EVALUATION TOOL CRITIQUE 1
Instrumental activities of daily living (IADLs) refer to thoseoccupations that support independence within the home and thecommunity (Cara & MacRae, 2013). Individual clients are assessedwith regards to the integration of body systems and functions.Notably, occupational performance involves meal preparation, safety,community mobility, communication management, shopping, religiousobservance, and care of children and pets (Cara & MacRae, 2013).Other important activities include administration and oversight of aperson`s home, finances, and health. Safety and emergency maintenancecan also help a client to avoid physical injuries. Patients mustmanifest the ability to understand what they are doing before theycan participate in IADL occupations (Gold, 2012). The paper aims toevaluate the viability of IADL as an occupational therapy tool.
The Assessment of Living Skills and Resources (ALSAR-R2 RevisedVersion) was created in 2008 by Clemson, Bundy, Unsworth, and Singh(Cara & MacRae, 2013). The tool was developed for the purpose ofcommunity-based older adults. Occupational therapists can freelyobtain the tool from the Sydney educational library. The ALSAR usesan interview-based assessment based on the patient’s self-report(Cara & MacRae, 2013). The authors designed it to screenfunctional ability in IADLs for elderly persons with a variety ofdiagnoses in community, residential, and hospital settings.Furthermore, the tool evaluates the availability of extrinsic supportand resources that can benefit the patient. ALSAR contains achecklist of 11 functional tasks which identify client needs, assignrisk, and prioritize interventions (Cara & MacRae, 2013). Some ofthe assessment items include money management, transportation,laundry, housekeeping, reading, and telephone use.
Moreover, the ALSAR is a reliable and valid tool for assessing IADLperformance in older adults. Elderly persons within a community canprovide a self-report that fosters performance observation andclinical judgment. The interrater reliability has the range 0.72-0.94for skills and 0.78-1.00 for resources (Cara & MacRae, 2013). Inaddition, the ALSAR has high internal consistency among scale items,as shown by an alpha value of 0.91 (Cara & MacRae, 2013). Thetool is also sensitive with regards to detecting the changes in riskfrom hospital admission to discharge. The ALSAR requires 30 minutesto administer and can be used during the morning hours when thepatient is well-rested (Cara & MacRae, 2013).
The tool uses a three-part scoring system to evaluate the level ofskill needed to accomplish a particular task. For example, the firstclassification recognizes whenever the client fulfills an activityconsistently and independently (Cara & MacRae, 2013). The secondgroup acknowledges partial performance while the last segment is usedfor patients, who fail to accomplish a particular task. Each activityis also rated on the availability of resources. Hence, the Task RiskScore is computed as a combination of the resource and skill scoressuch that a high value implies great risk. The ALSAR-R2 has animproved interrater reliability on all scores within the intraclasscorrelation range of 0.541-0.896 (Cara & MacRae, 2013). Thecriterion-related validity was based on critical correlations betweenrisk scores and specific changes reported within a six-monthfollow-up (Cara & MacRae, 2013). Notwithstanding, contentvalidity is established such that the tool can be used a validmeasure in clinical practice. The ALSAR is also viable as an outcomemeasurement.
The hypothetical OT client would be an older adult in hospital,clinic, or community settings. Nevertheless, institutionalizedpersons would derive little benefits from this instrument. Theselected tool is sufficient for older adults due to several factors.Some of these challenges include worsening chronic illnesses, acuteillness, normal aging changes, and increased hospitalization (Cara &MacRae, 2013). Consequently, the client can experience a debilitatingdecline in the ability to perform activities of daily living. Theolder adult may also suffer a spiral of iatrogenesis that createsfurther health problems (Cara & MacRae, 2013). Using the ALSARtool is important since functional assessment may provide objectivedata while evaluating the patient. In fact, such information couldindicate future decline or improvement in a client’s health status.
Advantagesand Limitations of Tool
The tool offers several advantages during the assessment of olderadults. For example, it can be used to evaluate the client’sfunctional ability with regards to feeding, continence, transferring,toileting, dressing, and bathing (De Vriendt et al., 2013).Additionally, it can assess other tasks related to heavy housework. The tool is crucial in the creation of a common language concerningpatient function (De Vriendt et al., 2013). Therefore, allpractitioners have consistent guidelines to follow in care anddischarge planning. The ALSAR is also beneficial since it is highlysensitive to minor changes in the client’s declining health status.Nonetheless, the tool is limited since it cannot detect improvementsin the rehabilitation status of older adults (De Vriendt et al.,2013). In many instances, the ALSAR needs to be combined with a fullcomprehensive geriatric assessment. Although the tool has been usedsuccessfully with long-term care patients, some adaptations have tobe made. For instance, the OTR has to use proper judgment to addressissues such as language barrier and dementia (De Vriendt et al.,2013). Other conditions may also interfere with cognition orcommunication. Therefore, interpreters may be required to ask olderclients to perform specific tasks or explain the reasons for theirrefusal (De Vriendt et al., 2013). The tool is also hampered bycognitive impairments that such as delirium, disorientation, anddementia.
Useof the Tool in Treatment Planning
IADLs can be used for treatment planning by focusing on thefunctional capabilities of older adults. In this regard, the tool canbe utilized in a variety of care settings to obtain baselinemeasurements of a client’s health status (Schmitter-Edgecombe,Parsey, & Lamb, 2014). Subsequently, periodic evaluations can bedone to assess the patient’s progress or decline. Treatmentplanning also involves adopting measures to combat environmentalchallenges to using the tool. Admittedly, some health institutionsmay lack the required toilets and bathing facilities(Schmitter-Edgecombe et al., 2014). Although some patients are fullycapable of performing activities of daily living, nurses feelinclined to support such clients (Gold, 2012). Therefore, the toolcan be used to encourage older adults to maintain their independence.In addition, the results of patient assessment can be shared with theclinical team and family members. Treatment planning requiresextensive collaboration to ensure that the client works to achieveindependence (Gold, 2012). However, some patients may be forced toask for assistance from family members. Hence, the tool shouldformulate a framework where responsibilities are shared.
Indeed, older adults need assistance during the performing ofinstrumental activities of daily living. The ALSAR is a reliable andvalid tool for use in occupational therapy. The information presentedcan be applied to older adults with cognitive impairments. Notably,patients with IADL deficits have a higher risk of developing dementiacompared to clients, who are capable of performing fundamentalactivities of daily living (Jekel et al., 2015). Therefore, it isvital to use assessment tools that are specifically designed andvalidated for older adults. Although patients with mild cognitiveimpairments face various challenges, it is possible for them toattain and maintain a measure of functional independence.
Cara, E., & MacRae, A. (2013). Psychosocial occupationaltherapy: An evolving practice. Ontario, Canada: Nelson Education.
De Vriendt, P., Gorus, E., Cornelis, E., Bautmans, I., Petrovic, M.,& Mets, T. (2013). The advanced activities of daily living: atool allowing the evaluation of subtle functional decline in mildcognitive impairment. The Journal of Nutrition, Health &Aging, 17(1), 64-71.http://dx.doi.org/10.1007/s12603-012-0381-9
Gold, D. A. (2012). An examination of instrumental activities ofdaily living assessment in older adults and mild cognitiveimpairment. Journal of Clinical and Experimental Neuropsychology,34(1), 11-34. http://dx.doi.org/10.1080/13803395.2011.614598
Jekel, K., Damian, M., Wattmo, C., Hausner, L., Bullock, R.,Connelly, P.J., Dubois, B., Eriksdotter, M., Ewers, M., Graessel, E.& Kramberger, M.G. (2015). Mild cognitive impairment and deficitsin instrumental activities of daily living: a systematic review.Alzheimer`s Research & Therapy, 7(1), 1.http://dx.doi.org/10.1186/s13195-015-0099-0
Schmitter-Edgecombe, M., Parsey, C., & Lamb, R. (2014).Development and psychometric properties of the instrumentalactivities of daily living: Compensation scale. Archives ofClinical Neuropsychology, acu053.http://dx.doi.org/10.1093/arclin/acu053