We are active beings . As with other animals, the human being needs to carry out multiple actions in order to survive.
We need to eat, move to avoid dangers, protect ourselves from the cold … and we usually do it almost without thinking, day by day and continuously. However, these actions are more complex than they seem, and despite the fact that most of us have automated them, they require learning and can be lost in certain circumstances.
In many cases, due to medical or psychiatric problems (for example, an accident, a disabling disease or dementia ) it is possible that basic and fundamental activities that we once carried out without problems on our own become a problem, requiring external help to carry them out. And knowing whether or not we are independent in the most basic functions can be useful to provide the help we need, or to analyze rehabilitation processes.
- Related article: “The 6 types of disability and their characteristics”
In order to assess our situation, there are different indices or scales, such as the Katz index or scale. It is about this instrument that we are going to talk about throughout this article.
The Katz scale / index: what is it and what is it for?
The Katz index (sometimes also called the Katz Functional Scale) is an evaluation instrument that allows assessing the degree of physical dependence of a subject to carry out the so-called basic activities of daily life.
With this concept we refer to the set of essential and most relevant skills for survival, self-care and self-preservation without having to depend on external support.
It is a scale that allows evaluating the degree of dependence or independence of a subject in six major basic skills: washing, dressing, using the toilet, moving / moving, toilet training and feeding. These skills are organized in a hierarchical way, ordered according to the progression that a child would carry out in his development.
This is relevant given that when the most fundamental activities require external support, it is usual that the rest of the basic functions also require help. In other words, if a person has difficulties to eat, it is most likely that they also have difficulties dressing or doing any of these activities. Its use allows both assessing the current situation of the subject and evaluating the progress made in rehabilitation processes.
Originally, the Katz Functional Scale or index was developed with the purpose of helping to assess the rehabilitation carried out by people with hip fractures, although over time its function has come to be used to assess the degree of dependency that Patients present with various types of conditions.
It is one of the most used in the functional assessment of geriatric patients or in palliative care , since it allows obtaining information on the degree of help or dependency that the person needs in their day-to-day life and better adjusting the help provided or rehabilitation to which it is subjected. It is possible to fill it in based on the observation of the patient by the professionals, or through the information provided by the subject himself or by the caregivers.
Items it includes
The Katz scale or index is an evaluation instrument that includes a total of six items to assess , each referring to one of the basic skills of daily life. Specifically, the items that are scored on this scale are as follows.
1. Washing
Bathing or washing is considered a basic activity of daily life, although one of the most complex. A person capable of washing only one part or completely without help will be considered as independent, while a person who needs help to wash, enter or leave the bathtub or wash more than one part of the body will be in a situation of dependency.
2. Dress
Dressing is a complex basic activity that requires some coordination , planning and motor skills. Independence or autonomy in this ability implies being able to take the necessary clothes, put them on or take them off and use elements such as buttons and zippers in order to achieve complete dress. Dependency will be considered in all those cases in which the person cannot dress alone or does so partially.
3. Use of toilet
A basic but somewhat more complex activity than those that follow, the independent use of the toilet implies the ability to access and exit the toilet , use it correctly, clean and fix clothes by oneself and without the need for external support. When there is dependency, help is needed to use this element or wedges or urinals are required.
4. Mobilization
Mobilization refers to the ability to move through the environment or perform acts such as getting up, sitting or lying in a chair or bed . This in turn enables other basic basic activities to be carried out. A person with dependence on this ability will require help to move, sit or lie down, or use items such as beds or chairs.
5. Continence
One of the most fundamental basic skills, we understand by continence the ability to control the processes of urination and defecation . That is, it implies the ability to contain feces and urine and to expel them voluntarily. Habitual incontinence, whether total or partial, would be valued as dependence on this ability.
6. Food
It is considered the most basic and relevant of all the basic activities of daily life. The ability to feed expresses the possibility on the part of the subject to move the food to their mouth and ingest it without the need for external help.
It is important to note that this does not include more complex processes such as cutting or smearing food with cutlery. If there is dependency on this basic ability, supports will be required to be able to feed, or the use of enteral or parenteral tube feeding .
Assessment of the information provided by the scale
The Katz index does not offer a numerical score and does not require complex calculations . To evaluate an individual with this scale, it will be noted for each of the basic activities of daily life whether the subject is independent or dependent on external aids (these aids include mechanical guidance, direction of action, or need for supervision). ).
In previous versions, there was the possibility of marking a partial dependency for each of the activities, although currently they only consider the condition of independence and that of dependency.
Once all the items have been evaluated, the number of activities for which the person is independent is analyzed and a letter is awarded, which will be the total assessment of the subject’s dependence / independence for these activities.
Thus we can find an independent person in all functions (A), independent in all except one (B), independent in all except bathing and another function (C), independent in all except bathing, dressing and another function (D), independent for all except bathing, dressing, using the toilet and one more function (E), independent for all except bathing, dressing, using the toilet, moving and another function (F), dependent for the six functions (G) or dependent on at least two functions but without being classifiable in C, D, E or F (H).
