Activities of Daily Living and Wheelchairs

     The Activities of Daily Living (ADLs) are necessary for human survival, and are used by various groups like insurance companies to determine Caregiver, assistance, and/or placement needs. Health Care Models like the Program of All-Inclusive Care for the Elderly (PACE) utilize ADLs in their assessment. ADLs are also used by Occupational Therapists, Nurses, Doctors, and other allied health professionals to quantify whether a patient is able to live independently. It is a functional status classification to describe self-care, usually used to describe the extent of a disability or aging. The ADLs can be defined variably, but involve six categories (1):

Personal Hygeine and Grooming: able to bathe, dress, brush teeth.
Self Feeding: able to prepare food, eat, and clean up.
Continence: able to use facilities and maintain dignity.
Dressing and Undressing: able to choose clothes, dress, and change attire.
Transferring: able to move from a chair to a bed, on an off a commode, into and out of a car.
Ambulation: able to walk.

     A more comprehensive listing is the Instrumental Activities of Daily Living, which allow for socialization within a community. IADLs include such things as taking medicines, managing money, doing laundry and housework, grocery shopping, using the telephone, transportation beyond a walking distance, preparing meals, and doing housework (2).

    Using 9 classifications, the Occupational Therapists typically assess IADLs that are optional and can be delegated to another person. These include child rearing, care of others, pet care, health management, financial management, meal preparation and cleanup, use of devices for communication, mobility in the community, and safety/emergency responses (2,3).

     The term Assistive Technology is used to describe anything that assists a person to live independently and safely. It includes items such as a shower grab bar, bedside commode, non-slip mat, wheelchair, walker, cane, programmable watch for medication reminders, door with a lock that does not require a key, and pharmacy labels with large print (3).

     The following Table combines ADLs and IADLS (4). It can be used as an assessment tool to determine the functional status of self-help needed for both survival and socialization. If deficiencies are noted in any area, the patient can be made aware of the need for assistance. Also, functional status based on ADLs and/or IADLs can be made over time, to determine if the patient is trending toward gaining, maintaining, or losing independence. Appropriate needs can then be met.

      To determine ADL/IADL assessment, simply assess the need (or independence) for each item in the first column. The recommendation is that the need is assessed monthly. In this manner, trends can be determined and the patient is optimized for survival, community socialization, and quality of life.


Date: _______________                         

Activities	Independent	Help Needed	Completely Dependent	Not Applicable
Bathing
Grooming
Dressing
Bowel/Bladder Control
Oral Hygiene
Walking
Mobility and Transportation
Eating
Climbing Stairs
Meal Planning and Cooking
Errand Running
Using the Phone
Managing Medications
Doing Laundry
Household chores
Money Management
Driving

 (By Shashank Nakate; Last Updated: 1/16/2012) (4)

     For patients having dysautonomia, EDS, Mastocytosis, POTS, or other diagnoses that render one to be bed-ridden, there is a need to improve quality of life. For example, if the patient is unable to walk or incapable of doing laundry, it is reasonable that improved mobility and transportation via wheelchair can be implemented for the patient to provide herself with clean clothes.

     In this case, the use of a wheelchair should not be viewed as an extreme or last-resort measure to afford the patient some mobility. Rather, the benefits of a generous provision of access to mobility in an otherwise depressing and 'nursing-home-at-home' environment (i.e. by providing a prescription for a wheelchair) should be seen as far outweighing the risks of dependence on a wheelchair. It may be that the majority of patients with the above-mentioned diagnoses are young women of child-bearing age who were previously active and healthy. In this case, it may be that these patients are self-motivated to abandon the wheelchair as soon as cerebral perfusion can be adequately maintained.

     Further research needs to be done on the effect of bed-ridden status, ADLs, IADLs, and quality of life with dysautonomia. The severity and incidence of depression, social and physical isolation, Vitamin D deficiency due to lack of sun exposure, muscle deconditioning, and lack of visual, auditory, and cerebral stimulation need to be ascertained. There is a paucity of data to ascertain whether the presence of a wheelchair in the patient's armament offers an increased chance of recovery. Variables that are associated with recovery of dysautonomia need to be better described, and there is a need for multi-center, prospective research to determine the major factors associated with recovery.



     
References:
(1)  http://www.fullcirclecare.org/ltcontinuum/everydaytasks.html
(2)  http://en.wikipedia.org/wiki/Activities_of_daily_living
(3)  Bookman, A., Harrington, M., Pass, L., and Reisner, E. Family Caregiver Handbook. (2007) Cambridge, MA; Massachusetts Institute of Technology.
(4)  http://www.buzzle.com/articles/activities-of-daily-living-checklist.html