instrumental activities of daily living

手段的日常生活動作

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/05/27 07:21:23」(JST)

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This article is about the basic activities of a typical human life as defined in most medical contexts. For the activities of living model, see Roper-Logan-Tierney model of nursing.

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Activities of daily living (ADLs or ADL) is a term used in healthcare to refer to people's daily self care activities. The concept of ADLs was originally proposed in the 1950s by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, Ohio and has been added to and refined by a variety of researchers since that time. Health professionals often use a person's ability or inability to perform ADLs as a measurement of their functional status, particularly in regard to people post injury, with disabilities 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.

Common ADLs include feeding ourselves, bathing, dressing, grooming, work, homemaking, cleaning oneself after defecating and leisure. A number of national surveys collect data on the ADL status of the U.S. population. While basic definitions of ADLs have been suggested, what specifically constitutes a particular ADL for each individual may vary. Adaptive equipment and devices may be used to enhance and increase independence in performing ADLs.

Basic

Basic ADLs consist of self-care tasks that include, but are not limited to:

• Bathing and showering
• Personal hygiene and grooming (including brushing/combing/styling hair)
• Dressing
• Toilet hygiene (getting to the toilet, cleaning oneself, and getting back up)
• Functional mobility, often referred to as "transferring", as measured by the ability to walk, get in and out of bed, and get into and out of a chair; the broader definition (moving from one place to another while performing activities) is useful for people with different physical abilities who are still able to get around independently.
• Self-feeding (not including cooking or chewing and swallowing)

One way to think about basic ADLs is that they are the things many people do when they get up in the morning and get ready to go out of the house: get out of bed, go to the toilet, bathe, dress, groom, and eat.

There is a hierarchy to the ADLs:" ... the early loss function is hygiene, the mid-loss functions are toilet use and locomotion, and the late loss function is eating. When there is only one remaining area in which the person is independent, there is a 62.9% chance that it is eating and only a 3.5% chance that it is hygiene."

Although not in wide general use, a mnemonic that some find useful is DEATH: dressing/bathing, eating, ambulating (walking), toileting, hygiene.

Instrumental

Instrumental activities of daily living (IADLs) are not necessary for fundamental functioning, but they let an individual live independently in a community:

• Cleaning and maintaining the house
• Managing money
• Moving within the community
• Preparing meals
• Shopping for groceries and necessities
• Taking prescribed medications
• Using the telephone or other form of communication

Occupational therapists often evaluate IADLs when completing patient assessments. The American Occupational Therapy Association identifies 12 types of IADLs that may be performed as a co-occupation with others:

• Care of others (including selecting and supervising caregivers)
• 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

Role of therapy

See also: Occupational therapy

Occupational therapists teach and rebuild the skills required to maintain, regain or increase a person's independence in all Activities of Daily Living that have declined because of health conditions (physical or mental), injury or age-related debility.

Physical therapists use exercises to assist patients in maintaining and gaining independence in ADLs. The exercise program is based on what components patients are lacking such as walking speed, strength, balance, and coordination. Slow walking speed is associated with increased risk of falls. Exercise enhances walking speed, allowing for safer and more functional ambulation capabilities. After initiating an exercise program it is important to maintain the routine otherwise the benefits will be lost. Exercise for patients who are frail is essential for preserving functional independence and avoiding the necessity for care from others or placement in a long term care facility.

Assistance

Main article: Activities of daily living assistance

Assisting in activities of daily living are skills required in nursing and as well as other professions such as nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed. For hygiene, this often involves bed baths and assisting with urinary and bowel elimination.

Evaluation

There are several evaluation tools, such as the Katz ADL scale, the Older Americans Resources and Services (OARS) ADL/IADL scale, the Lawton IADL scale and the Bristol Activities of Daily Living Scale.

In the domain of disability, measures have been developed to capture functional recovery in performing basic activities of daily living. Among them, some measures like the Functional Independence Measure are designed for assessment across a wide range of disabilities. Others like the Spinal Cord Independence Measure are designed to evaluate participants in a specific type of disability.

Most models of health care service use ADL evaluations in their practice, including the medical (or institutional) models, such as the Roper-Logan-Tierney model of nursing, and the resident-centered models, such as the Program of All-Inclusive Care for the Elderly (PACE).

Research

ADL evaluations are used increasingly in epidemiological studies as an assessment of health in later-life that does not necessarily involve specific ailments. Studies using ADL differ from those investigating specific disease outcomes, as they are sensitive to a broader spectrum of health effects, at lower-levels of impact. ADL is measured on a continuous scale, making the process of investigation fairly straightforward.

Sidney Katz initially studied 64 hip fracture patients over an 18-month period. Comprehensive data on treatments, patient progression, and outcomes were collected during this study. After analyzing the study data, the researchers discovered that the patients they viewed as being most independent could perform a set of basic activities – ranging from the most complex bathing activity, to the least complex feeding activity. From these data, Katz developed a scale to assess patients' ability to live independently. This was first published in the 1963 in the Journal of the American Medical Association; the paper has since been cited over 1,000 times.

Although the scale offers a standardized measure for psychological and biological function, the process of arriving at this assumption has been criticised. Specifically, Porter has argued for a phenomenological approach noting that:

Katz et al. (1963) made a claim that became the basis for the ontological assumptions of the ADL research tradition. In their suggestion that there was an "ordered regression [in skills] as part of the natural process of aging" (p. 918), there was an implicit generalization, from their sample of older persons with fractured hips, to all older persons.

Porter emphasizes the possible disease-specific nature of ADLs (being derived from hip-fracture patients), the need for objective definition of ADLs, and the possible value of adding additional functional measures.

A systematic review examined the effectiveness of imparting activities of daily life skills programmes for people with chronic mental illnesses:

Life skills programme compared to standard care

Summary
Currently there is no good evidence to suggest ADL skills programmes are effective for people with chronic mental illnesses. More robust data are needed from studies that are adequately powered to determine whether skills training is beneficial for people with chronic mental health problems.
Outcome Findings in words Findings in numbers Quality of evidence Life skills - no important change - in household activity skills. Follow-up: mean 12 weeks Life skills programmes may reduce the risk of not improving in day-to-day functioning for general household activity skills when compared with standard care, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited. RR 0.24 (0.01 to 4.72) Very low - in laundry skills. Follow-up: mean 12 weeks Life skills programmes may reduce the risk of not improving in day-to-day functioning for laundry skills when compared with standard care, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited. RR 0.14 (0.01 to 2.38) Very low - in self-care skills. Follow-up: mean 12 weeks Life skills programmes make no difference to self-care when compared with standard care, but, at present it is not possible to be confident about the difference between these two treatments. This finding is based on data of very limited quality. RR 1 (0.28 to 3.54) Very low Leaving the study early Leaving the study early Follow-up: 6 to 16 weeks Life skills programme make no clear difference to the risk of loss to follow up compared with standard care. Data supporting this finding are very limited. RR 1.16 (0.4 to 3.36) Very low Mental state Average score. (Positive and Negative Syndrome Scale - positive syndrome). Follow-up: mean 24 weeks People receiving life skills programme scored the same as people receiving standard care. Findings are based on data of very limited quality.* MD 0 (3.12 lower to 3.12 higher ) Very low Quality of life Average score (Quality of Well-Being Scale index). Follow-up: mean 24 weeks On average, people receiving life skills programme scored 0.02 lower than people treated with standard care. There was no clear difference between the groups and this finding is based on data of very limited quality.* MD 0.02 lower (0.07 lower to 0.03 higher) Very low * At present the meaning of these scores in day-to-day care is unclear.

See also

Library resources about Activities of daily living

Resources in your library

• Activities of daily living assistance
• Assisted living
• Care of residents
• Global Assessment of Functioning
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UpToDate Contents

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• 1. 高齢者の職場健康診断office based assessment of the older adult [show details]
  … (ADLs), instrumental activities of daily living (IADLs), and advanced activities of daily living (AADLs). Two commonly used indices are the Katz index for ADLs and the Lawton scale for IADLs AADLS are …
• 2. 包括的老年医学的評価comprehensive geriatric assessment [show details]
  …basic activities of daily living (BADLs), instrumental or intermediate activities of daily living (IADLs), and advanced activities of daily living (AADLs). BADLs refer to self-care tasks which include: Bathing; …
• 3. 脳卒中スケールおよび重症度分類システムの利用および有用性use and utility of stroke scales and grading systems [show details]
  …sensitive to change . Instrumental activities of daily living (IADL) scales attempt to bridge the gap between disability and handicap. Combining basic scales such as the BI or FIM with IADL assessments may provide …
• 4. Mental status scales to evaluate cognitionmental status scales to evaluate cognition [show details]
  …observed changes in the patient memory, orientation, judgment, and performance of instrumental activities of daily living. The full version of the IQCODE includes 26 items , but a shorter version has subsequently…
• 5. 癌患者に対する包括的老年医学的評価comprehensive geriatric assessment for patients with cancer [show details]
  …of an evaluation of functional status (Activities of Daily Living [ADLs] and Instrumental Activities of Daily Living [IADL]), cognition (Mini-Mental State Exam [MMSE]), and psychological state (Geriatric …

English Journal

• Differences in self-awareness of functional deficits between amnestic single- and multidomain mild cognitive impairment.

• Steward KA, Bull TP, Wadley VG.
• Journal of clinical and experimental neuropsychology. 2019 Jul;41(5)544-553.
• Prior research examining self-awareness of deficits in those with mild cognitive impairment (MCI) has been inconsistent, suggesting that preservation of insight at this disease stage may be conditional on the domain(s) examined as well as individual characteristics. The current study is the first to
• PMID 30870084

• Verbal test of practical judgment (VPJ): a new test of judgment that predicts functional skills for older adults.

• Mansbach WE, Mace RA, Tanner MA, Schindler F.
• Aging & mental health. 2019 Jun;23(6)718-726.
• The clinical assessment of older adults' judgment is important for mitigating safety risks that often precipitate loss of independence. Our national survey of geriatric healthcare providers (N = 496; M years of experience = 17.11 ± 10.60) indicated that formal judgment tests are underutilized in
• PMID 29570362

• Psychometric validation of Fuld Object Memory Evaluation in older adults with cognitive impairments.

• Ho RTH, Fong TCT, Hon T, Chan WC, Kwan JSK, Chiu PKC, Lam LCW.
• Aging & mental health. 2019 Jun;23(6)711-717.
• Mild cognitive impairment (MCI) refers to an early but abnormal state of cognitive impairment with minimal functional impairment. The present study aimed to evaluate the validity of Fuld Object Memory Evaluation (FOME) as a measure of episodic memory function. The study sample included 204 Chinese o
• PMID 29517270

Japanese Journal

• 急性期作業療法で応用的活動を活用するための院内活動表の作成

• 白砂 寛基,谷口 敬道,小賀野 操,杉原 素子
• 国際医療福祉大学学会 = Journal of
• 本研究の目的は，急性期作業療法でBADL とIADL のから成る応用的活動を活用しやすくするための介入ツールを作成することである．日本作業療法士協会作業療法事例報告集などから急性期作業療法に利用される119 の活動項目を抽出し，試作版院内活動表を作成した．これを用いて作業療法士8 名が入院患者16 名に介入し，実施された活動を記録した．また，作業療法士を対象に有用性を質問紙にて調査した．試作版院内 …
• NAID 120006600931

• Micro-errorの工学的モデル化に関する基礎研究 (知覚情報研究会・マルチモーダル応用及び一般)

• 行事 光,Giovannetti Tania,白鳥 敦也,長澤 勇貴,坂本 麻衣子,原田 哲也,山口 武彦
• 電気学会研究会資料. PI = The papers of
• NAID 40021870609

• 整形外科に通院している地域在住女性高齢者の転倒恐怖感と手段的ADLおよび健康関連QOLとの関係

• 中越 竜馬,武政 誠一
• 理学療法科学 34(2), 211-215, 2019
• <p>〔目的〕整形外科に通院している地域在住女性高齢者の転倒恐怖感と手段的ADLおよび健康関連QOLとの関連性を明らかにすることを目的とした．〔対象と方法〕整形外科に通院する地域在住高齢者の女性27名とした．質問紙によりFESとFAI，GDS，SF-36の聞き取り調査と握力の測定を実施した．〔結果〕FESは握力とFAI，GDS，SF-36のPF，GH，VT，MHと有意な相関がみられた． …
• NAID 130007638058

Related Links

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• INSTRUMENTAL ACTIVITIES OF DAILY LIVING SCALE (IADL)

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• Instrumental activities of daily living | definition of instrumental ...

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★リンクテーブル★

リンク元	「IADL」「手段的日常生活動作」
関連記事	「instrument」「instrumental」「daily」「living」

「IADL」

　　[★]

• 手段的日常生活動作 instrumental activities of daily living
• 中間的日常生活動作 intermediate activity of daily living

「手段的日常生活動作」

　　[★]

英

instrumental activities of daily living, instrumental ADL, IADL

同

手段的ADL

関

日常生活動作

「instrument」

　　[★]

• n.

• 道具、器具、機器、計器。楽器。手段。法律文書。(法律文書としての)証券、(約束)手形

• v.

(器具を)装着する

関

apparatus、device、equipment、fit、instrumental、machine、tool、utensil、wear

　 　 　 　 　 　 　

「instrumental」

　　[★]

• adj.

• 機器の、手段になる、役立つ

関

avail、available、avenue、equipment、gateway、help、helpful、instrument、mean、means、policy、serve、serviceable、subserve、tool、useful、valuable

　 　

「daily」

　　[★]

• 一日の、日々の、日周の、((副詞))毎日

関

day-to-day、diurnal、each day、everyday、quotidian

　 　 　 　

「living」

　　[★]

• adj.

• 生きている、生存している

関

alive、exist、survival、survive