, nursing staff in some countries are often required to have national license as nurses, such as having passed the NCLEX. Nursing care is usually divided into general and specialized care. Particular difficulties arise when caring for the severely ill. A healthy workspace is an important factor. If caregivers are mistreated or burnt out, it can lead to residents being neglected and mistreated.
Special care needs
Mobility
Patients who are immobile should be repositioned at least every two hours to prevent the development of pressure ulcers, commonly known as bed sores. Repositioning hospitalized patients also offers additional benefits, such as a reduced risk of deep vein thrombosis, fewer pressure ulcers, and less functional decline. To protect the patient's head from injury during repositioning, a pillow is commonly placed at the head of the bed. To move a bedridden patient up in bed, caregivers utilize either a friction-reducing sheet or a draw sheet.Bathing
A bed bath involves using a bath blanket to cover the patient, ensuring that only the area being washed is exposed at any given time. This practice maintains privacy and keeps the patient warm. Typically, the eyes are cleansed first, using water without soap to prevent irritation. Each eye should be cleaned from the inner corner near the nose outward, to avoid transferring debris to the tear duct. A clean section of the cloth is used, or the cloth is rinsed before cleaning the second eye, to prevent the spreading of any organisms. After washing, each area is dried before moving on to the next.Perineal care follows a specific protocol to minimize the transfer of microorganisms. The perineum should be washed from the least contaminated area to the most contaminated area. In females, this involves spreading the labia and washing from the pubic area toward the anal area, never in reverse. For males, the tip of the penis is cleansed first, moving away from the urethral opening. The foreskin is gently retracted, washed, and then promptly returned to its original position to prevent restricting circulation. For children, the foreskin is not retracted to avoid injury.
Toileting
A bedpan is used for bed-bound patients for bowel elimination as well as urinary elimination for females. The head of the bed is raised to assist in voiding or defecating.Dressing
For individuals with one side weaker than the other, it is recommended to dress the weaker side first using the stronger arm. Conversely, when undressing, the stronger side should be undressed first.When making an occupied bed, for instance for patients who cannot or have difficulty getting out of bed, the bed is made one side at a time. However, for patients for whom rolling to the side is contraindicated, such as those recovering from hip replacement surgery, the process is modified. These patients are assisted into a sitting position while the caregiver makes the top half of the bed. Once completed, the patient is then helped to lie back while the bottom half of the bed is made.