Instrumental Activities of Daily Living (IADLs)

activity card sort

-(Baum, Edwards, Gray & Cordel, 2008) -clients describe their IADL, leisure, and social participation -89 color photos are sorted -can be utilized as a checklist -designed for older adults -I've never done this, I continue to do this, I do this less than I used to, I gave this up, I started to do this after my health condition

ADLs

-activities oriented toward taking care of one's own body

IADLs

-activities to support daily life within the home and community

ADL examples

-bathing/showering -toileting/toileting hygiene -dressing -eating -functional mobility -grooming -sexual activity -rest and sleep

IADL examples

-care of others -care of pets -child rearing -communication management -driving/community mobility -financial management -health management -home management -meal prep/cleanup -religious/spiritual expression -shopping -safety/emergency maintenance

modified barthel (MBI)

-contains some of the 10 items

barthel index

-measures ADL and functional mobility in hospitalized patients -10 items -can be done in patient hospital room -good reliability and validity -score ranges from 0-20 (lower scores indicate increased disability -if used to measure improvement after rehab, changes of more than 2 pts in the total score reflect a probable genuine change -change on 1 item from fully dependent to independent is also likely to be reliable

functional independence measure (FIM)

-no longer accepted by medicare -measures patient's level of disability or assist needed to complete ADLs and functional mobility -7 point ordinal scale from independent to dependent -designed for inpatient rehab to measure progress during admission

occupation as a means

-occupation acting as the therapeutic change agent to remediate impaired abilities or capacities -using the engagement and performance of occupations as intervention -a means to skill development/functional recovery -a remedial approach based on activities/occupations that are meaningful to the patient.

occupations not listed in COPM

-phone & computer use -medication management -multitasking (at work, during housework, etc) -schedule management/calendar use -home organization -work organization -managing interruptions -sleep

limitations of COPM

-reporting issues that are challenging to measure (driving, going back to work, translating cog skills like attention or short term memory into an activity) -limited insight into OP issues (may have not returned home yet, or do not identify as an issue even if performance is subpar)

canadian model of occuptional performance (COPM)

-semi-structured interview to establish an OP and goals -individualized outcome measure -a self-report of occupational performance and change -for clients of all ages and all disability groups (5+) -embedded in client-centered practice -pre and post scores -ask about self care (personal Care, functional mobility, community mgmt), productivity (paid or unpaid work, household mgmt, school/play), & leisure (quiet, active, socialization) -evaluate current importance, performance, & satisfaction 1-10

occupation as an end

-the outcome of intervention or goal is the ability to perform or engage in occupation, but does not necessarily mean the use of occupation was used directly as an intervention -intervention focused on learning how to accomplish the activities and tasks that constitute roles in an adapted way -may also address safety and adequacy conditions including the following: -a modify approach that uses education of adapted methods, assistive tech, & adaptation of physical and/or social contexts

the lawton

-used to assess a person's ability to complete IADLS -best for older adults in any setting besides institutionalized -8 domains of function measured -historically men were not scored in the domains of food preparation, housekeeping, laundering

the katz

-used to assess functional status as a measurement of the client's ability to perform ADLs independently -more reliable in older adults -clients are scored yes/no for independence in each of 6 functions -a score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment

5 step process of COPM

1. identify occupations they need to, want to, or are expected to do in daily life 2. rate importance 3. rate performance and satisfaction of each item before moving onto the next one 4. score 5. repeat steps 3&4 at reassessment

steps to select appropriate assessment

1. identify the overall purpose(s) of the evaluation 2. have clients identify their needs, interests, and perceived difficulties with ADL and/or IADL (occupational profile) 3. further explore the client's relevant activities so that the activities are operationally defined (what does the occupation/activity mean to the individual person) 4. estimate the client factors that affect occupational performance and/or the assessment process (pathology and its effect on performance) 5. identify contextual factors that affect assessment 6. consider features of assessment tools 7. integrate the information from steps 1 to 6 to select the optimal tool