The Lawton Instrumental Activities Daily Living/Activities Daily Living Scales

Koskas, P.; Henry–Feugeas, Marie-Cécile; Feugeas, Jean Paul; Poissonnet, Aurore; Pons-Peyneau, Cécile; Wolmark, Y.; Drunat, O.

doi:10.1177/0891988714522694

Cited by 22 publications

(8 citation statements)

References 55 publications

(150 reference statements)

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“…Functional impairment was ascertained in three ways: firstly, establishing self-reported ART adherence of >80 %; secondaly by administration of the modified Lawton Activities of daily living scale (LADL) [26]; and thirdly the presence of a positive response to functional symptoms reported on the SSQ and CAT-rapid. We assigned a functional assessment (FA) score of two (marked impairment), if the participant scored 14 or less on the LADL, OR 15 AND was noted to have an adherence problem.…”

Section: Methodsmentioning

confidence: 99%

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A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

et al. 2016

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Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.

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Section: Methodsmentioning

confidence: 99%

“…Similarly, the ability of the IHDS to detect MND and ANI is variable. In one study using a cut-off score of ≤11 to detect HIV-D plus MND, a sensitivity and specificity of 81 and 54 % respectively were reported [12, 26]. Others have reported lower sensitivity to mild HAND [1, 3, 27].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

et al. 2016

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“…Although in widespread use, both scales have shortcomings as mentioned above: they have poorly described psychometric properties, the scoring systems are not sensitive enough to detect subtle deficits, and they do not identify causes of limitations in ADL [9,43,58–61]. Many studies have attempted to improve the potential use of the Katz Index and Lawton Scale, including using item response theory methods [34], providing short versions of these scales [62], or by combining both scales in new evaluations [63,64]. However, these improvements could not overcome all mentioned shortcomings.…”

Section: Introductionmentioning

confidence: 99%

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

et al. 2017

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BackgroundAssessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.Methods and findingsThe construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65–93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840–.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805–.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978–1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759–.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.ConclusionsThis evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

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“…MMSE is a well-known screening tool but with low sensitivity (Roalf et al, 2013) and is potentially misleading. Similarly, the IADL and Katz ADL scales are not sufficiently sensitive (Koskas et al, 2014) and were not associated with decision-making by the hospital team or the expert panel. Everyday observation of the patient by the team is certainly more pertinent.…”

Section: Discussionmentioning

confidence: 98%

Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process

et al. 2018

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RÉSUMÉL’hospitalisation des personnes âgées s’accompagnent d’un risque de déclin fonctionnel, et d’une grande fréquence de réadmission. Nous avons cherché à comprendre les processus de prise de décisions cliniques qui influencent l’orientation des patients âgés après leur sortie de l’hôpital. Les procédures déterminant l’orientation d’un patient âgé après une hospitalisation en service aigu ne sont pas claires. Nous avons comparé les décisions d’orientation (retour à domicile ou maison de retraite) réalisées par l’équipe avec celles d’un groupe d’experts; les décisions étaient prises de manière indépendante et aveugle. Cent deux (102) patients ont été inclus (âge moyen : 83,13 ± 6,74). Il existe une différence statistiquement significative entre les décisions des experts et de l’équipe (p <.001 ; coefficient kappa : 0,468). Les décisions du panel étaient plus étroitement associées à l’isolement (p = 0,018), aux aidants fiables (p = 0,004), aux problèmes sociaux (p = 0,001), et à la présence de comportements perçus comme agressifs (p = 0,001). Les deux processus de décision ont pris en compte le refus de soins (p = 0,025 et 0,016 respectivement) et les problèmes sociaux (p = 0,001 et < 0,001 respectivement). Les modalités de sortie des hôpitaux diffèrent selon les pays, les équipes et le type de patients, mais notre étude suggère la nécessité d’une évaluation plus précise des besoins du patient.

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The Lawton Instrumental Activities Daily Living/Activities Daily Living Scales

Abstract: Our results suggest that the Lawton IADLs-4 item scale and ADLs scale lack sensitivity to AD dementia in elderly people and support a better sensitivity of MOCA rather than MMSE and IADLs-4 item/ADLs at the expense of specificity.

Cited by 22 publications

References 55 publications

A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process

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