Texas Functional Living Scale (TFLS)
The TLFS was developed as a brief quantitative measure of cognitively oriented instrumental activities of daily living that does not rely on information from an informant. Using a direct measure helps to reduce the bias introduced by caregivers, who characteristically over– or underestimate their loved ones’ abilities. Preliminary studies have shown that the TLFS correlates highly with standard neurocognitive screening tasks, but goes beyond such measures by using tasks based on everyday activities in which most people engage. The subscales sample different domains of functioning which can be used individually to assess an examinee’s “real world” abilities to carry out various everyday tasks. As such, the TLFS can be useful as an adjunct to traditional neurocognitive assessments in developing a profile of functional abilities that outlines areas of strength and weakness, in addition to depicting an individual’s overall level of functional impairment.
The TLFS T-Score provides a snapshot of the overall functional ability of the examinee. The TLFS T-Score states functional impairment in terms of mild, moderate, and severe, which also has implications for placement and assistance needs. Generally, a T score above 40 points suggest that an individual can live independently, while scores below 25 points often suggest that an individual may need to reside in a special care unit. Individuals with T scores of 26 – 40 (mild, mild-to-moderate, and moderately impaired) may need partial or fully assisted living. Individuals with moderate-to-severe impairment may require special care placement.
Time Subscale
The Time Subscale assesses an individual’s ability to use a calendar, tell time depicted on a clock face, and to depict time. Poor performances on these items suggest that the individual may have trouble carrying out time-dependent activities. They may have difficulty tracking important dates, using timers or watches to prompt activities (e.g., such as taking pills), or gauging when to initiate certain activities. Difficulties using these instruments suggests that external guidance and assistance is needed as an individual is compromised in their ability to independently carry out time-dependent activities.
Family members may need to guide use of the instruments, help with making and keeping appointments (e.g., doctor’s visits), prompt initiation of certain activities (e.g., attending support group the third Thursday of the month), or take over some/all of the time-dependent activities (e.g., paying monthly dues and quarterly taxes). Poor performance in this area may also suggest the need for regular time/reality orientation activities.
Money and Calculation Subscale
The Money and Calculation items assess the ability to count money and make change. Items range in complexity from adding several coins to calculating how much change one should receive (e.g., subtracting $2.81 from $5). Difficulties completing these items suggest that activities involving money exchange, even small amounts, is problematic for the individual. Such problems could lead the individual to have insufficient funds to make purchases, pay inaccurate amounts, and get short-changed. Some individuals compensate by handing over their purse/wallet and inviting the cashier to take out what they owe. Others take an inordinate amount of time counting money, disrupting the ongoing activities and potentially causing frustration for themselves and others. Difficulties with money calculations also leave individuals vulnerable to exploitation.
Communication Subscale
The Communication items assess the individual’s ability to use various communication tools to carry out daily functions. The tasks include writing a check to pay a utility bill, addressing an envelope to mail a check, looking up phone numbers in a phone directory and dialing the numbers, and knowledge of what number to call in an emergency. Other tasks include having the subject describe the steps involved in making a sandwich and assessing the capacity to learn and follow written directions to cook a meal in a microwave oven.
Difficulties filling in the check and mailing it imply that the individual’s ability to fulfill contractual responsibilities is compromised, and services that support their functioning in the community may be disrupted. Assessing services and maintaining contacts with significant others may be affected if the individual has difficulty searching out resources, and safety risks may arise if the individual does not know how to reach emergency services. Difficulty describing or following simple directions on how to carry out a simple activity or to use appliances also limits the individual’s capacity to reduce reliance on others and function as independently as possible in the community. Impaired communication is often a primary factor precipitating institutionalization.
Memory Subscale
Items in the Memory Subscale assess an individual’s ability to carry out an instruction after some time has elapsed and the effectiveness of a nonspecific cue (an alarm) in prompting an activity. This task specifically examines the individual’s ability to remember to take a specified number of pills when an alarm sounds. Other items assess the capacity to retain factual information of activities the individual has completed. Difficulty with the pill-taking items suggest that the individual may have trouble with treatment adherence because of memory impairment, and that nonspecific cues to carry out certain activities may have no practical utility. The individual may tend to forget take medications or take the wrong amount. Also, difficulties remembering to whom and for how much the check was written raise concerns about the individual’s ability to handle basic transactions.