Our protocol make it possible to assess the evolution of functional independence of elderly patients during hospitalization for an acute medical episode. The ADL score is reproducible, easy to use, and can be used to join as a loss of functional independence at an early stage to allow adaptation of the rehabilitation care plan. To evaluate bathing, ask patients how they bathe and whether they need someone to help them with bathing.
If so, ask which part of the body they require help with and note whether they're independent or dependent in bathing activities. Ask patients whether they can dress and undress alone and whether they can take their clothes out of the closet without help. Then ask whether they need help with putting on socks or other items of clothing and note, whether they are independent or dependent in dressing activities.
Ask patients whether they go to the toilet unassisted at home and whether they can sit down and stand up from the toilet, arrange their clothing as needed, and clean the genital area without help. Then note whether they are independent or dependent in toileting. To evaluate transferring, ask patients whether they can move from bed to chair and from chair to bed without human assistance and note whether they are independent or dependent in transferring.
Then ask patients whether they have complete self control over urination and defecation, and whether they can use a urinary catheter or diaper without help. Note whether the patients are independent or dependent with respect to continence. Finally, ask patients whether they eat without help and if they're able to cut meat or to open the lid of a yogurt container, and note whether they are independent or dependent in feeding activities.
Then sum of the scores for all of the activities to determine the ADL score. During the first day of hospitalization, offer patients a shower. If they feel able to take one, accompany them to the bathroom and check whether they are able to wash by themselves.
If patients do not feel able to do this, offer to wash them in bed or at the basin. After observing whether the patient can breathe alone or if they need guidance or help with certain parts of the body, note whether they are independent or dependent in bathing. During the first day of hospitalization, propose that patients get dressed, asking them to select clothes from the closet and to put them on.
If patients have difficulty help them to get dressed. In the evening, follow the same procedure, but as applied to undressing. Then note whether the patients are independent or dependent in dressing.
During the first few days of hospitalization, check whether patients are able to go to the toilet alone, sit upon, and stand up from the toilet, arrange their clothing, and clean the genital area. Note whether patients are independent or dependent in toileting. Evaluate whether a commode or bedpan is needed and note whether patients are independent or dependent in continence.
On the first day of hospitalization, ask patients to transfer from the bed to a chair and from the chair to a bed, offering mechanical transferring aids and helping them to make the transfer as necessary. Note whether patients are independent or dependent for transferring. During the first meal at the hospital, observe whether patients are able to eat alone, including cutting meat and opening the lid of a yogurt container, and help if necessary.
Note whether the patient is independent or dependent for eating. Then sum the scores for all of the activities to determine the ADL score. In this group of patients with favorable ADL dependence trajectories, two ADL function trajectories were possible.
Patients who maintained their ADL score throughout hospitalization and those who's score at hospitalization was lower than at baseline, but who regained their baseline level of function by discharge. Patients were discharged when their baseline ADL function had an 83.8%or 67%chance of maintaining function for one month and one year after discharge, respectively. The mortality rate for both groups was 17.8%In this group of patients with unfavorable ADL dependence trajectories, three types of cases were identified.
Patients who retained their baseline independence on admission to the hospital, but showed deterioration during hospitalization and did not regain full independence thereafter, patients who lost their baseline independence prior to hospitalization and did not regain it during hospitalization, and patients who showed deterioration of independence both prior to and during hospitalization and who did not regain full independence. Of the patients discharged with new or additional disability in ADL, 33.5%recovered their baseline level of ADL function within the first month after discharge, and 30.1%did so within the first year. The one year mortality rate was 41.3%for these patients.
The most important thing to remember is that for the protocol to be effective, the score must be noted regularly during hospitalization. Our protocol allows us to identify patients who should receive rehabilitation care on the priority as is in order to start them in the program as soon as possible.
