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’ll 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. Research shows that individuals over age 85 generally need assistance with daily living, with more than 20% of seniors over 85 requiring help with ADLs.
Basic ADLs, as outlined by the Katz Index of Independence in Activities of Daily Living,  include six essential skills:
Instrumental activities of daily living (IADLs) require planning, problem solving, and organizational skills. While ADLs are very fundamental, IADLs are skills that allow seniors to function independently and manage their own affairs. IADLs, as outlined by the Lawton-Brody scale , include the following:
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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. Assistance with daily activities from senior communities and in-home care services can provide individuals with help to complete ADLs and IADLs.
Knowing your loved one’s ability to complete ADLs and IADLs can help you, with the input of a doctor, answer the following questions:
Assessing 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. If you find that in-home services are not enough to help your parent complete a key ADL, assisted living communities offer facility-based support for seniors who need daily assistance.
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, ‘OK, 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 or other medical statuses 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 in creating a bigger picture of your loved one’s functional capabilities. Family or hired caregivers are often able to notice when a senior needs more assisted daily living support than they used to — for example, a parent may start asking for help in situations they could once tackle alone. 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 checkup.
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 independently 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:
Following the tips described in this article may 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, therapy treatments, or assistive devices to make bathing, transferring on and off furniture, or using the toilet easier can help your loved one perform ADLs independently.
Read related article:Do You Need a Geriatric Care Manager?
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. If your loved one needs help with even one ADL, assisted living or home care services could be helpful possibilities to consider.
When you’re ready to explore senior support options, reach out to one of A Place for Mom’s Senior Living Advisors. At no cost to you, an advisor will work to understand your parent’s unique situation and needs, compare different senior living options, and offer personalized referrals. We’ve helped more than two million families along their journey to find senior living, and we’re ready to help you start the search today.
Edemekong, P. F., Bomgaars, D. L., Sukumaran, S., & Schoo, C. (2022, November 19). Activities of daily living. StatPearls.
McCabe, D. Katz index of independence in activities of daily living (ADL). Hartford Institute for Geriatric Nursing.
Graf, C. (2008, April). Lawton-Brody Instrumental Activities of Daily Living Scale (IADL). Maine Health.
Kernisan, L. Personal interview.
Williams, E. I., & Wallace, P. (1993, April). Health checks for people aged 75 and over. Occasional Paper (Royal College of General Practitioners).
Linacre, J. M., Heinemann, A. W., Wright, B. D., Granger, C. V., & Hamilton, B. B. (1994, February). The structure and stability of the functional independence measure. Archives of Physical Medicine and Rehabilitation.
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