Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are used by healthcare professionals to describe the fundamental tasks a person must be able to accomplish to live independently at home.
The widely-used activities of daily living assessment tool known as the Katz Index of Independent In Activities of Daily Living (ADL) was initially developed in the 1950s by renowned geriatrician and health services researcher Dr. Sidney Katz and a team of health service professionals at the Benjamin Rose Hospital in Cleveland, Ohio.
The Katz assessment tool provided healthcare professionals with the first standardized index for measuring how well someone can perform essential self-care activities, such as feeding, dressing, and using the bathroom. Since then, the activities of daily living scale has been expanded to include additional, more complex activities such as managing prescriptions, using the telephone, and preparing food.
These more complicated activities, called the instrumental activities of daily living (IADLs), are not essential for basic functioning; however, they are critical for older adults to continue living independently. They are assessed using Lawton’s Instrumental Activities of Daily Living (IADL) Scale similar to the Katz ADL.
Together, the ADL and IADL scales serve as the primary basis for the functional assessment of older adults. They are now used routinely in clinical settings and for hospital discharge planning.
What Are ADLs and IADLs?
The Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) are activities required to lead a healthy, independent life at home. These activities range from essential functions like eating and bathing to more complicated tasks like grocery shopping and handling finances.
ADLs and IADLs matter to healthcare professionals because they determine whether an aging person needs help and if so, what type and how much support is required.
ADLs and IADLs serve as an objective scale for healthcare professionals when recommending a course of action. In other words, health professionals use an Activities of Daily Living Checklist to determine if someone needs assistance to live independently at home. If someone does need aid to live alone at home, the independent living skills checklist can also help identify what type of help is needed and how much.
What’s the Difference Between ADLs and IADLs?
ADLs and IADLs vary in complexity. The activities of daily living (ADLs) assessment tool was developed in the 1950s and includes the essential functions that are necessary for survival. More recently, the activities of daily living scale has been expanded by Lawton-Brody to include more complex tasks, called the instrumental activities of daily living (IADLs).
What are activities of daily living? Activities of Daily Living (ADLs) are the cornerstones of self-care and include essential functions such as feeding, dressing and using the bathroom. The six tasks on the basic activities of daily living list are necessary for survival, and we usually learn them as very young children.
ADLs are judged to be the six most basic personal care activities. They are the basic activities of daily living activities that very young children learn when being taught to care for themselves.
In order to live independently, a senior adult needs to be able to get food from a plate to their mouth. When you hire a professional caregiver, they can offer manual help and arrange for specific accommodations such as table and chair height or specialized utensils and dishware that make mealtimes more manageable.
Bathing & Hygiene
The activities of daily living assessment tool helps a healthcare professional evaluate how someone washes their face and body in a bath or shower. A professional caregiving agency, such as LivHOME, can assist your loved one with personal hygiene activities like bathing and shampooing.
An elderly adult who wants to live independently at home must be able to select clothes and put them on. A professional at-home caregiver can help, especially with tying shoelaces and fastening buttons, which can be particularly problematic.
One of the activities of daily living is “grooming,” or being able to manage one’s personal appearance. A caregiver can assist your loved one with personal care activities like shaving and toenail clipping.
Transferring & Mobility
Living independently involves a lot of “transferring and mobility,” which means that someone must be able to get from one place to another, such as from the bed to a standing position or from a wheelchair to the toilet. A professional caregiver is trained to help make transfers safer and less stressful.
Toileting & Continence
The activities of daily living questionnaire includes “toileting and continence,” an evaluation of whether or not someone can get to the bathroom appropriately, use the toilet properly and then clean themselves. A senior caregiver can provide the assistance needed to make sure your loved one is comfortable and safe with regard to all toileting activities.
Although they’re not as essential to survival as ADLs, the Instrumental Activities of Daily Living (IADLs) are seen as vital for older adults who want to continue living independently. IADLs include activities such as shopping, using the telephone and managing transportation. You can think of IADLs as the tasks of daily living that we learn as teenagers.
The instrumental activities of daily living index includes activities that are more complex than ADLs. Although they’re not essential for survival, IADLs are vital for older adults who want to live independently at home. Here’s a list of the six IADLs and how LivHOME professionals can assist with each one:
In order to live independently at home, an older adult must be able to greet visitors, be sociable and manage the household’s telephone and mail. Professional caregiving providers can help with all this and more.
LivHOME’s staff are excellent conversationalists, providing necessary and sometimes-lacking face-to-face interaction for your loved one. LivHOME professionals can also engage your loved one with games, help with crafts, and promote social outings.
Transportation is an important aspect of daily life. An older adult living independently at home needs to be able to get to and from doctor appointments, the grocery store, the pharmacy and other places.
A professional caregiving agency such as LivHOME, can provide senior transportation services, as well as assistance once your loved one has reached their destination. That means a LivHOME professional can attend your loved one’s medical appointments and accompany them wherever else they want to go.
Shopping & Meal Preparation
Anyone who wants to live independently at home must be able to shop for groceries and prepare meals. With a caregiver from LivHOME, you can rest assured that your elderly loved one is maintaining a healthy, well-balanced diet.
Housework & Home Maintenance
Living independently involves keeping up with household chores like laundry and taking out the trash. A caregiver can help with light housekeeping such as making beds and changing linens, dusting and vacuuming, and even pet care.
One of the key instrumental activities of daily living is managing medications. This task involves contacting the pharmacy to get prescriptions filled, as well as taking medicines on time and in the right dosages. Senior caregivers have the training to assist your loved one with their daily medications and can monitor side-effects.
Managing Personal Finances
An older adult who wants to live independently at home must be able to balance their checkbook and pay bills on time. An at-home caregiver can offer assistance in this area and alert you to any issues that may arise.
Evaluating The Need for Care
The ADLs and IADLs checklists allow health care professionals to determine what kind of help, if any, an older adult needs in order to live independently.
On one end of the spectrum, there’s someone who is fully independent and needs no help whatsoever. On the other end, there’s someone who is wholly dependent, thus unable to complete any of the ADLs or ISDLs on their own. In the middle of the spectrum, some people can still live independently, provided they have assistance with some tasks.
At LivHOME, we create custom plans to address what’s needed, building in the flexibility to add new needs to the list should they arise. Here are a few diagnoses we may find during an ADLs and IADLs assessment:
Okay on ADLs & IADLs
A person who is fully independent can accomplish the activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) on their own. If your loved one falls into this category after an IADL and ADL assessment, it’s likely they can live independently at home without any help.
Okay on ADLs, but not IADLs
After evaluation by a healthcare professional using an activities of daily living questionnaire, it may be determined that your loved one can independently accomplish all of the basic activities of daily living (ADLs); however, they may fall short on one or more of the instrumental activities of daily living (IADLs).
This would mean that your loved one can live independently at home but will need some occasional help, perhaps from a family member, friend, or professional caregiving agency.
Not Okay on ADLs or IADLs
If the ADLs and IADLs evaluation shows that your loved one has significant shortcomings on both the activities of daily living and on the instrumental activities of daily living, she cannot live independently at home without help. In instances like this, professional caregiving is recommended.
Who Performs the ADL & IADL Evaluation?
The ADLs and IADLs evaluation can be performed by a healthcare professional such as a doctor, nurse or therapist; however, it’s often best to enlist someone who is specially trained in geriatric care.
LivHOME’s Geriatric Care Managers are skilled at assessing the elderly for both the basic activities of daily living (ADLs) and the instrumental activities of daily living (IADLs). Plus, if it’s determined that help is needed, they know best how to keep your loved one safe, happy, and comfortable, since this is their specific area of expertise.
How Often Should ADLs & IADLs be Evaluated?
Your loved one will be evaluated for ADLs and IADLs in the clinical setting before every hospital discharge. The independent living scales may also be evaluated whenever a disability, no matter how slight, is detected by a healthcare professional or someone else.
Does Failure on Any Individual ADL or IADL Require Caregiving Assistance?
As the LivHOME Care Manager completes the activities of daily living questionnaire, she notes how well the elderly adult can accomplish each task. Some activities may be performed entirely independently. A few activities may not be accomplished at all. Others may fall somewhere in the middle, meaning the activity can be achieved, as long as some help is provided.
At times, the assistance that’s required can be taken care of by family members. For instance, if the elderly adult can no longer drive to the grocery store, perhaps a family member can do the driving (or the shopping). In other cases, in-home caregiver help may be required, but only for specific activities, such as taking showers or managing medications. Sometimes, an elderly adult may be so dependent on assistance that they need professional caregiving 24/7.
If you are in need of caregiving services, contact LivHOME today to discuss how we can provide your loved one the care and support they need to continue to live independently at home.