The Lawton And Brody Scale To Assess Autonomy In The Elderly

One of the main consequences of aging is the progressive loss of autonomy. The deterioration of physical and mental health influences the elderly to become more and more dependent, especially if they suffer from some type of dementia or brain damage. The Lawton and Brody scale allows detecting the first signs of difficulty and lack of autonomy in the person.

This brief instrument is one of the most widely used internationally and the most widely used in geriatric units in Spain. It allows to measure the degree of independence in elderly people, both institutionalized and not. In addition, it should be noted that it does so through the evaluation of the instrumental activities of daily living (AIVD).

Instrumental Activities of Daily Living

When analyzing dependency we have to look at the person’s ability to carry out activities of daily living. To classify, we can divide them into two groups: basic and instrumental.

The former refer to those most elementary aspects of personal care, such as food, toilet training or mobility.

Instrumental activities, on the other hand, are more complex tasks, but no less important in order to lead an autonomous life. They include activities that require decision-making and problem-solving skills. It is precisely these that the Lawton and Brody scale deals with.

The Lawton and Brody scale

This simple, but complete screening instrument requires no more than five minutes to apply. It is composed of eight items with various response alternatives that together assess the ability of the elderly to carry them out autonomously.

The answer options score 1 (the person performs them independently) or 0 (dependent).

The total score is obtained by adding the values ​​obtained in each item and ranges from 0 (totally dependent) to 8 (absolute independence). Depending on the case, the scale will be completed by the patient himself or by a reliable caregiver (in case the elderly person is not capable).

Aspects that are evaluated

Ability to use the phone

  • Use the phone on your own initiative (1 point)
  • Dial a few well-known numbers (1)
  • Answers the phone, but does not dial (1)
  • Not able to use the phone (0)

Go shopping

  • Make all the necessary purchases independently (1)
  • Buy small things independently (0)
  • You need a company to make any purchase (0)
  • Totally unable to buy (0)

Food preparation

  • Plan, prepare and serve meals independently (1)
  • He prepares them properly if he is given the ingredients (0)
  • Reheats and serves meals, but does not maintain a proper diet (0)
  • You need meals prepared and served (0)

Home care 

  • Take care of the house alone or with occasional help (1)
  • Performs light tasks like scrubbing or making the bed (1)
  • Performs light tasks, but does not maintain acceptable cleanliness (1)
  • You need help in all tasks (1)
  • Does not participate in any work (0)

Laundry

  • He washes all his clothes himself (1)
  • Wash small items (1)
  • Needs someone else to do the washing (0)

Means of transport

  • Travel alone by public transport or use your car (1)
  • Is able to take a taxi, but does not use any other means (1)
  • Travel by public transport accompanied by another person (1)
  • Only travel by taxi or car with the help of others (0)
  • Does not travel (0)

Medication

  • Take your medication at the correct time and dose (1)
  • Take your medication if the dose is prepared in advance (0)
  • You are unable to take your medication (0)

Economic Affairs

  • Manages your financial affairs on your own (1)
  • Handles everyday affairs, but needs help with large purchases and going to the bank (1)
  • Unable to handle money (0)

Utility of the Lawton and Brody scale

This instrument has proven to be effective in the objective assessment of dependency in the elderly. Its main advantage lies in the fact that it not only offers a total score, approximate a degree of deterioration, but also gives us information on the areas in which this deterioration has occurred. In other words, it not only gives us useful information for the “diagnosis”, but also for a possible intervention.

This last point is essential to design and implement a therapeutic plan. That is, to be able to provide the person with new strategies to preserve their independence. Finally, it should be noted that the scale has proven to be more reliable when applied to women, since many of the aspects it evaluates have traditionally been assigned to the female role.