Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Functional assessment and activities of daily living
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Sudden functional loss is acute illness
An abrupt inability to walk, transfer, toilet, dress, eat or manage medicines may be the presenting sign of stroke, sepsis, fracture, delirium, hypoxia, hypoglycaemia, retention or medicine toxicity.
Action: Assess ABCDE and time-critical causes first, establish dated pre-illness function through collateral, provide safe assistance and pressure and thrombosis prevention, then reassess tasks after pain, physiology and cognition improve.
Synopsis
Describe basic and instrumental daily function precisely, identify the medical, cognitive, sensory, environmental and social mechanism of loss, and turn observed ability into rehabilitation, equipment and support that works in the person's real setting.
Function is both an outcome and a diagnostic sign. Record what changed, when, why and what assistance makes the activity possible.
Basic ADLs include washing, dressing, toileting, transfers, continence and feeding; IADLs include shopping, cooking, housework, transport, communication, finances and medicines.
First-line assessment uses direct history plus collateral and observed performance. A score alone cannot distinguish strength, pain, cognition, vision, environment or motivation.
Key red flags
New unilateral weakness, speech change or loss of coordination requires an acute stroke pathway, not routine therapy referral.
Acute functional collapse
A sudden baseline gap demands medical diagnosis and delirium assessment before long-term placement decisions.
Investigation priorities
01
Dated functional historyFirst step
Establish usual performance and recent trajectory.
Management branches
First-line assessmentCompare baseline, capacity and current performance
A person reports or demonstrates new dependency.
Treat urgent illness and obtain a dated task-by-task baseline from the person and collateral sources.
Observe relevant ADLs and IADLs with usual aids and identify physical, cognitive, sensory, emotional and environmental mechanisms.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.