Disability in the Elderly and Instrumental Activity of Daily Living

Acute illness conditions or deteriorating situations amongst the aged can lead to enhanced worsening of their functional abilities. Usual changes occurring in the aging process and health complexities are mostly associated with a decline in the physical capabilities of the aged. Such circumstances can reduce their independence and safety and make their daily chores more difficult to perform. In this regard, the ability to function can be categorized into two kinds; basic activities of daily living and instrumental activities of daily life. The Lawson Instrumental Activity of Daily Living (IADL) is known to facilitate the assessment of an individual’s capacity to carry out chores such as using the telephone, washing clothes, shopping, driving, maintaining the house, taking medicines and handling personal financial matters. The changes associated with aging and disabilities amongst the aged tend to interfere with their ability to perform daily chores, in addition to creating major adversities in their lives. The IADL proves to be an effective means in evaluating the ability to live independently and is very helpful in ascertaining whether an elderly patient is restrained due to disability or age in living independently. It also allows determining if such patients need to be given advanced caring such as assisted living and nursing facilities at home. The objective of this paper is to investigate the different ways in which the geriatric population is impacted by illness and to determine ways through which nurses can use the IADL in ascertaining whether an individual is functioning normally and whether there is an improvement with the given interventions (Doble, 2008).

The World Health Organization has made a clear distinction between disease-related conditions such as impairment, disabilities, comorbidities and handicaps. It is known that disease can lead to considerable impairment of organs and such failure can eventually lessen the ability of people to perform certain tasks. A handicap in this regard can be said to be the result of external demands that can be mitigated with environmental alterations. It has been found that there are several kinds of cognitive impairments that can impact the physical and psychological functioning of the elderly. Organ-specific physiological changes and morbidity can occur because of aging. This limits the patient’s ability to cope with any kind of therapy. In addition, the aging process can be associated with decreased physiological strength is adversely affecting different systems of the body. This situation leads to frailty and can interfere with the functional status of the patient, even in the absence of specific comorbidities. The manifestations of frailty include various conditions such as weight loss. Therefore, as the population ages, recognition of frailty in older adults becomes increasingly important. Under the circumstances, it becomes apparent that important elements of geriatric care include creating tailor-made treatment options for the elderly in order to safeguard them from frailty. In addition, it is important to introduce interventions to improve treatment results and to recognize when palliation proves to be most effective.
Health care providers mostly conceptualize frailty as being a vulnerable condition amongst the elderly that is typified by weakness and reduced physiological capacity.

The elderly who are frail have a lesser propensity to cope with stressful situations such as trauma and severe illnesses. Such an enhanced vulnerability leads to greater risks relative to falls, disabilities and death. Health care providers caring for the elderly have observed that some patients that are undergoing a rapid decline in health that is apparently not caused by any particular disease are prone to depict symptoms that can be ignored during treatment. In spite of advanced age, some patients can become temporarily disabled due to trauma-related illnesses but they eventually recover and get back to their normal routines. Some elderly patients do appear to be healthy and strong, but after suffering from an ailment they are unable to cope with stress and to recoup in terms of re-attaining the ability to perform all their functions. Some of the elderly are known to experience a steady decline in their ability to perform physical functions because of the lack of any stress factors. Weak elderly patients impose major challenges for healthcare providers because they mostly have complicated symptoms and do not have the physical strength to carry themselves through the treatment processes. It is possible to improve the quality of care for such patients if clinicians become more aware of the frailty syndrome and its associated complexities.

Multimorbidity can be understood as the combined occurrence of psychiatric and medical conditions that have the potential of interacting directly with one another in regard to the same patient. In this context, multimorbidity is a term that can be used in place of co-morbidity, which is indicative of medical circumstances in which there is an index disease. For example, oncologists could be concerned about the impact of co-morbidity on the management of lung cancer, while multimorbidity relates to the general complexity of patients without the need to focus on any single disease. Multimorbidity relates to traditional diseases and syndromes such as heart disease, diabetes, rheumatologic conditions, chronic pulmonary disease and dementia, which are all known to cause a rapid decline in the IADL skills of elderly patients. The same approach is used in considering other common and unceasing ailments such as sleep disorders, falls, persistent bursitis and impairment of sensory abilities. The elderly that suffer from all these conditions often become dependent on IADL and Activity of Daily Living (Seo, Roberts, Yates, & Yurkovich, 2011).

Graf (2008) has held that deteriorating chronic conditions or severe illnesses can reduce the physical abilities of elderly people because while undergoing hospitalization, their mobility and associated factors could reduce quickly. They are unable to perform their daily activities and such conditions could occur on a permanent basis. Under such circumstances, the Lawton IADL scale helps in assessing the person’s ability to perform all the ADL tasks (Lawton & Brody, 1969). The Lawton IADL scale is most appropriate for aged patients because it can be conveniently used in hospital and community settings. The tool is of immense benefit for nursing home residents, institutionalized elderly and elderly patients who receive full-time care. They are able to get assistance with their IADL and do not require any further intervention (Graf, 2008). The IADL scale measures eight domains of functioning, which include the independent ability to use the telephone, to do shopping, to prepare food, to maintain the house, to wash clothes, to commute by private or public transport, to take personal medication and to handle finances, including going to the bank. The IADL scale enables a range between 0-8, whereby 0 is indicative of low functionality and extreme dependency of patients, while 8 indicates high functionality and high levels of independence amongst patients. It is thus apparent that a score of 8 will require no interventions, while scores lesser than 8 require interventions by healthcare professionals in order to determine the skills required by the patient to perform the given functions. In addition, it becomes possible to ascertain the additional resources that are required to overcome conditions of suboptimal functioning (Rensbergen & Pacolet, 2013).

It is easy to use Lawton’s scale in obtaining self-reported data relative to the ability of patients to perform necessary functions. At the same time, there are disadvantages associated with scale’s characteristic process of producing surrogate reports instead of giving information that demonstrates the efficiency of performed functions. Moreover, the instrument is known to be insensitive to minor alterations in functions. Given that Lawton’s scale provides subjective information and the medical practitioner using the scale cannot observe the patient performing all the functions as suggested in the instrument, the process may sometimes prove to be impractical and time-consuming. Such patterns can result in imprecision because the outcomes may be overestimated or underestimated. However, these are minor shortcomings because overall, the IADL scale is very helpful in assessing the ability of elderly patients to live independently.

The scale has major implications in care for elderly patients and can be effectively used in detecting a subtle or overt decline in the ability of patients to perform basic functions in living independently (Kane, Ouslander, Abrass, & Resnick, 2008). In effect, the IADL proves to be very effective in ascertaining the ways in which individual functions presently and the improvements that are made subsequently in terms of carrying out the daily activities efficiently. The Lawton IADL scale measures 8 functional domains. The scores range between 0 to 9, whereby 0 denotes low functionality and high levels of dependence, while 9 denotes high functionality and higher levels of independence. This scale is a decisive tool in determining if the functional deterioration emanating from all these factors is important enough in requiring further medical attention. It also allows determining whether additional resources are required; such as the need for individualized rehabilitation, need for home services, need for assistance in meal preparation, need for house chores, need for medical administration and need for admission to a nursing home.

It is widely held that Advance Practice Nurses (APNs) play a very important role in caring for and treating elderly people. They make available services such as counseling, health examination, critical care and all-inclusive caring to this section of the population. In addition, they exert their influence in the allocation and use of resources, while promoting consistency in treatment given to aged patients. APNs provide the much-needed education to elderly patients and their families and provide the required feedback and appraisal reports to other healthcare professionals providing such care. APNs come in contact with elderly patients by way of different functions relative to primary care, hospital and inpatient care, rehabilitation centers, and specialty care (Ciaccio, Ferraro, Brezovsky, Martìn-Escobar, & Costa, 2013). It is known in this regard that elderly patients are now living longer because of better medicines and their numbers are increasing because the baby boomers generation is fast approaching old age. APNs are true providers of geriatric care, with great potential for serving an increasingly aging society. It is very important for APNs, to devise better ways of assessing the health conditions of the elderly population, which is possible by using different tools of assessment and by monitoring their overall health status. The IADL scale can be easily administered by APNs to elderly patients in all settings in order to imbibe the skills required by them for independent living. APNs can detect any deficits that may require their interventions in meeting the additional needs of the elderly.

In conclusion, it can be stated that Lawton’s ADL scale is a very useful tool in assessing the functional status of elderly patients. It is apparent that the health status and functional abilities that change in elderly patients because of severe illnesses, deteriorating health conditions and hospitalization are the direct outcomes of declining IADL abilities in them. APNs play a very important role in this regard because they can involve in early detection and assessments and use appropriate interventions in ensuring that elderly patients receive the required resources to compensate for the lack of IADL skills.

References

Doble, S. (2008). Assessing Functions in the Elderly: Katz ADL and Lawton IADL. Web.

Graf, C. (2008). The Lawton Instrumental Activities of daily living scale. American Journal of Nursing, 108(5),59-63.

Kane, R., Ouslander, J., Abrass, I., & Resnick, B. (2008). Essentialsof clinical geriatrics. (6th ed.). Ontario: McGraw-Hill.

Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179-186.

Seo, Y., Roberts, L., Yates, B.C., & Yurkovich, J.M. (2011). Predictors of modification in instrumental activities of daily living in person with heart failure. Journal of Cardiovascular Nursing, 57(9), 90-98. Web.

Rensbergen, V., & Pacolet, J. (2013). Instrumental activities of daily living (IADL) trigger an urgent request for nursing home admission. Archives of Public Health, 71(3), 1-9.

Ciaccio, P., Ferraro, C., Brezovsky, P., Martìn-Escobar, E., & Costa, N. (2013). The joint action MODE (Mutual Organ Donation and Transplantation Exchanges): a sound contribution to the implementation of health policies in organ donation and transplantation.Archives of Public Health, 71(3). Web.

Appendix A

The Lawton Instrumental Activities of Daily Living Scale

Ability to Use Telephone

1. Is able to operate telephone independently and can look up and dial any number…………. 1
2. Can dial some well-recognized numbers ……………………….1
3. Can answer the phone but cannot dial……………………l
4. Is unable to use the telephone……………………………..0

Shopping

1. Can take care of all shopping requirements……………..1
2. Can do shopping for small items independently……………………….0
3. Requires company while going on shopping………………0
4. Is unable to do any kind of shopping………………………………………….0

Food Preparation

1. Has the ability to plan, prepare and serve food independently………………………..1
2. Can prepare food if given the ingredients……………0
3. Can heat and serve prepared food or can make food but is unable to keep up with a normal diet………………………………………………………..0
4. Requires to prepare meals and to serve the same……………………0

Housekeeping

1. Is able to maintain the house with a little help…………………………1
2. Has the ability to perform simple routine work such as making the bed and washing the dishes……………………………………………………………….1
3. Can perform simple routine work but cannot keep things reasonably clean………………..1
4. Has to be helped with all household work………………..1
5. Is not inclined to take part in house maintenance……………..0

Laundry

1. Is able to do laundry completely………………………………..1
2. Can wash only small clothing items…………1
3. Wants that all laundry should be done by other people………………………………0

Mode of Transportation

1. Can travel independently or can drive on own…………………………………………………1
2. Can make travel arrangements by taxi but is unable to use public transport……….1
3. Can travel on public transport only with assistance or in the company of others………….1
4. Can travel only by taxi or with others’ help…………………………………………………0
5. Is unable to travel on own………………………………………………….0

Responsibility for Own Medications

1. Is able to take medicine at the right time and in right quantity…………1
2. Can take medicine if the dosage is provided in advance……………………………………0
3. Is unable to dispense own medications…………………0

Ability to Handle Finances

1. Can manage financial issues independently. Can make a budget, write checks and do all work related to the bank. Is able to manage income very well………..1
2. Is able to independently manage daily shopping but requires support for big purchases and bank work…………………………………………………1
3. Unable to handle money issues………………………………………0