Multidisciplinary studies of illness in aged persons: II. A new classification of functional status in activities of daily living

Abstract

At The Benjamin Rose Hospital, a hospital for prolonged illness in Cleveland, Ohio, methods were established for obtaining quantitative information about the progressive loss of abilities and progressive increase in death rate of aged patients. The methods were initially designed in relation to fractures of the hip. In the present report, an Index of Independence in Activities of Daily Living was defined, newly evolved and more specific than previously available. The index was a composite evaluation of the functional independence or dependence of patients in bathing, dressing, going to toilet, transferring, continence, and feeding. Use of the Index of ADL in evaluating deterioration and progression of deterioration was demonstrated, and the significance of these applications was discussed. Evaluation 6 months after the occurrence of fracture revealed deterioration in activities of daily living in 38 per cent of patients classified as A (according to the Index of ADL) prior to fracture, in 56 per cent of those classified as B and C, and 100 per cent of those in the more dependent classes. Mortality in the 3 groups was 7, 18, and 20 per cent, respectively. Progression of deterioration during the second 6-month interval was more frequent in patients who had shown deterioration in the first 6-month interval than in patients who had not shown such previous deterioration. Mortality, too, was greater in patients showing previous deterioration.