From Body to Mind: Changing the Measuring Criteria of Aging

In the 1950s, Dr. Sidney Katz and his team at the Benjamin Rose Hospital in Cleveland, Ohio first used the term Activities of Daily Living (ADLs) to refer to people’s daily self-care activities. Health professionals often use a person’s ability or inability to perform ADLs as a measurement of their functional status. Common ADLs include feeding oneself, bathing, dressing, grooming, work, homemaking, cleaning oneself after defecating.

These indices turned out to be reasonable proxies for the amount of care needed to care for a profoundly frail older person. Later, entire reimbursement systems were designed around ADLs. This was 60 years ago, a time when we viewed frailty in older ages as inalterable.

Back in the 50s, the nursing home population averaged age 70 (?). Residents had been born in the 1880s. There was little expectation of long life and the focus was on indigence and enfeeblement. Most older people, by and large, lived in the community, among us. The 1960s, Medicaid and Medicare gathered them up, in large measure, for the first time. The subsequent institutional specialization stimulated the development of a new toolbox for frailty. Caring sons and daughters felt somewhat guilty in placing mom in the nursing home, but also were relieved to transfer the obligation of care. The guilt was relieved by two…