In This Issue:

1. A Benchmark of Health and Safety: Independence in ADL
2. Independence in ADL:  More Valuable than Health and Safety
3. Red Flag!  Find It and Fix It!
4. Helpful Tips for Independent Living

Losing the ability to care for oneself is a red flag that cannot be ignored. The SAFE Aging September newsletter is about Basic Activities of Daily Life (BADL) and tips to maximize health and safety. We hope you enjoy this issue!

1. A Benchmark of Health and Safety: Independence in ADL

Activities of Daily Living (ADL) is a descriptive term commonly used in health care as a measure of health, wellness and safety. ADL describes activities people do in life.  Daily life activities includes self care, care of other people and things, play, leisure, work, education and social participation.

The most basic ADL, also known as BADL, are vital daily life tasks that are done to protect and care for one's body. These are activities necessary for survival. They have to be done every day. BADL include: 

ü      Bowel and bladder control and management

ü      Dressing

ü      Eating

ü      Feeding

ü      Movement (moving or transferring from one place to another)

ü      Personal hygiene

ü      Grooming

ü      Sleeping  

The ability to independently do all basic activities of daily living (BADL) is a bench mark indicator of health and safety. In health care, the loss of independence in the ability to personally perform BADL is a predictor of:  

ü      nursing home admission

ü      use of physician services

ü      use of hospital services

ü      mortality

Maintaining independence in self care is essential for health and safety.

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2. Independence in ADL: More Valuable than
Health and Safety  

I was thinking about what it means to be independent in ADL's. My grandparents immediately came to mind. Nanny and Poppy were born around 1910. They were the generation that relied only on themselves. It was their way of life, and it was good.

When they had a job to do, they did it and did not complain. No one helped and they did not ask for it. During the World War, they defended independence. They were willing to suffer the consequences to protect it. They valued independence, and expected nothing less in their lives.

As my grandparents aged beyond 80, their bodies deteriorated due to falls, multiple fractures, emphysema, macular degeneration and cancer. They had a tough time, but thought their problems were just part of being old. They were willing to struggle forever as long as they could live independently at home. They did not complain. Nanny and Poppy struggled far too long. There were many options available to them, but they were not aware of them, and they weren't about to ask for help.

Nanny and Poppy both feared losing their independence more than they feared illness, injury or disease. They down-played their difficulties with the family. For them, living independently was far more valuable than their health or safety, and they would not complain or even suggest they were having problems coping.

Do What It Takes To Make "Doing Possible"

In the story about my grandparents, eventually, our family insisted on making some changes in Nanny and Poppy's home. Nanny's vision was pretty bad, as she had macular degeneration and glaucoma. She also had painful arthritis. The arthritis affected her hand strength, coordination, reach, and energy levels.

Poppy had emphysema and cancer. They were both losing their overall strength, balance and flexibility. As a result, their ability to do basic activities of daily living was compromised. They needed help.  Here were some of their basic self care challenges involving an inability to safely bathe and shower, some simple solutions, and an estimated cost of the suggested solutions.

Slipping on bath tub and floor. Solutions: Added bathtub safety treads on floor next to tub Added bathtub rubber mat to reduce slipping Added safety rails for additional support Cost:  About $40.00
Difficulty safely getting into and out of shower. Solutions: Removed glass enclosure (to make transfers easier). Added a shower curtain (to prevent water from getting on floors and for privacy). Added padded transfer tub bench: Eliminated need to step into tub. Added a hand held shower hose: Eliminated need to stand up. Cost: About $ 200.00
Losing balance when soap fell or when washing feet. Solutions: Purchased a long handled sponge.  This eliminated need to bend. Made a soap on a rope. This eliminated the need for holding the soap and prevented it from falling on the floor. Cost: About $8.00
Getting up and sitting down on commode. Solutions: Added a raised toilet frame. This reduced the strength needed to lower and lift their bodies, and they could use armrests. Cost: About $ 65.00
Limited sight for grooming tasks Solutions: Increased light bulb wattage Added a neck magnifier for personal hygiene. This eliminated the need to hold a magnifier and made it easier to read pill labels and clip finger nails. Cost: About $10.00
For more information on assistive devices, visit our Learning Center!
Compare the Costs One-time equipment purchase: $300 Assisted living for two for one year: $72,000 Nursing home living for two for one year: $144,000 Comparative costs for assisted living for both Nanny and Poppy for one year would have been at least $72,000.00! Costs for one year in nursing home for both Nanny and Poppy would have been about $144,000! Although Nanny and Poppy didn't put a value on their independence, they both agreed it was great to be living at home. In cost benefits, the initial equipment costs was10 times less than the cost of one month in an assistive living community (based on $3,000 a month) or 20 times less than the cost of one month in a nursing home (based on $6,000 a month). One year costs in assisted living would have been about $72,000 for two, and in nursing home $144,000.! WOW OH WOW!!!!!

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3. RED FLAG! Find It and Fix It!  

A decline in the ability to do any BADL is a big red flag. A red flag is a warning sign that a problem exists. A red flag in this case should never be ignored. Such a loss in basic self care abilities suggests the following: 

1.      Health, wellness and safety is at risk!

2.      Quality of life is at risk!

3.      The risk of a cascading loss of abilities is very real!

Tips To Prevent Deterioration in BADL 

STEP ONE:  Find It!

The first step to prevent deterioration in abilities to self care is to be aware. Pay attention to changes. When a change is noticed, find the cause. Do not delay. Here are some factors to consider: 

1. Could there be a medication side effect?
2. Is there an unrecognized medical cause?
3. Is there a decline in fitness such as in _________?
   1. strength
   2. balance
   3. flexibility (joint range of motion)
   4. coordination
   5. posture
4. Is there a nutritional cause?
5. Has there been an unreported injury?
6. Has there been an environmental change?
7. Has there been a cognitive or mental status change?
8. Is there a change in sensory abilities such as vision, sense of touch, hearing?
9. Has a major change in life happened such as _______?
   1. death of a loved one
   2. financial losses
   3. divorce
   4. retirement, etc.
10. Is there evidence of abuse? (physical, mental, etc)

 STEP TWO: Fix It!

Once the reason is known for a decline in abilities, action can be immediately taken to fix the problem. A decline in overall health and safety can follow if preventive measures aren't taken. Here are some ideas using the factors listed in the above article:

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4. Helpful Tips for Independent Living

Doing basic ADL requires muscle strength, coordination, balance, cognitive and sensory skills and adequate joint range of motion. All of these things depend on good blood circulation and good breathing ability.  

The environment also plays a big role in living independently. When the environment is not helpful, even able bodied people can be dis-abled. 

A problem with any one or combination of these factors can cause a loss of independence.  

There are many strategies that can be used to maximize abilities in BADL. The following are some generic tips for independent living.

1. Be aware of changes that reduce abilities.

• Pay attention to changes

• Find the cause and fix It

• Consult with health care specialists as soon as a change is noticed

2. Manage pain: Work to eliminate or reduce pain that can decrease desire or ability to do a BADL.
    

3. Make sure the home is safe:

• Place safety rails where support would be helpful

• Make sure lighting throughout the home is bright enough

• Make sure pathways are free from obstacles

• Make sure floors and bathtub/shower are not slippery

• Make sure pathways are well lit

• Remove any hazards that could cause falls or injuries

4. Use assistive devices for safety and to make doing possible:

• Bath tub safety mats: Reduces tub/shower floor slipperiness

• Brighter lighting: This is useful in most cases

• Canes, walkers, etc.: Used to provide support, prevent falls, reduce effort

• Hearing aids: Useful for safety and communication

• Larger grips: Reduces need for hand strength

• Lighter objects: Reduces need for strength

• Long handled equipment: Useful when reach or balance is limited

• Magnifying devices: Used to make it easier to see

• Raised toilet seats: Reduces amount of strength needed to raise and lower self)

• Safety treads: Reduces floor slipperiness

• Shower (tub) seats: Reduces need to move about in tub/shower

• Use wheels: Reduces need for strength when lifting or carrying

5. To reduce fatigue: Assure rest breaks but avoid immobility

6. Eat well balanced meals: The body needs good food for strength and energy

7. Drink lots of water: The body needs water for blood circulation

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7. Internet Resources for this Newsletter

• D D Dunlop, S L Hughes, L M Manheim. Disability in Activities of Daily Living: Patterns of Change and a Hierarchy of Disability. Am J Public Health. 1997 March; 87(3): 378–383. (Pub Med)

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