What are Activities of Daily Living (ADLs)?
Activities of Daily Living (ADL) include the everyday self-care activities that we do for ourselves. These are tasks that are necessary for everyday living. These tasks include but are not limited to:
Walking. Being able to move around your home or elsewhere without tripping or falling.
Feeding. Having the ability and coordination to transfer food to the mouth.
Dressing. Matching clothes and deciding appropriate outfits, being able to put clothes on in the correct order, and generally keeping up with one’s appearance. For example, putting underwear first and then pants.
Ensuring Personal Hygiene. Brushing teeth and hair for proper grooming. Also cleaning and keeping up personal appearance.
Bathing/Going to The Bathroom. Cleansing yourself properly and being able to get on and off of the toilet. This also includes being able to control bowel movements.
Maintaining Mobility. Transferring yourself from place to place, being able to sit up or stand up independently when laying down, or have the range of motion to be able to move around your home.
ADLs are used to understand the activities related to essential routine tasks that an elderly is functionally able to perform independently. ADLs are important because they determine how much help your elderly loved one will need. Based on whether your elderly loved one is able to perform these activities independently, you will better understand the amount of support you need to provide to your elderly loved one. This can range from only needing small amounts of assistance to assistance most of the day. Your loved one may only require minimal care and a few reminders about certain tasks and get through the day with some help from family members or a caregiver from local home care agencies, or may require full-time senior care and need to be transferred to an assisted living facility.
When these activities become increasingly difficult for elderly people, that usually means it is time to call someone for help, most likely this is the time to start looking for assisted living facilities near you that will provide the exact care your elderly loved one needs.
What are IADLs?
Instrumental activities of daily living (IADL) are different from ADLs. IADLs require more cognitive expertise and skills than the ADL’s physical skills. As a result, being able to perform IADLs is not 100% necessary for basic everyday living.
However, if your loved one is struggling with IADLs, then it may be time to consider companion care services to support with the following examples of IADLs:
Managing Finances. Making sure bills are paid and assets are being managed on time.
Independently Transporting. The capability of driving, taking a ride on public transportation, or setting up other arrangements (e.g., Uber, Lyft, taxi).
Shopping. Going out to buy necessities, such as food or clothes, or gifts.
Cooking. Being able to obtain the ingredients, preparing healthy nutritious meals, and consuming the meals.
Maintaining the Home. Cleaning up all rooms of the house and having general cleanliness so that the fall risk is decreased.
Managing Communications. Communicating with others via telephone, email, tablet, or any other communication devices; visiting friends and family, and not encountering a state of senior loneliness or isolation.
Managing Medications. Obtaining medications from the pharmacy or through mail delivery, and taking the proper dosage for the recommended duration at the indicated time.
Pets. Being able to care for pets, as applicable.
An important aspect to remember is that ADLs are more of a necessity, whereas you do not have to be able to perform IADLs to survive. ADLs are tasks you need to do to be able to have a high quality of independent life, while IADLs are more complex skills that you do not necessarily need to be able to do on your own.
Checklists and Assessments for ADLs and IADLs
A great way to keep track of the mental and physical abilities of senior citizens is keeping checklists of a decrease or increase in the ability to perform ADLs and IADLs. Consider creating a checklist with the following three columns: “no help needed”, “some help needed” and “unable to perform activity independently”. As some points of the day and certain days may be more challenging than others, observe when the troubling times and activities may be.
These assessments with checklists will help you develop an action plan with your loved one, which will then become the basis of their care plan created by the elders’ primary care physician or the expert senior caregivers. The checklist would also help the caregivers monitor your senior loved one’s rehabilitation.
If your elderly loved one is becoming increasingly dependent or if you have questions for the primary care physician or expert senior caregivers, then write down your concerns and questions to help you remember during your next conversation.
When creating a checklist and completing the assessments, it is also important to understand why the problem began. For example, is your elderly loved one having trouble with ADLs because of mental decline with age or an unknown medical condition? Understanding your elderly loved one’s ability to perform the ADLs and IADLs can help solve problems you didn’t know existed yet and will prevent future problems from happening. You should consider assessing your elderly senior for the following:
- Does your loved one have trouble driving?
- Are there emotional, financial, physical or verbal problems such as abuse, mood swings, stress, etc.?
- Are there problems paying bills on time?
- Were there any recent medical concerns or hospital visits?
- Does your loved one experience memory problems or poor judgment?
- Has there been a change in appearance or attitude?
- Are there any incomplete pending daily or weekly tasks that have not been completed in a while?
- Does your loved one experience difficulty maintaining personal hygiene and home maintenance?
- Have you noticed significant issues related to communication and contact with others, such as elderly isolation, loneliness, or maintaining relationships with others?
If you notice some or all of these observances, then ask a medical professional about conducting a thorough health assessment for nursing practice. It is important to remember that the sooner you identify and resolve concerns, the better, since most mental challenges and health issues are progressive and will continue to become worse if untreated or not properly cared for. In order to ensure you stay on top of tracking your loved one’s health condition, here are a few health assessments to consider:
- The Caregiver or Family’s Assessment: Usually the family members around the elderly loved ones know them well enough to be able to put together an accurate report of how the patient is doing, along with the help of a medical professional. As challenging as it may be, the family members and caregivers should try to not be biased so that they can provide an accurate account. We do understand how challenging this may be because even though they want what is best for their loved one, they may be scared to let down their elderly family members.
- The Clinician’s Clinical Health Assessment: As used by nurses, physicians, and expert senior caregivers, this method may be perceived as the most objective way of determining a person’s functional status. The clinical health assessment provides an unbiased account of the patient, and will enable the experts to create a plan of action with the patient’s loved ones that best suits the senior’s unique situation.
- Self-Report: The person experiencing these changes sometimes has the most thorough insight about themselves, but other times can be clouded by impaired functions or personal interpretations, depending on how severely their mental state may have declined. This report can also be biased.
Main Types Of Senior Care that Help with ADLs and IADLs
Here are three common types of senior living facilities that can be used to ensure you provide the best care for your elderly seniors, particularly, when there is a significant decline in ADLs and IADLs. Each senior is different so what is best in life for your elderly loved one depends on his or her unique situation and individual preferences.:
In-Home Care: Some seniors tend to live a happier life when they reside within their own home with all of their personal belongings. They’ll feel more comfortable, which leads to a better quality of life. A bit of extra support from a home care agency or a companion caregiver may be just what your loved one needs. For example, their home could be messy, which would only lead to more dangerous living conditions. Their homes may become covered in filth with obstacles everywhere. With the extra support, they may be able to enhance their living and lifestyle conditions.
This option is suitable when the seniors can perform most ADLs by themselves or with minimal care. However, this may not always be the case for everyone, especially when the mental state worsens, which unfortunately all people are prone to.
Assisted Living Facilities: Assisted living means providing residential housing to seniors where they will have the trained senior caregiver experts to help them perform ADLs and IADLs, but does not require on-site skilled nursing care. So, assisted living facilities provide help and surveillance with tasks such as ADLs and IADLs, but without the support of a specialized medical assistance response team.
Nursing Home: Nursing homes are similar to assisted living facilities. They will help with all of the ADLs and IADLs that assisted living facilities help with, plus the added support of skilled nursing care services. Seniors who reside in a nursing home usually have more significant health challenges and are usually unable to perform most ADLs and IADLs by themselves.
If your elderly loved one is not capable of performing ADLs and IADLs and you are considering extra support, then you may also consider asking your primary care physician to complete a full health assessment, including a fall risk assessment. If your loved one is struggling with other activities, there may be a root cause that may result in risk for falls. A fall risk assessment will determine how high of a fall risk your loved one has. This could also help in the decision to transfer him or her to an assisted living facility or nursing home, as appropriate, instead of taking the risk of letting your elderly loved one stay home by themselves for the majority of the time.
Some other assessments to suggest are depression assessment and mental status assessments. These are also important when establishing a plan of care. Most seniors wish to maintain their independence for as long as possible. This is why your elderly loved ones may prefer to not communicate difficulties they may be experiencing with ADLs or IADLs. They may be worried that they may have to relocate to an assisted living facility and everything will change. It is important to assure them that this is not the case, but this is an important reason to look out for the signs yourself, in case your elderly loved ones does not express their concerns with you.
How and Why Seniors Are No Longer Able to Perform ADLs And IADLs
About 1 in 3 people over the age of 65 will develop Alzheimer’s. There is not yet a cure, which makes this disease even scarier. When a senior develops a mental illness such as Alzheimer’s, their ability to perform ADLs and IADLs slowly decreases. Alzheimer's Disease, by definition, is a disease that destroys memories and other important mental functions. Your elderly loved one may first forget small things like shutting off the water, forgetting to run their errands, forgetting their meals or medicines, etc. Then, it increases to more important things like forgetting your family and no longer recalling how to take care of themselves. The impairment in physical function can also be a result of musculoskeletal, neurological, circulatory, or sensory conditions.
A significant change in behavior or appearance is the first sign you may observe in your elderly loved ones. It is important to visit a medical professional if you notice concerning symptoms. If the symptoms are ignored or downplayed, then the quality of life for your elderly loved could increasingly worsen. They could be living in hazardous living conditions and succumb to an overall poor quality of life.
General weakness and tiredness from old age can also contribute to the inability of performing ADLs or IADLs. Moreover, social isolation can be a reason for negative affects to an elder’s ability to perform simple tasks. Your elderly loved one would be much better off in an assisted living facility if you are not able to provide the proper care yourself, and may be unintentionally subjecting your loved one to elderly neglect. Determining whether an assisted living facility is the best option would be a combined decision by the patient, the family around them, and the primary physician.
How Assisted Living Facilities Support with ADLs and IADLs
The main purpose of assisted living facilities is to provide your elderly loved ones the care they deserve but can no longer attain themselves. Deciding whether or not your loved one is ready to transition into life in an assisted living facility can be difficult, especially when you have unanswered questions or if your loved one is hesitant to move to assisted living. To overcome this fear, you must learn more about what services are being provided in an assisted living facility.
Also, assisted living facilities provide free-tours to clarify all the doubts associated with senior living facilities. Your elderly loved one will soon learn how loving and comforting the environment of an assisted living facility can be. The assisted living facility you choose will be able to assist your senior 24/7, 7 days a week, with any ADLs or IADLs needs, such as:
- Daily Grooming/Hygiene: Staff will assist with brushing teeth, brushing hair, trimming nails, and maintaining overall self-care tasks.
- Walking: Getting assistance moving around the assisted living facility’s premises, going to the bathroom, and even with transportation to locations away from the assisted living facility when needed.
- Bathing or Toileting: When it comes to bathing and toileting, seniors should be extra cautious since bathrooms and bathtubs can be very slippery, and toilet seats may be lower than expected. Having assistance getting in or out of the tub or getting on and off the toilet will reduce the risk of falls. Even when there are handrails, sometimes, seniors need help with performing these activities. So, assisted living facilities have trained on-site staff who are always ready to assist their residential senior community members.
- Feeding: Seniors may experience trouble with coordinating, so feeding and independently eating can be troublesome. Staff at the assisted living facilities would be able to feed your elderly loved one healthy nutritious meals to ensure your loved one receives their essential vitamins and nutrients.
- Cooking: Cooking can be dangerous when involving sharp utensils or heat from a stove. Letting staff members prepare meals is the safest option for seniors.
- Dressing: Getting dressed by yourself requires great coordination and can be easily stress-inducing. Staff at assisted living facilities are well-trained to help seniors dress appropriately for the weather or occasion.
- Finances: IADLs, such as finances, can be challenging for a younger generation to handle, so consider the situation for an elderly loved one. Why not request support from a personal accountant to manage their money and bills?
- Medication: Taking medications properly should not be taken lightly. Taking the risk of a mix up could have severe consequences, so having the staff who are trained to support your loved one with their medication management would be ideal.
- Transportation: When a senior has impaired judgment, having them drive a vehicle or independently access public transportation may not be ideal. Staff at assisted living facilities can provide transportation to doctor’s appointments, planned excursions, or any other necessary or preferred location.
We tend to take our ability to perform ADLs and IADLs for granted, and often do not realize how much work we put into the tasks of day-to-day living. Sometimes, these activities can become a lot more difficult for our elderly loved ones to take on than we may realize, and they may silently suffer from their hardships due to concerns about not contributing to the burden on your shoulders. For example, our elderly loved ones may have trouble buttoning or unbuttoning a dress shirt, zipping up pants, or putting on a winter coat. Such difficulties may make their lives very complicated. If left unnoticed, these conditions can easily worsen and cause severe issues, such as low self-esteem, lack of confidence, depression, and an array of other mental health issues. Studies have shown that seniors who are silently hiding their inabilities of performing ADLs or IADLs are prone to fall risks, which further can lead to injuries.
Role of Cognitive Decline in ADLs
If your loved one has a mental illness, such as Dementia, then the tasks they tend to around the home may only be partially completed, resulting in a disorganized home and a subpar quality of life. As dementia is a progressive mental illness, the condition may continue to decline unless help is sought out. Not only will someone with a mental illness, such as dementia, not be able to perform or remember their ADLs or IALDs, they will begin to forget their memories as well.
For example, if your elderly loved one has a messy home, is constantly confused, is frequently running around, or simply cannot clean themselves, they are at an increased risk of a fall. Messes in hallways, especially by stairs or in-door frames, puts them at a high risk of tripping and falling. Not being in the right mental state can cause a fall and cause the inability to perform simple tasks, such as showering, walking from room to room, or going out in public.
If the senior, family, or medical staff are worried about elderly falls in the home, they can reduce the risk by adding grab bars on walls and non-slip mats in the bathtub, and consider slip-resistant hardwood flooring. Wearing slip-resistant shoes is also an effective way to decrease fall risk.
Associated with cognitive decline due to old age or dementia, poor judgment with ADLs or IADLS can be a dangerous sign to have. For example, if it’s freezing outside and a senior decides to go out in shorts and a t-shirt, then they may be subjected to hypothermia. Or, if it’s raining and they decide they want to go for a drive, then there may be risk for a senior citizen to be in a car accident. Your elderly loved ones could end up hurting themselves or even other people. It’s not just their lives that are in danger. Inability to perform ADLs can cause significant issues to the surrounding people as well.
How to Help Someone Who Can No Longer Perform ADLs and IADLs
After you have noticed changes in your loved one or have noticed their inability to perform ADLs and IADLs, it is important to remain calm. Most seniors who are presented with the news that they have a mental health problem and may need to be moved to a memory care facility do not take it very well, which is completely understandable, since their life is being turned upside down. It's important to have the help of a medical professional so that your loved one can have a sense that what is going on is serious. And for the time being, you can hire home health care or consider visiting assisted living facilities to support with determining the most effective arrangements that would be best for your unique circumstances.
When the elderly loved gives you a green light to move to an assisted living facility, do choose the right one. Senior Living Help can help you find the right assisted living facility near you. All you have to do is use our locator tool to find the nearest assisted living facility out of 50,000+ available options. We aim to give best care for our seniors in times of need.
About the Author:
"Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)" is authored by Anisha Rao, MPP, Healthcare Consultant, Certified Lean Six Sigma Green Belt Healthcare Professional. Anisha holds a Master of Public Policy from the University of Maryland, Baltimore County, as well as a Bachelor of Arts in Health Administration and Public Policy, a Bachelor of Arts in Psychology, and a Minor in Management of Aging Services. Anisha has extensive experience in Healthcare Services and Aging issues, including dementia care, senior health, and nursing home care. Anisha is passionate about ensuring seniors receive the best care possible and empowering seniors to become more involved in their care planning decisions.