The Activities of Daily Living Understanding ADLs and IADLs

Do you ever think about the everyday tasks you complete to care for yourself—things like bathing, getting dressed, or moving around your home? Chances are, you don’t give them much thought, as these activities of daily living (ADLs) are second nature to most of us. 

But as we approach middle-ages or older, the ability to perform ADLs can decline, impacting our independence and quality of life.

Understanding ADLs is crucial for aging individuals and the loved ones who care for them. ADLs are a barometer of an older adult’s capacity to live independently and signal when additional support is needed. 

Whether you’re a baby boomer planning for your future or a caregiver to an aging parent, this article will equip you with the knowledge you need to navigate changes in ADL abilities and promote independence for years to come.

What Are ADLs? 

The term “activities of daily living” or “ADLs” refers to the fundamental skills required to care for oneself independently. Sidney Katz, MD, a physician widely known as the father of geriatric medicine, developed the concept in the 1950s. 

Dr. Katz defined ADLs as “the things we normally do…such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure.” 

Activities of daily living examples are broken into five categories:

1. Personal Hygiene: Bathing, grooming, nail care, and oral care.
2. Dressing: Selecting appropriate attire and being able to dress and undress oneself physically.
3. Eating: The ability to feed oneself, though not necessarily to prepare food.
4. Maintaining Continence: Both the mental and physical capacity to use a restroom, including getting on and off the toilet and cleaning oneself.
5. Transferring/Mobility: Being able to walk and get in and out of bed and a chair.

While these ADLs tasks may seem simple, the ability to complete ADLs is strongly linked with an individual’s capacity to live independently in their home. Difficulty with ADLs, which becomes more common as we age, can make living alone unsafe or impossible without additional support.

Why ADLs Matter

Healthcare professionals assess an older person’s functional status by examining their Activities of Daily Living (ADLs), which reflect their ability to care for themselves and navigate daily life. Changes in these activities can often signal a decline in health or indicate a higher risk for falls and other hazards at home. In this context, home care services can be crucial in supporting individuals to maintain their independence and safety.

Challenges with one or more ADLs can stem from a variety of health conditions that impact physical strength, balance, and mobility, such as:

• Arthritis
• Stroke 
• Parkinson’s disease
• Injuries from falls
• Vision loss

Cognitive decline associated with dementia and Alzheimer’s disease can also make performing ADLs difficult, as they rely on memory and decision-making skills. For instance, a person with dementia may forget the steps involved in dressing themselves or lack the judgment to maintain good hygiene.

Fortunately, by understanding the role ADLs play in overall wellness and independence, older adults and their caregivers can be proactive in monitoring ADL abilities. Recognizing changes early allows for timely interventions and discussions about getting appropriate support before a crisis occurs.

Beyond ADLs: Instrumental Activities of Daily Living 

While activities of daily living (ADLs) encompass the fundamental skills needed for self-care, instrumental activities of daily living (IADLs) involve more complex behaviors necessary for truly independent living. 

The concept of IADLs was developed by gerontologist M. Powell Lawton and his colleagues in the late 1960s to assess capabilities that allow individuals to interact with and manage their environment.

IADLs are higher-level ADL tasks that require mental and physical dexterity as well as organizational and problem-solving skills. They include more complex ADL tasks such as:

• Managing finances.
• Meal preparation.
• Shopping for groceries and other necessities.
• Doing housework and laundry.
• Using the telephone or computer.
• Managing medications.
• Arranging transportation.

For example, while eating is an ADL, the ability to plan and cook a nutritious meal is an IADL. Similarly, getting dressed is an ADL, but doing the laundry and making sure clean clothes are available involves IADLs.

The ADL Score: How Healthcare Professionals Assess ADLs and IADLs

Geriatricians, occupational therapists, and other healthcare professionals use standardized assessments to evaluate an older adult’s ability to perform ADLs and IADLs. These tools provide a systematic way to identify areas of difficulty and track changes over time. 

These are some of the most common assessments:

Katz Index of Independence in Activities of Daily Living

The Katz ADL Index is one of the most widely used assessments. It focuses on the six primary ADLs: bathing, dressing, toileting, transferring, continence, and feeding. Individuals are scored as either independent (1 point) or dependent (0 points) for each activity. A total ADL score of 6 indicates full function, while an ADL score of 2 or less suggests severe functional impairment.

Barthel ADL Index

The Barthel Index expands on the Katz scale, adding additional categories like grooming and stair climbing. Each activity is rated on a scale of 0-10 or 0-15 points, with a higher ADL score indicating greater independence. This assessment is particularly useful for measuring incremental changes in ADL function.

Lawton-Brody Instrumental Activities of Daily Living Scale

Many healthcare providers turn to the Lawton-Brody scale to assess IADLs. This tool evaluates eight domains: using the telephone, shopping, preparing food, housekeeping, doing laundry, using transportation, managing medications, and handling finances. Individuals are scored on each activity, with total scores ranging from 0 (low function) to 8 (high function).

Advice for Family Caregivers

As a family caregiver, you are often the first to notice changes in your loved one’s ability to manage everyday activities. Knowing what to look for and how to respond can make a world of difference in maintaining their health, safety, and quality of life.

These are some common red flags to watch for that an older adult may be having difficulty with ADLs include:

• Poor personal hygiene, body odor, or unkempt appearance.
• Wearing the same clothes multiple days in a row.
• Noticeable weight loss or signs of poor nutrition.
• Increased incontinence or accidents. 
• Unsteadiness while walking or getting up from a chair.
• Unexplained bruises or injuries that may result from falls.

If you notice any of these signs, you must talk to your loved one and consider getting a professional assessment. However, you can also take steps at home to evaluate ADLs and IADLs.

Assessing ADLs and IADLs at Home

Family caregivers can use simple checklists to evaluate their loved one’s abilities and identify areas where support may be needed. The AARP’s “Determine Your Loved One’s Needs” guide provides printable checklists to assess both ADLs and IADLs.

When completing these assessments, consider your loved one’s current level of function compared to their baseline. Are there ADLs tasks they can no longer do that they could easily manage a few months ago? Take notes on your observations and share them with your loved one’s healthcare provider.

Having the Conversation About Getting Assistance

Discussing the need for additional help with ADLs or IADLs can be challenging. Many older adults fear falling into an ADL assisted living arrangement or becoming a burden on their families. As a caregiver, you can make this conversation easier by:

• Expressing your concerns with love and empathy. 
• Focusing on specific ways additional support can enhance your loved one’s safety and well-being.
• Involving your loved one in the assisted living decision-making process if they are cognitively able.
• Highlighting that seeking assistance with everyday activities can ultimately foster independence, especially in long-term care.

Together with your loved one and their healthcare team, you can determine the right level of care to meet their unique needs.

Promoting Independence, One Task at a Time

Activities of daily living and instrumental activities of daily living are more than just checklists—they are key indicators of an older adult’s ability to age with dignity and autonomy. By understanding how ADLs and IADLs impact independence and knowing how to assess and address challenges, seniors and their caregivers can proactively navigate the aging process.

Remember, needing assistance with daily tasks is not a sign of weakness or failure. It is a normal part of the aging journey for many older adults. With the right support and resources, it is possible to maintain a sense of control and live life to the fullest, even in the face of ADL or IADL limitations.

If you are a baby boomer planning for your future, take steps now to prioritize your health, build a strong support network, and learn about the care options in your community. If you are a caregiver, know you are not alone in this journey. Don’t hesitate to seek help and connect with others who understand the challenges and rewards of supporting an aging loved one.