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ADLs and IADLs: An Essential Guide for Seniors

Angelike Gaunt
By Angelike GauntApril 26, 2020

Understand how to assess your aging loved one’s ability to complete activities of daily living (ADLs) to help ensure they live their best life.

What are activities of daily living (ADLs)?

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.

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The Katz Index of Independence in Activities of Daily Living is an effective tool used to assess overall health and functional status of older adults and those with disabilities. Basic ADLs include six essential skills:

  1. Bathing and showering: the ability to bathe self and maintain dental, hair, and nail hygiene
  2. Continence: having complete control of bowels and bladder
  3. Dressing: the ability to select appropriate clothes and
    outerwear, and to dress self independently
  4. Mobility: being able to walk or transfer from one place to another, specifically in and out of a bed or chair
  5. Feeding (excluding meal preparation): the ability to get food from plate to mouth, and to chew and swallow
  6. Toileting: the ability to get on and off the toilet and clean self without assistance

What are instrumental activities of daily living (IADLs)?

Instrumental Activities of Daily Living, or IADLs, are more complex activities required for senior independent living that often involve thinking and organizational skills. IADLs outlined by the Lawton-Brody scale assessment include:

  • Cleaning and housekeeping, including maintenance and other home care chores
  • Doing laundry
  • Managing money
  • Managing medications and taking medicines as directed
  • Preparing meals
  • Shopping for groceries and other necessities
  • Transportation, including changing residences and moving
  • Using communication devices, including the telephone or computer

Why are ADLs and IADLs important for caregivers?

ADLs represent everyday tasks that challenge both mental and physical capabilities. A person needs to have the physical ability to perform ADL tasks themselves, and the planning and mental capacity to conceptualize the tasks and understand what needs to be done.

A decline in IADL performance is often the first sign that an older adult may be experiencing mild or early cognitive impairment.

Conversely, a decline in the ability to complete basic ADLs may not be noticeable until later stages of dementia or physical disability.

Knowing your loved one’s ability to complete ADLs can help you and your aging parent’s doctor answer these questions:

  • Do you or a neighbor need to check on your aging parent routinely?
  • Does your aging loved one need physical therapy?
  • Is your aging parent able to continue living independently?
  • Would moving to an assisted living community be beneficial?

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.

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. ADLs require more intensive, hands-on care.

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. 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 says.

Ultimately, when it comes to ADLs and IADLs, “caregivers have more information about how a senior loved one is doing than the doctor does.”   – Dr. Leslie Kernisan, geriatric expert.

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 because:

  • A change in ADL can trigger medical evaluations that may uncover a medical issue
    It’s important to understand the root cause of the problem or change in ability.
  • Understanding root causes can help you and your loved one’s doctor work together to find ways to improve function
    Some common ways to improve function include medical treatment, physical therapy, or a device such as a walker.
  • Understanding ADLs is critical to having an accurate care plan
    If your parent’s doctor doesn’t realize there’s a functional problem, the care plan they create may not be in line with your loved one’s abilities. For example, if the doctor isn’t aware that your loved one is sometimes forgetful, then their expectation that your parent can regularly monitor their blood sugar on their own may not be realistic.

How are ADLs and IADLs assessed?

ADLs and IADLs can be assessed in a variety of ways. Caregiver input can be helpful to create a bigger picture of a person’s functional status. However, caregiver burnout and the tendency to overestimate or underestimate someone’s true abilities 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-report measures leave the results open to a person’s own interpretation.

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.

The 3 types of ADL assessments physicians use

Health care professionals commonly use these tools to assess ADLs:

Signs that it’s time to assess ADLs and IADLs

Kernisan suggests keeping an eye out for specific safety factors when visiting a senior relative, including:

  • Driving: Have there been any accidents or close calls? Do passengers feel worried?
  • Elder abuse: Do you have any concerns about emotional, financial, physical, or verbal abuse?
  • Finances: Are there problems paying bills? Are you concerned about scams?
  • Health: Has your loved one had any falls? Have there been repeated trips to the ER or hospital?
  • Memory and thinking: Have there been problems with forgetting, getting lost, or wandering? Is there concern about poor awareness or poor judgment?

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.

ADL and IADL: assessment tips for caregivers

As you assess your loved one’s ADLs and IADLs capabilities, follow these tips:

  • Ask your siblings’, friends’, or neighbors’ opinions 
    Inquire about any changes you’ve noticed in your loved one’s abilities. Pick two or three people to discuss your concerns.
  • Assess on a spectrum
    Ask yourself whether your loved one can do the task a little bitsometimes, or often rather than a simple “yes, they can do the task,” or “no, they can’t.
  • Be patient
    “If a person is doing a task more slowly than they used to, it doesn’t mean they can’t do the task,” says Kernisan.
  • Consider the time of day and how tired they are
    Many seniors have sharper cognitive abilities and more energy in the morning.
  • Consider their health
    If they’re fatigued or fighting a virus, their abilities can be momentarily impaired.
  • Find the time
    “It’s common to be in a hurry and it’s difficult to find the time to observe, but it’s important to take the time and when you do, be patient,” Kernisan says.
  • Look at your own preconceived notions about your loved one
    Are they interfering with your ability to make an impartial assessment?
  • Make the effort to help correct what you can
    Ensure your loved one can live life to the best of their abilities and as independently as possible.

“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 you feel that a parent or senior loved one’s abilities have declined and they need help, then you may be wondering how to broach this difficult conversation with them. A good way to bring up the topic is to ask them how they feel things are going.”

If your loved one is unable to perform daily tasks outlined in the ADLs and IADLs, or if you have other safety factors, it may be time to discuss increasing their level of support or moving to an assisted living community.

ADLs and IADLs: a checklist for the elderly

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.

Here’s what Dr. Kernisan recommends:

  • Ask your aging parent’s doctor if a change in medical plan is required (for example, a complicated diabetes plan may need to be revised).
  • Ask if your loved one qualifies for a service like Medicaid.
  • Ask what’s causing any issues or inabilities.
  • Be aware of your loved one’s true abilities when it comes to ADLs and IADLs.
  • Consider whether the limitations have short- or long-term implications.
  • Help your loved one remain independent as long as possible with adaptive assistance.
  • Seek treatment.

How to get help with ADLs for your loved one

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, or using the toilet easier can help your loved one perform ADLs independently.

If your aging parent needs additional help, there are a variety of assisted living communities that can provide different levels of care to fit your loved one’s needs.


Angelike Gaunt
Author
Angelike Gaunt

Angelike Gaunt is a content strategist at A Place for Mom. She’s developed health content for consumers and medical professionals at major health care organizations, including Mayo Clinic, the American Academy of Family Physicians, and the University of Kansas Health System. She’s passionate about developing accessible content to simplify complex health topics.

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