Patient Name:______________________ Date:_____________
Patient ID #________________________
Source:
Katz Index of Independence in Activities of Daily Living
Activities Points Independence Dependence
(1 or 0) (1 Point) (0 Points)
NO supervision, direction or personal WITH supervision, direction,
assistance. personal assistance or total
care.
BATHING (1 POINT) Bathes self completely or (0 POINTS) Need help with
needs help in bathing only a single part of bathing more than one part of
Points: __________ the body such as the back, genital area or the body, getting in or out of
disabled extremity. the tub or shower. Requires
total bathing
DRESSING (1 POINT) Get clothes from closets and (0 POINTS) Needs help with
drawers and puts on clothes and outer dressing self or needs to be
Points: __________ garments complete with fasteners. completely dressed.
May have help tying shoes.
TOILETING (1 POINT) Goes to toilet, gets on and off, (0 POINTS) Needs help
arranges clothes, cleans genital area transferring to the toilet,
Points: __________ without help. cleaning self or uses bedpan
or commode.
TRANSFERRING (1 POINT) Moves in and out of bed or (0 POINTS) Needs help in
chair unassisted. Mechanical transfer aids moving from bed to chair or
Points: __________ are acceptable requires a complete transfer.
CONTINENCE (1 POINT) Exercises complete self (0 POINTS) Is partially or
control over urination and defecation. totally incontinent of bowel or
Points: __________ bladder
FEEDING (1 POINT) Gets food from plate into (0 POINTS) Needs partial or
mouth without help. Preparation of food total help with feeding or
Points: __________ may be done by another person. requires parenteral feeding.
TOTAL POINTS: ________ SCORING: 6 = High (patient independent) 0 = Low (patient very dependent
try this: Best Practices in Nursing Care to Older Adults, The Hartford Institute for Geriatric Nursing, New York University, College of
Nursing, www.hartfordign.org