Cleaning your home, preparing dinner, and taking a shower are essential activities of daily living, or ADLs, that feel like second nature to many of us. But as we age, it’s normal for these tasks to become more and more difficult to perform. If you’ve noticed your loved one has had trouble completing these key life tasks, it may be a signal that it’s time for a major change in care.
Learning the proper level of care for your aging parent is simple with the right guidance. To make an informed decision about your loved one’s care needs, read on to familiarize yourself with these key terms and related skills. You will also find ADL and IADL checklists that will help you assess your loved one’s well-being.
ADLs are basic tasks a person needs to be able to do on their own to live independently. Health issues and aging may make it difficult for seniors to complete certain everyday self-care tasks that are essential to keep them healthy and safe.
Basic ADLs, as outlined by the Katz Index of Independence in Activities of Daily Living, include six essential skills:
Instrumental Activities of Daily Living, or IADLs, are activities you do to care for yourself, your family, and your home. While ADLs are very fundamental, IADLs refer to more complex activities often involving more thinking and organizational skills that help a senior live and function independently. IADLs, as outlined by the Lawton-Brody scale, include:
As a family caregiver, you have the power to give your loved one the best life possible. When you track your loved one’s health and functional capabilities, it will become easier to notice signs of deterioration and improvement. Knowing what ADL and IADL changes to look for will help you know what level of care your loved one needs.
Understanding the functions of ADLs and IADLs can help you take note of what activities of daily living your loved one can and cannot do. Ideally, they should have the physical and mental capabilities to conceptualize and carry out the tasks on their own or with minimal assistance.
Changes in these capabilities occur gradually over time. Often, a decline in the ability to complete basic ADLs may not be noticeable until later stages of physical or mental disability.
Knowing your loved one’s ability to complete ADLs and IADLs can help you, with the input of a doctor, answer the following questions:
ADLs can also help caregivers and health care professionals understand the level of care needed. The level of care for someone who can’t complete IADLs is different from the care needed by someone who can’t complete basic ADLs.
As you track your loved one’s status and plan for future steps, keep in mind that ADLs require more intensive, hands-on care. In some cases, IADL deficiencies may be managed by different service providers, such as a senior meal preparation or delivery service, a housekeeper, or a money management professional.
Families rarely ask about ADLs until a parent or senior loved one is going through the process of assessment for long-term care, says Dr. Leslie Kernisan, a geriatric expert.
“If someone is concerned about their mom, then knowing how they’re doing with ADLs is important,” she says. “It can educate a person and take them from feeling like ‘Mom needs help, I’m worried,’ to be able to answer questions like, ‘Okay, where does she need help?’”
She recommends bringing up changes in a loved one’s ability to do these tasks when talking with a physician.
According to Kernisan, it’s a good idea to share changes in ADLs with your loved one’s medical team. Before your next clinician visit, consider the following:
ADLs and IADLs can be assessed in a variety of ways. Caregiver input can be helpful to create a bigger picture of your loved one’s functional capabilities. However, caregiver burnout, the tendency to overestimate or underestimate someone’s true abilities, or a change in the caregiver’s ability to provide adequate care can make this method less accurate than others.
Self-reporting can also help get the conversation about ADLs started. No one understands a situation better than the person experiencing it. Self-reporting is especially helpful when individuals have minimal cognitive decline. However, self-reporting can introduce bias as your loved one may not feel an incident is really worth recording.
While a health care professional’s report is often believed to provide the most objective view of a person’s functional status, a combination of assessments may fully capture the picture of disability for a given individual.
Health care professionals commonly use these tools to assess ADLs:
To help you assess and monitor your loved one’s activities of daily living, download A Place for Mom’s ADL and IADL checklists. These are great tools to take with you the next time your loved one has a medical check-up.
As you assess your loved one’s ability to complete ADLs and IADLs, follow these tips:
“It’s very challenging to have people see you as less able,” Kernisan says. Caregivers should “be discreet and empathetic” when assessing for ADLs, she suggests.
If your loved one is unable to perform daily ADLs and IADLs, or if you have other safety concerns, it may be time to discuss increasing their level of support or moving to an assisted living community.
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Kernisan suggests keeping an eye out for specific safety factors when visiting a senior relative.
If you answered “yes” to any of the above questions, it may be time to assess your aging loved one’s ADLs and IADLs, either by a medical professional or from your perspective as a family member.
When it comes to assessing ADLs and IADLs, there’s a lot of technical information about different assessments. This can be overwhelming for families to navigate.
Dr. Kernisan understands this struggle and recommends the following:
If you’re worried about your loved one’s ability to perform everyday tasks, connect with their doctor to discuss your concerns. It’s important to identify any limitations your aging parent may have, but it’s even more critical to support them by finding solutions to help solve or alleviate those limitations, or by finding the care they need.
Taking these steps will help your loved one to be as independent as possible so they can enjoy a greater quality of life.
In some cases, simple lifestyle adjustments such as hearing or vision aids, physical therapy, or assistive devices to make bathing, transferring on and off furniture, or using the toilet easier can help your loved one perform ADLs independently.
If your aging parent needs additional help, consider reaching out to an A Place for Mom Senior Living Advisor to find the level of care that fits your loved one’s needs.
The information contained in this article is for informational purposes only and is not intended to constitute medical advice or diagnosis. Always seek the advice of your physician or other qualified health care provider regarding any medical condition or treatment, and never disregard professional medical advice or delay treatment based on anything you have read on this site.Links to third-party websites are only for the convenience of the reader; A Place for Mom does not offer blanket endorsements of the contents of third-party sites.
Graf, C. (2008, April). Lawton-Brody Instrumental Activities of Daily Living Scale (IADL).
Liebzeit, D., King, B., & Bratzke, L. (2018). Measurement of function in older adults transitioning from hospital to home: An integrative review. Geriatric Nursing.
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McCabe, D. (n.d.). Katz index of independence in activities of daily living (ADL). Hartford Institute for Geriatric Nursing.
The National Palliative Care Research Center. (n.d.) Measurement and Evaluation Tools.
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