Professionals who work in aging often want to know whether an older person needs any help with “ADLs or IADLs.”
These medical abbreviation terms stand for Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). They represent key life tasks that people need to manage, in order to live at home and be fully independent.
If you’re an older adult or a family caregiver, it can be good to familiarize yourself with these terms and the related skills.
Difficulties with ADLs and IADLs often correspond to how much help, supervision, and hands-on care an older person needs. This can determine the cost of care at an assisted-living facility, whether someone is considered “safe” to live at home, or even whether a person is eligible for certain long-term care services.
Continue reading, or watch this subtitled video, to learn what ADLs and IADLs are and why they matter for older adults.
Activities of Daily Living (ADLs)
These are the basic self-care tasks that we initially learn as very young children. They are sometimes referred to as “Basic Activities of Daily Living” (BADLs). They include:
- Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
- Feeding, as in being able to get food from a plate into one’s mouth.
- Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
- Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
- Bathing, which means washing one’s face and body in the bath or shower.
- Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.
If a person is not fully independent with ADLs, then we usually include some information about the amount of assistance they require.
For each ADL, people can vary from needing just a little help (such as a reminder or “stand-by assist”) to full dependency, which requires others to do the task for them.
ADLs were originally defined in the 1950s by a geriatrician named Sidney Katz, who was trying to define what it might look like for a person to recover to independence after a disabling event such as a stroke or hip fracture. So these measures are sometimes called the “Katz Index of Independence in Activities of Daily Living.”
Instrumental Activities of Daily Living (IADLs)
These are the self-care tasks we usually learn as teenagers. They require more complex thinking skills, including organizational skills. They include:
- Managing finances, such as paying bills and managing financial assets.
- Managing transportation, either via driving or by organizing other means of transport.
- Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
- Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
- Managing communication, such as the telephone and mail.
- Managing medications, which covers obtaining medications and taking them as directed.
Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking.
For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.
IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”
Why ADLs and IADLs matter
Generally, older adults need to be able to manage ADLs and IADLs in order to live independently without the assistance of another person.
Geriatricians, social workers, and other professionals assess ADLs and IADLs as part of assessing an older person’s “function.” Problems with ADLs and IADLs usually reflect problems with physical health and/or cognitive health. Identifying functional difficulties can help us diagnose and manage important health problems.
Physical therapists and occupational therapists also often assess ADLs and IADLs, and can provide treatment to help an older adult compensate for a difficulty, and recover function if possible.
But most importantly, we try to identify functional difficulties because we want to make sure older adults are getting the help and support they need to compensate for, or overcome, these difficulties. We also want to help any family caregivers who might be struggling to assist a relative who needs help.
How to manage difficulties with ADLs and IADLs
If an older person is having difficulty with any ADLs or IADLs, it’s important that they be evaluated.
An evaluation will help determine how severe the issue is, and should also identify the underlying cause(s) of the ADLs or IADL difficulty.
In virtually all cases, the underlying cause(s) will relate to some type of health or medical issue. Physicians can help evaluate for the underlying medical cause.
Physical therapists and occupational therapists have particular expertise in assessing the severity of ADL and IADL difficulties, and in creating a treatment or management plan. Generally, physical therapy focuses more on tasks that involve the movement of larger muscles (such as mobility), and occupational therapy focuses on helping people achieve daily tasks such as eating or getting dressed. Occupational therapists can also assist with most IADLs.
ADLs, IADLs, and elder care options
ADLs and IADLs are also important when it comes to arranging elder care, whether that’s home care or possibly moving an older person to assisted living or another residential option.
If you are wondering what type of senior living would be a good fit for an aging parent (independent living vs assisted living vs memory care vs a nursing home), answering this question often requires understanding what type of ADL and IADL support the older person needs now…and is likely to need in the near future.
For instance, assisted living facilities can often help with the IADL of medication management, and can provide meals and housekeeping.
But assisted living facilities may not be a good fit for an aging adult who needs help with many ADLs, such as help with personal hygiene, or toileting, or help transferring from a bed to a wheelchair. Whereas nursing homes are able to care for residents who need assistance with ADLs.
Now, some assisted living facilities do offer help with toileting or other ADLs, for an extra cost. It’s also sometimes possible for families to hire their own personal care assistant. Or, help with ADLs may be included as part of memory care. So it is often possible for older adults to remain in assisted living, even if they need help with ADLs. But, it’s usually expensive!
(Wondering how to pay for assisted living or other forms of elder care? I have information about this here: Providing Elder Care: Covering the Cost of Home Care, Assisted Living & Other Options.)
For all these reasons, most facilities will request some type of ADL and IADL assessment, as part of evaluating an older person who may want to move into the facility.
Last but not least: ADL and IADL assessments are often required to trigger long-term care insurance benefits, which may not be available unless an older adult needs help with ADLs.