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Katz Index of Independence in ADLs
Katz Index: Measures basic survival skills. A score of 1 = Independent (can perform without physical assistance). 0 = Dependent (requires physical assistance or supervision).
Assess 6 basic functions
Bathing
Bathes self completely or needs help in bathing only a single part of the body (e.g., back).
Dressing
Gets clothes from closets/drawers and puts on clothes and outer garments complete with fasteners.
Toileting
Goes to toilet, gets on/off, arranges clothes, cleans genital area without help.
Transferring
Moves in and out of bed or chair unassisted (mechanical transferring aides are acceptable).
Continence
Exercises complete self-control over urination and defecation.
Feeding
Gets food from plate into mouth without help (preparation of food may be done by another person).
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Baseline functional assessment of older adults in primary care or upon hospital admission.
Determining the level of caregiving assistance required at home.
Tracking functional decline or recovery in chronic illness and rehabilitation.
Predicting mortality and institutionalisation risk in the elderly.
The Hierarchy of Decline
The Katz Index is built on the physiological observation that ADLs are lost in a specific, hierarchical sequence in dementia and aging: complex tasks (bathing, dressing) are lost first, while basic survival functions (eating) are preserved until the very end stages.
Section 2
Formula & Logic
Scoring
6 basic functions assessed: Bathing, Dressing, Toileting, Transferring, Continence, Feeding.
Each scored as 1 (Independent) or 0 (Dependent).
Total score: 0–6.
Interpretation
Score 6
High/Full Function. Patient is independent.
Score 4 - 5
Moderate Impairment. Needs specific assistance.
Score 0 - 3
Severe Functional Impairment. High caregiver burden, likelihood of institutionalisation.
Section 3
Pearls/Pitfalls
Barthel vs. Katz
While the Barthel Index is more granular (0-100 scale) and better for tracking small rehabilitation gains, the Katz Index (0-6) is simpler, faster, and widely used in primary care and nursing home intake assessments to quickly categorise dependency levels.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
Studies of Illness in the Aged. The Index of ADL: A Standardized Measure of Biological and Psychosocial Function.
Katz S et al. • JAMA.. 1963;185:914-9. The foundational paper establishing the hierarchy of functional loss in aging.
Section 6
Origins
Sidney Katz
Developed by Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland in the 1960s. They observed that the loss of independent function in chronic illness mirrors the reverse order of skill acquisition in childhood development (eating/continence first, complex dressing/bathing last).
