Activities of Daily Living (ADLs) are self-care activities a person must be able to do to live independently. Activities of Daily Living include basic tasks we learn as children, such as bathing and dressing. We often take these tasks for granted until they become challenging, so if you want to Age in Place in your latter years, it is essential to start preparing today.
Physical and cognitive health declines can make it difficult for seniors to complete Activities of Daily Living. In some cases, the decline is gradual. In others, an unfortunate event alters a senior’s capabilities. No matter the cause, if seniors can’t complete Activities of Daily Living, it is no longer safe for them to live alone.
This article will detail everyday Activities of Daily Living. It will also outline the closely associated Instrumental Activities of Daily Living (IADLs), which include more complex tasks. Finally, the article will discuss the importance of both ADLs and IADLs.
Activities of Daily Living (ADLs)
Activities of Daily Living (ADLs) are essential to living independently. There are variations in ADL categorization, but the Katz Index of Independence in ADLs considers six self-care tasks.
- Bathing — Ability to bathe independently and maintain personal hygiene. Includes hair, nail, and oral care.
- Continence — Control of bladder and bowels.
- Dressing — Able to select appropriate clothes, including outerwear, and to get dressed independently. Individuals with arthritis and other manual dexterity challenges may have trouble using zippers and buttons or getting on shoes.
- Mobility — The ability to stand without support from a seated position, to get in and out of bed or the tub, get on and off the toilet, and walk from one place to another. If mobility is impaired, assistive or mechanical devices such as wheelchairs or scooters can be used. However, to be considered independent, one must be able to get into a position to use the device and operate it without assistance.
- Feeding (excluding meal preparation) — The ability to get food from the plate to the mouth, drink from a beverage container, manage utensils, and safely chew and swallow food and beverages. If a person can independently eat finger food and drink soup from a cup, they can be considered independent with feeding.
- Toileting — Ability to get into the bathroom, on and off the toilet, and clean oneself without assistance.
Instrumental Activities of Daily Living (IADLs)
Instrumental Activities of Daily Living (IADLs) are self-care tasks that are less focused on personal care and require higher cognitive or physical abilities than ADLs. A declining senior typically loses these capabilities first. As the people around them may not be on the lookout, behaviors that should be red flags often go overlooked. Key IADLs include…
- Communication – Managing communication by phone, mail, and email.
- Household Upkeep – Housekeeping, laundry, and home maintenance.
- Shopping and Meal Preparation – Includes shopping for food, household essentials, and clothing.
- Organizing Finances – Includes paying bills, tracking assets, taxes, and planning expenditures.
- Getting Around – Driving or arranging alternative transportation.
- Managing Medications – The ability to obtain medications as well as the ability to follow instructions on dose and timing.
Why are ADLs and IADLs important?
To live independently without assistance, humans need to be able to manage their Activities of Daily Living. The inability to perform these tasks creates a level of dependence on caregivers. As needs increase, the individual may need medical intervention or daily living support. Declines in the ability to perform ADLs and IADLs indicate underlying health or cognitive issues. Without proper interventions, these issues can worsen quickly.
It is essential to discuss declines in your ability to handle ADLs with a qualified healthcare provider. If you or the elder experiencing challenges has a trusted companion, such as a spouse or family member, their participation can be helpful. It is ideal to have an open discussion with your healthcare provider regarding a plan of action.
It isn’t easy to comprehensively assess an individual’s mental and physical condition in a single office visit. Therefore, it is vital to provide the physician with details of the declining ability to perform ADLs. Either the patient or their companion can share this information. Discussing struggles with self-care tasks will help your doctor make the proper diagnosis. In turn, this will help them select appropriate interventions and care plans.
Aid from public and private-sector service providers is often contingent on an ADL assessment. Medicaid and Veteran benefits may be contingent on ADLs, including Veteran Aid and Attendance benefits. Private Long Term Care Insurance policies may only pay benefits once a patient requires help with ADLs. (Policy requirements vary. It is essential to read the policy closely and speak to the agent or a company representative before you finalize plans).
The ADL/IADL assessment will determine the specific issues an individual is struggling with and whether or not there are multiple tasks where the patient requires help. It is important to remember that the ability to perform an activity exists on a continuum, so the evaluation should go beyond yes/no responses. As you consider these needs for yourself or a loved one, you should consider each ADL/IADL and how well it can be performed:
- Requires no assistance
- A person can independently and safely perform this task.
- Requires some assistance
- A person may need help or reminders to perform this task.
- Requires total assistance
- A person is unable to perform this task without assistance.
If your needs are minimal, you can perform an ADL assessment independently. However, if there is a greater need for assistance or care benefits, you must schedule a professional assessment with a physician or other service provider. If you are considering moving to a senior care community or employing a home care agency, they will perform an evaluation using their assessment tools.
A proactive approach can slow the decline of your ability to perform Activities of Daily Living. The first step is to partner with your healthcare provider. There are also non-medical strategies; to learn more, see our follow-up article, 4 Steps to Compensate for Declines in ADLs and IADLs.
If you have noticed ‘red flags’ related to an older family member or friend’s ability to perform Activities of Daily Living, it is crucial to raise your concerns. This may be uncomfortable, but it can be essential to ensuring their ongoing health, happiness, and quality of life. Recognize that this can be a very sensitive topic, and best approached by sharing a specific observation and asking for their thoughts or perspective on this.
For those who are getting older and living on your own, I urge you to discuss any challenges in your self-care tasks with your physician or a trusted advisor. Raising minor issues may feel like a risk to your independence, but identifying an appropriate intervention before a minor issue becomes a major problem could have the opposite effect, allowing you to live your best possible life as a self-sufficient individual.
For more information, see our articles on How to Determine Care Needs using ADLs and IADLS, as well as 4 Steps to Compensate for Declines in ADLs and IADLs.