Activities of Daily Living

When discussing alternative housing arrangements, it is important to consider how capable the senior is of performing daily activities. Activities that should be considered usually include bathing, dressing, moving and feeding oneself. Most of the time, it is obvious when a person is fully capable and totally incapable of taking care of themselves, however, what becomes questionable is the area between being completely capable or incapable. The best person to make this call may be a physician, occupational therapist or social worker, and, they may make the decision individually or in conjunction with each other. However, even their evaluation may be challenged, especially by the individual being judged.

While attempting to determine if a senior is able to perform daily activities, some good evaluation tools are the Dependency Scale and the Barthel Activities of Daily Living Index (Barthel Index) (Refer to rating scales in following pages). The Barthel Activities of Daily Living Index is highly recommended; however there have been some uncertainties about the reliability when it is used on the elderly. The Barthel Index addresses ten items – eating, bathing, grooming, dressing, bowels, bladder, toilet use, transfers from the bed to the chair and back, mobility, on level surfaces and stairs. There is a score that goes with each response and there are ranges set based on those scores to determine the independence of each person. For example, 80-100 is the independence range for men.

There are some objective guidelines to assist physicians and others in making a decision; however, there is also a lot of subjectivity and professional judgment involved. In addition to evaluating a senior’s ability to perform daily activities, judgment has to be used to assess a senior’s cognitive impairment or other mental issues. Something to consider is if children are able to determine a parent’s ability to perform activities of daily living. A major concern is the senior’s assessment, assuming that they are of sound mind to do so, which is another judgment that needs to be made. A common question is how to determine if a senior is of sound mind. Many turn to lawyers and judges, but who is to say that they are able to determine how much assistance is needed.

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