Katz Index of Independence in Activities of Daily Living 

Purpose

To provide clinicians with a way “...to assess functional status as a measurement of the client’s ability to perform activities of daily living independently” in adults in diverse settings. (Wallace, M. & Mason, V., 2007).

Basic Information

• Title/Author(s):
  Katz Index of Independence in Activities of Daily Living (Katz ADL Index)
  Developed by: Sidney Katz, MD, and colleagues.
  
  

• Edition and Year:
  Originally developed in 1963 at Benjamin Rose Hospital.
  Continues to be widely cited and updated in modern rehabilitation resources.
  
  

Assessment Details

• Identify TWO Types:
  
  

  • Occupation-based assessment
    
    

  • Standardized assessment (standardized scoring protocol)
    
    

• Cost & Accessibility:
  
  

  • Cost:
    
    

    • Free for clinical, research, and educational use.
      
      

  • Access:
    
    

    • Available through Shirley Ryan AbilityLab – Katz ADL Index
      
      

    • Also available via many public rehabilitation resources.
      
      

Population & Setting

• Population:
  
  

  • Older adults (65+ years)
    
    

  • Adults (18–64 years) with:
    
    

    • Stroke recovery
      
      

    • Traumatic brain injury (TBI)
      
      

    • Multiple sclerosis
      
      

    • Dementia or Alzheimer’s disease
      
      

    • Severe depression or psychiatric disability
      
      

    • Frailty or generalized disability
      
      

• Settings:
  
  

  • Acute care hospitals
    
    

  • Long-term care facilities
    
    

  • Skilled nursing facilities (SNFs)
    
    

  • Outpatient rehabilitation clinics
    
    

  • Home healthcare services
    
    

  • Community-based aging and disability services
    
    

Purpose & Areas Assessed

• Purpose:
  
  

  • To evaluate basic functional independence in self-care activities.
    
    

  • Guides decision-making regarding care needs, discharge planning, and support recommendations.
    
    

• Activities Assessed (6 Core ADLs):
  
  

  • Bathing
    
    

  • Dressing
    
    

  • Toileting
    
    

  • Transferring (e.g., bed to chair)
    
    

  • Continence
    
    

  • Feeding
    
    

• Observation Priority:
  
  

  • Clinicians should directly observe client performance whenever possible.
    
    

  • Interviewing caregivers or clients should be used only when direct observation is not feasible.
    
    

Administration & Scoring

• Administration:
  
  

  • Time Required: Typically 5–10 minutes depending on client performance.
    
    

  • Format:
    
    

    • Observation of actual ADL performance preferred.
      
      

    • If necessary, interview of client or caregiver about ADL ability.
      
      

• User Qualifications:
  
  

  • Can be administered by occupational therapists, nurses, physical therapists, physicians, or trained rehabilitation staff.
    
    

• Materials Required:
  
  

  • No specialized materials needed.
    
    

  • Requires access to appropriate ADL settings (e.g., bathroom, bed, dining area).
    
    

• Scoring Procedure:
  
  

  • Each ADL is scored as either:
    
    

    • Independent (1 point) or
      
      

    • Dependent (0 points)
      
      

  • No partial scores given; any required assistance results in a dependent score for that ADL.
    
    

  • Total Score:
    
    

    • 6 = Full independence
      
      

    • 4 = Moderate impairment
      
      

    • 2 or less = Severe impairment
      
      

  • Used to guide functional care needs and planning.
    
    

Psychometrics/Standardization

• Reliability:
  
  

  • Reports of adequate to high interrater reliability, especially in geriatric populations.
    
    

• Validity:
  
  

  • Construct validity well-supported for use with older adults and in rehabilitation contexts.
    
    

  • Frequently cited in outcomes research for stroke, dementia, and disability studies.
    
    

• Norms:
  
  

  • Not norm-referenced — scores are interpreted relative to clinical expectations for independence, not statistical norms.
    
    

Critical Thinking Sections

Strengths

• Quick and efficient — Can be completed rapidly, often in under 10 minutes.
  
  

• Widely accepted — Frequently used in hospitals, skilled nursing, and home care.
  
  

• Free and accessible — No cost barrier for clinical use.
  
  

• Applicable to many populations — Useful for stroke recovery, dementia care, psychiatric disability, and frailty assessment.
  
  

• Supports discharge planning — Clearly identifies functional care needs.
  
  

Weaknesses

• Binary scoring — No credit for partial independence, which may limit sensitivity to minor functional gains.
  
  

• Limited scope — Focuses only on basic ADLs; does not assess higher-level IADLs (e.g., managing finances, medication management).
  
  

• No cognitive differentiation — Does not distinguish whether functional difficulties are due to cognitive versus physical impairment.
  
  

• Observation subjectivity — Some variability possible between raters without clear operational definitions.
  
  

• Ceiling effect — May be less useful for detecting subtle decline in highly independent clients.

References 

Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: The Index of ADL, a standardized measure of biological and psychosocial function. JAMA, 185(12), 914–919. https://doi.org/10.1001/jama.1963.03060120024016

Shirley Ryan AbilityLab. (2016, December 1). Katz Index of Independence in Activities of Daily Living (Katz ADL Index). Rehabilitation Measures Database. https://www.sralab.org/rehabilitation-measures/katz-index-independence-activities-daily-living

Wallace, M., & Mason, V. (2007). Katz Index of Independence in Activities of Daily Living (ADL). Annals of Long-Term Care, 15(5), 26–30.