The Key Ingredient to Independence that No One Talks About

If you or your spouse live independently and want things to stay that way, you aren’t alone. 75% of Americans age 50 or older want to stay in their homes and communities over the next few decades. 46% of those people think they can pull it off. Unfortunately, the reality is that far fewer people actually do (1).

At InPlace Health, we’re all about this! We want to give people the knowledge and the tools to achieve life-long growth and control their own health. It isn’t necessarily easy, but it can be done, and over the next few posts we’ll talk about each topic in detail. Today, we’d like to start simple by talking about one of the single best predictors of where you are and where you might be heading. Doctors call it your functional baseline.

Wherever you currently are with your health, your functional baseline is going to be a relevant topic. When you visit your doctor, they are likely making a functional assessment of you, be it formally or informally. In situations where you require intensive care (e.g. chemo, heart failure, COPD), they use your functional baseline to tailor clinical therapy to what you can tolerate. Afterwards, it becomes their target for when you are safe enough to leave the hospital.

You probably already have an idea of your functional baseline. It’s that gut feeling you have, the reaction you get when a healthcare provider asks you, “How are you doing today?”

In 1963, a man by the name of Sidney Katz decided to quantify this using what he called an Index of Independence of Activities for Daily Living, or what is commonly known today as the ADLs. Born in Cleveland in 1924 and unable to enter medical school due to the beginning of WWII, he spent time in the US Navy as a specialist in nursing surgery before returning to Western Reserve Medical school for his medical degree. At the Western Reserve, he found the care of older people to be tremendously satisfying and became one of America’s first “geriatricians” prior to the actual coining of the term. Over 18 months, he analyzed the basic activities of 64 patients with hip fractures, and developed a scale to score a patient’s ability to live independently; he published his results in the Journal of the American Medical Association in 1963.

Today, the Katz scale for ADLs and the Lawton-Brody scale for IADLs (which we’ll discuss at a later date, but are less essential activities than the ADLs) are the primary ways your functional baseline is turned into an objective number physicians can track over time.

The ADLs are categorized by:

• Personal hygiene — Bathing, nail care, etc.
• Continence
• Dressing — being able to select outfits, undergarments, putting them on and off without assistance
• Feeding
• Ambulating — walking, getting up out of a chair

The IADLs are categorized by:

• Companionship and mental health
• Transportation (driving)
• Meal preparation (cooking, grocery shopping)
• Household chores (taking out the trash, laundry, cleaning)
• Medication management (getting prescriptions filled)
• Social communication (phones, mail, visitors)
• Finance management (bills)

As you can see, the ADLs and IADLs aren’t anything fancy; they’re every day activities we all have to do. They’re very important and we couldn’t go through modern life without them. They’re also everyday activities we sometimes forget or mess up.

That’s why they’re so useful to doctors. As measurements of your functional baseline, they aren’t very susceptible to fluctuations in your daily life. For example, say you go on vacation and forget to pick up a prescription; that won’t change your IADLs significantly. A large change in the ADLs or IADLs likely reflects a real, long-term alteration in your ability to be independent. Even more incredibly, these assessments of your function when compared head to head in clinical trials to blood tests, sophisticated organ scans, or DNA testing, are better at predicting your current state and how well you’ll recover after a hospital stay or a therapy (like chemo).

If they’re so useful, why don’t we use them? Well, physicians definitely do! As with any assessment, the more often you do it, the more data you have to make decisions with.

In today’s world it’s easy to get lost in the glamor of high tech surgeries and fancy diagnostics, but the truth is that getting to know you is the best way to understand your health. And the better you know yourself, the easier it is for your physician to get to know you.

You can join our program to track key elements of your health so that you can plan towards living independently. Just visit our website to get started!

1. Binette, Joanne and Kerri Vasold. 2018 Home and Community Preferences: A National Survey of Adults Age 18-Plus. Washington, DC: AARP Research, August 2018.