The Katz Index of Independence in Activities of Daily Living (ADLs) is a foundational tool in geriatric care, designed to measure an individual's functional independence in six key areas. The simplicity of its scoring method, which assigns either a 0 or 1 for each activity, makes it an efficient and practical instrument for caregivers and healthcare professionals. The total score, ranging from 0 to 6, offers a straightforward summary of a person's overall functional ability.
The Six Activities and How They Are Scored
For each of the six functions assessed, a person is rated as either independent (1 point) or dependent (0 points). The scoring is based on the ability to perform the task without supervision, direction, or personal assistance, except in very specific circumstances. Any inability to perform an ADL, whether due to physical or cognitive issues, is scored as dependent.
Bathing
This activity assesses a person's ability to wash themselves completely. Independence requires washing and rinsing the entire body in a tub, shower, or sponge bath without assistance.
- 1 Point (Independent): The individual bathes themselves completely, though they may require assistance with only one single area of the body, such as the back, a disabled extremity, or the genital area.
- 0 Points (Dependent): The person needs assistance with bathing more than one area of the body or requires total assistance for bathing.
Dressing
For this activity, independence involves the ability to get clothes from closets and drawers and put on and remove garments, including fasteners.
- 1 Point (Independent): The individual gets and puts on all their clothing, including fasteners. They may have help tying shoes.
- 0 Points (Dependent): The person needs help with dressing or must be completely dressed by someone else.
Toileting
This measure evaluates a person's capacity to manage toileting needs, including getting to and from the toilet, managing clothing, and personal hygiene.
- 1 Point (Independent): The person goes to the toilet room, gets on and off the toilet, cleans themselves, and arranges clothes without assistance. They may use assistive devices like a cane, walker, or wheelchair.
- 0 Points (Dependent): The person needs assistance transferring to the toilet, cleaning themselves, or arranging clothing. This score is also given if a bedpan or commode is used with assistance.
Transferring
Transferring assesses the ability to move from one position to another, such as in and out of a bed or chair.
- 1 Point (Independent): The individual moves in and out of bed and chairs without help. Mechanical aids are permitted.
- 0 Points (Dependent): The person needs help moving from bed to chair or requires a complete transfer by another person.
Continence
This activity measures the ability to control bladder and bowel function completely.
- 1 Point (Independent): The individual has complete self-control over urination and defecation.
- 0 Points (Dependent): The person is partially or totally incontinent of bladder or bowel. This includes needing supervision to maintain control or using a catheter.
Feeding
Feeding evaluates the ability to get food from a plate or bowl into the mouth.
- 1 Point (Independent): The person gets food from the plate into their mouth without help. A person may have their food prepared by another person.
- 0 Points (Dependent): The individual needs partial or total assistance with feeding or requires parenteral feeding.
Comparison of Katz ADL Scores and Interpretations
The total score on the Katz Index directly relates to the level of functional impairment. Here is a comparison of scores and their typical interpretations based on the sum of the individual activity scores.
| Total Score | Interpretation | Examples of Needs |
|---|---|---|
| 6 | High/Independent | Requires no assistance for all six ADLs. Minimal monitoring may be needed, but no direct physical help. |
| 4 | Moderate Impairment | Needs moderate assistance, suggesting dependence in some key areas, such as bathing, dressing, or transferring. |
| 2 or Less | Severe Functional Impairment | Requires significant assistance with most or all of the six basic ADLs. |
| 0 | Very Dependent | Completely dependent and requires total assistance for all basic ADLs. |
Considerations and Limitations of the Katz Index
While a robust and easy-to-use tool, the Katz Index does have limitations that caregivers and clinicians should recognize. Firstly, it does not assess instrumental activities of daily living (IADLs), such as shopping, managing finances, or meal preparation, which are more complex tasks necessary for independent community living. For this, other tools like the Lawton IADL scale may be needed.
Additionally, the Katz Index has a noted "floor effect," meaning it is not sensitive enough to detect small improvements in function in individuals who are already severely impaired. For example, a patient might learn to transfer with moderate assistance instead of total dependence, but their score would remain a 0, masking progress. Despite these limitations, the tool remains invaluable for quickly establishing a baseline functional status and monitoring significant changes over time.
Conclusion
The Katz index provides a simple, quantifiable, and widely understood method for scoring a person's independence in basic activities of daily living. By assigning a 0 or 1 point for each of the six fundamental tasks—bathing, dressing, toileting, transferring, continence, and feeding—it offers a clear snapshot of an individual's functional abilities. This data is critical for care planning, discharge planning, and effectively communicating a patient's level of independence among the entire care team. Although it has limitations regarding subtle changes and IADLs, its effectiveness and ease of use make it a central component of functional assessment, particularly in geriatric care.
- Hartford Institute for Geriatric Nursing: https://hign.org/consultgeri-resources/try-this-series/katz-index-independence-activities-daily-living-adl
