Familiarize yourself with this common senior care term
By Grace Matelich, last updated August 8, 2022
If you're considering an assisted living community for yourself or a loved one, you may have heard talk about the "activities of daily living" (ADLs). The term seems self-explanatory, but what are the actual activities of daily senior living in aged care?
The definition of ADLs is quite simple. ADLs are self-care activities necessary for living independently, such as bathing or getting dressed. ADLs are a way to measure how well a person is able to live independently and function on a day-to-day basis. There are many different scales nurses and other medical personnel use to measure these functions, but this is perhaps the most common.
The ADLs were first proposed in the 1950s by Sidney Katz. To this day they remain the same activities across most definitions. Katz founded his study on a person’s ability or inability to to perform the basic functions of ADLs. Katz went on to adapt an ADL assessment tool and an activities of daily living list to take note of the patient’s basic functions and how they relate to ADLs.
Once you understand your loved one's ability to handle the activities of daily living, you then have the information you need to make an educated decision regarding assisted living or other senior care options.
To understand the types and levels of assistance a person may need, first you need to recognize the person’s limitations. By using an ADL assessment tool you can determine what kind of care is needed and if home care is even an option.
There are 5 basic ADLs:
Older adults sometimes have difficulty walking without help. This activity of daily living also focuses on the ability to change from one position to another, as you need to do when standing up from a seated position, getting out of bed, getting into a bathtub, or stepping in or out of a car.
Using a checklist to monitor the level of ADL disability along with IADLs will help to examine which tasks your loved one needs help with and how much assistance is needed. Charting your loved one’s progress will determine what kind of care and support they will need from a qualified professional.
While the basic ADLs are what matters most when you're determining the type of care you or your loved one needs, it's also of value to keep in mind what medical professionals call the instrumental activities of daily living (IADLs). IADLs are activities related to living independently and are an integral part of determining a person’s ability to care for themselves.
The Lawton-Brody scale was developed in 1969 in order to assess more complex activities required for seniors that involve thinking and organizational skills. The scale is still used today today to rate the competence of a person’s ability in each activity.
The IADLs are activities that focus more on how a senior connects to their community and their ability to live and manage their independence. They measure more complex skills as detailed below. If you're trying to decide between an independent living or an assisted living facility for your loved one, IADLs might help you in your decision-making process. The IADLs that were assessed by the Lawton-Brody scale include eight functional tasks:
Occupational therapists use additional evaluations with the Lawton-Brody scale while completing patient assessments. The American Occupational Therapy Association identifies the following 12 IADLs that may be performed alongside the original IADLs on the Lawton-Brody scale.
When you understand your loved one's ability to handle both the ADLs and IADLs, you're in a better position to know how much help they need on a daily basis. If you can connect your aging loved one with the right support, you can rest assured they will be aging in the safest and healthiest way.
While assisted living communities and home care services can help with all of the ADLs, they are typically less equipped to handle dementia or Alzheimer's, which can impact a person's ability to handle both ADLs and IADLs. Seniors experiencing dementia or other cognitive difficulties will be safest in memory care environments, or with 27/7 home care supervision (and, often, with home improvements to prevent wandering).
Similarly, seniors who need more complex medical care, such as daily injections, IV medication, or wound care, need the skilled nursing available at a nursing home, or Skilled Nursing Facility (SNF). Their medical needs or impairments will determine how long they stay in a SNF: if they are recovering from an operation or injury, for example, they might be able to return to their home relatively quickly. If, however, they need ongoing care, they might need to move to a long-term care facility with staff that can accommodate their needs and craft a holistic care plan for them.
ADLs and IADLs are both a very important part of daily living activities, but what is the difference between them?
ADLs address the most basic everyday functions to take care of themselves such as bathing or eating. IADLs are a little more specific. They are the things you can do to enhance your personal interactions and community, but still are still very much part of every day care.
IADLs are an important part of a senior’s journey to getting back to “normal” after a sickness or surgery. Once they have recovered and mastered the ADLS then they can concentrate on getting their IADL skills back up to speed.
The ADL and IADL assessments are most important to assess the older person’s ability to “function.” When you're trying to make medical decisions or decisions about living arrangements for yourself or a loved one, evaluating the ADLs and IADLs is key.
Intervention is not immediately needed just because a loved one is not able to handle one of the ADLs. Sometimes occupational therapists can help seniors find ways to handle the basic activities of daily living without the assistance of another person.
Adaptive equipment is also available for many basic daily tasks. For example, a button-holer can help seniors who are having difficulty dressing themselves, and a long-handled sponge can help with bathing. Shower chairs, toilet seat risers, two-handed cups, and bed rails are just a few other examples of assistive technology that can help if a senior is having difficulty with an ADL. But, if the inability to perform multiple ADLs increases due to pain, aging, or medical condition, it might be time for a professional assessment. This would include researching environments that can best support the assistance for daily life your loved one will need.
ADLs and IADLs aren’t just helpful to family members and caregivers, but are also metrics used to determine eligibility for financial assistance and care services. State government aid programs and some types of Medicare also do ADL assessments to determine what kind of assistance and level of care elderly or disabled people might qualify for.
It is not always easy to determine if your loved one needs help with their day to day activities unless you see them struggle. Once any kind of struggle is apparent you need to decide where to turn to first. Turning to the family doctor for assessment is a practical first step. The doctor’s assessments can focus on not only your loved one’s medical well-being but their emotional well-being.
Social workers, nurses, physicians, occupational and physical therapists are all qualified to make assessments regarding a senior's need for help with the basic ADLs, and of course, the senior should also be deeply involved in that assessment. Another great professional to seek out is a geriatric care manager. They are trained to do an entire home health care assessment, as well as an ADL assessment. Remember, your loved one may have concerns that don't come up in the evaluation, such as the ability to reach items on high shelves, that the medical professionals should know about.
Getting your loved one ADLs and IADLs assessed is so important. Once the evaluation is complete it will clearly state if staying at home with help is an option or if more robust care is necessary. The assessment will open up options for the care they need when they need it, rather than waiting until an emergency situation to intervene.