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Address correspondence to Barry J. Gurland, FRCPhysicians (London), FRCPsychiatry, Stroud Center for Studies on Quality of Life in Aging, Columbia University Medical Center, 100 Haven Avenue # 330F, New York, NY 10032-2645.
The late Sidney Katz, MD (Figure 1), who died on May 4 at age 88, founded a science of human functioning that fundamentally
changed understandings and practice of long term care for older persons. By deconstructing
and scaling the capacities required for independent living, the Katz Index of Activities
of Daily Living (ADL)
, he provided a basis for measuring, predicting, and comparing declines and recovery
in chronic illnesses of aging, or after catastrophic episodes such as stroke, cardiac
events, and fractures; and a marker of needs for supportive care and/or a sheltered
environment. This method of evaluation sprang from a seminal insight that all humans
rely on being able to perform six functions for their basic independent survival:
transferring from reclining to standing, feeding, dressing, bathing, using the toilet,
and being continent. The Katz ADLs represent a universal language of need for health
and social help that is understood worldwide and across disciplines. Those methods
are the substrate of the contemporary national strategy for surveillance of standards
of care in, and eligibility for admission to, nursing homes; and of the humanist movement
to improve the well-being of older adults who are facing the challenges of aging and
chronic illness. The common language provided by the terms he introduced to describe
a patient's functioning has united fields of research worldwide, facilitated such
diverse services as multidisciplinary team management, determining whether a new intervention
is effective, or deciding whether nursing home admission is advisable and eligible
for insurance coverage. Since his initial paper in 1963 in JAMA on the ADL,
it has been cited in over 46,886 professional publications. Virtually all Federal
proposals to provide long term care include an ascertainment of the individual's activities
of daily living.
