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.
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:
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:
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:
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:
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.
Health care professionals commonly use these tools to assess ADLs:
Kernisan suggests keeping an eye out for specific safety factors when visiting a senior relative, including:
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.
As you assess your loved one’s ADLs and IADLs capabilities, 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 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.
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:
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 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.