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The scales of functional assessment of Activities of Daily Living in geriatrics.

The editorial presented here aims to complement the importance of the research carried out by Chiu Ming-Jang et al.’s Diagnostic accuracy of instrumental activities of daily living for dementia in community-dwelling older adults [1]. This study shows how the functional evaluation in instrumental activities of daily living, and consequently with the use of scales of functional assessment in instrumental activities of daily living, can help to obtain a clinical orientation as a result of the evolution towards a dementia, similar to that obtained with a cognitive evaluation. Functional assessment is of undeniable interest to the health professional, not only generally, in the area of old age, but also specifically, with regard to dementia [2, 3]. This is because, as a consequence of the aging process of the central nervous system, there results a loss of adaptability coupled with a general slowing down of any physical or mental activity on the part of the old person [4–7]. The scales of functional assessment of activities of daily living (ADL) are instruments which are necessary in order to carry out a correct evaluation of the functional state of the individual in a systematic, individualised way. In the words of De la Fuente [7] ‘they allow us to obtain a clear profile of the operative possibilities of the subject, both from the strictly physical, instrumental point of view and including the neuropsychological and communicative character as well’. The activities of daily living are a total package of the conduct of a person on a daily basis which allows him/her to live autonomously as well as be integrated in his/her environment, fulfilling a determined social role [7]. These forms of conduct can be divided into three types, depending on their degree of complexity: basic ADL (BADL), instrumental ADL (IADL), and advanced ADL (AADL). The BADL were described by Katz et al. [8] and are the combined primary activities of a person with an aim toward his selfcare and mobility which grant him elementary autonomy and independence and allow him to live without the constant help of others [9] and are activities which refer to the functions of eating, controlling one’s sphincter, toilet, use personal hygiene, dressing oneself, bathing and the capacity of movement (transference, strolling, going up and down stairs and the ability to use a wheelchair, etc.). The IADL, described somewhat later by Lawton and Brody [10], are those which allow a person to adapt to his environment and maintain independence in the community [9]; they entail a more complex level of human conduct and for that reason depend more on the BADL than other areas of health (cognitive and affective states and social surroundings) [11] and the activities which are evaluated are the use of the telephone, shopping, preparing food, housekeeping, doing laundry, using means of transport, controlling of medication and the management of money. Finally, the AADL are a relatively new type of activity, at least with reference to the short amount of time that has passed since their segregation from the IADL formulated by Reuben et al. [12], and are of a more complex level than the instrumental ones where they had been included up until now. They are the behaviour of control over both one’s physical and social surroundings which allow the individual to develop his/her own social role, maintain good mental health and enjoy excellent quality of life [7, 13]. They include physical exercise (intense exercise, intense work such as gardening or do-it-yourself work, etc.), social activities (hobbies, trips, and social participation) and mixed activities (sports and work activity). The first losses seen in the sufferer of Alzheimer’s disease are, in order, first in the advanced activities [13] followed by the instrumental ones and, finally, in the basic activities. The use of scales of functional evaluation enable us to obtain a wide range of advantages [7]: first, they provide a good instrument for the exploration of the physical and psychic deterioration of the subject and allow us to evaluate the functional state of some specific or determinate areas in a more reliable way, making it possible to observe deterioration to a greater or lesser degree. The greater the strength of the psychometric tool, the greater the precision in distinguishing the degree of deterioration [13, 14]. This in turn allows us to observe those areas of disability which require rehabilitation or specific assistance. The ideal scale of functional assessment is that which, being easy to apply, can reflect the physical, psychic, emotional and social state of the patient, with the sufficient necessary precision to indicate suitable therapeutic intervention, although we are aware that, in practice, none is perfect at this level [7, 14–16]. We must also consider the functional assessment in activities of daily living as a complement to the pertinent clinicial studies, as these evaluations do not give us a medical diagnosis, but rather an evaluation of the functional situation of the person, apart from providing interprofessional terminology by using a language common to all. This common language can be used by all the members of a team and at other levels of assistance, thus facilitating interdisciplinary