geriatrics & safetyscoring tool

Katz ADL Index

The Katz Index of Independence in Activities of Daily Living assesses functional status across 6 basic ADLs: bathing, dressing, toileting, transferring, continence, and feeding. Score ranges from 0 (fully dependent) to 6 (fully independent).

inputs

when to use

Use to quantify basic functional independence in elderly patients, rehabilitation settings, and care planning discussions. Provides a standardised snapshot of self-care ability. Useful for tracking functional decline over time, discharge planning, and care package assessment.

when not to use

Katz ADL measures BASIC activities only. It does not capture Instrumental ADLs (cooking, shopping, finances, transportation) — use the Lawton IADL scale for those. Not suitable for assessing acute changes in function (may reflect illness rather than baseline). The binary (independent/dependent) scoring loses nuance about partial assistance needs.

clinical pearls

  • ADL loss typically follows a hierarchical pattern: bathing is usually lost first, then dressing, toileting, transferring, continence, and feeding last. Recovery follows the reverse order. This hierarchy can guide rehabilitation goal-setting.
  • Katz ADL measures what the patient CAN do, not what they typically do. A patient who chooses not to bathe but is physically capable still scores 'independent' for bathing.
  • Pair Katz ADL (basic ADLs) with Lawton IADL (instrumental ADLs) for a complete functional picture. A patient may be independent in basic ADLs but unable to manage shopping, cooking, or finances.
  • Document both pre-illness and current ADL status. The change in function is often more informative than the absolute score for acute care decision-making.
  • In the UK, ADL assessment informs NHS Continuing Healthcare assessments and social care funding decisions. Accurate ADL documentation has direct implications for patients' care entitlements.