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Fig. 1. Sidney Katz, MD. 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)1, 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,1 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. Dr. Katz took a leadership position in many of the initiatives of the Institute of Medicine, including Chairing the 1983 Committee on Nursing Home Regulation, with the mandate to evaluate the Federal/ State regulatory system on quality of care in nursing homes: the recommendations of which laid the ground for the 1987 Federal Nursing Home Reform Act and Omnibus Reconciliation Act,2 leading to the 199 |
