QMC

What are ADLs?

Activities of Daily Living

The activities of daily living (ADLs), based on the Katz Index of Independence, are the basic activities of daily living we do to stay alive and well. Examples include eating, going to the bathroom and moving from place to place. Medical conditions affecting our minds or bodies can limit your ability to perform ADLs. Healthcare providers conduct ADL assessments to determine how well you can do ADLs to help you get the care services the person needs. ADL assessments can help determine whether a person can remain in independent living, independent living but with home care, assisted living, or may require a full care facility or long term care in a nursing home. The goal of these assessments is always to maximize quality of life and to accurately determine care needs, if any.

What are activities of daily living (ADLs)?

Activities of daily living (ADLs) are important tasks you do on a regular basis to take care of your body and overall well-being. ADLs include things like eating, bathing and using the bathroom — tasks you must do to keep your body functioning. ADLs can also include more complex tasks like managing your money, cooking and doing laundry — things you must do to live independently.

Some people need help doing ADLs for a short time — for example, while recovering from surgery. Others might need help for a long time, even for the rest of their lives. This might happen if you have a chronic condition that affects how well you can move, remember or solve problems.

ADLs may come up in conversation with your healthcare professional, geriatric care manager, or your loved one’s care team. Understandably, this isn’t the easiest topic to talk about. You might worry that you’ll need to rely on others, or that your loved one won’t be able to live on their own anymore. These are common concerns, and healthcare providers will take the time to listen to how you feel and what you prefer. Having this open and honest conversation can help you and your family understand available options to make an informed decision.

To have this conversation, it helps to know exactly what healthcare providers mean by ADLs. In general, ADLs fall into two main groups:

  • Basic activities of daily living.
  • Instrumental activities of daily living.
Basic activities of daily living (basic ADLs)

Basic activities of daily living are tasks you typically do every day that are essential to your physical survival and well-being; these are basic self-care tasks. They’re sometimes called physical activities of daily living because they relate to your body’s needs, and can help determine a person’s level of independence.

Examples of basic activities of daily living
  1. Bathing: Using soap, water, towels and other supplies to wash, rinse and dry your skin. Standing, sitting or moving in ways that allow you to bathe every part of your body.
  2. Personal hygiene and grooming. Cleaning your teeth, including dental orthotics and prosthetics. Washing, drying and styling your hair. Using supplies like cosmetics, deodorant, tweezers, scissors and nail clippers for grooming.
  3. Toileting and continence. Moving to the toilet and getting into the proper position. Using supplies like toilet paper and menstrual products for personal care. Managing devices like a catheter or colostomy. Controlling when you urinate (bladder function) and poop (bowel function).
  4. Eating and feeding. Chewing and swallowing food so it can reach your stomach. Using utensils to bring food from the plate to your mouth.
  5. Dressing. Getting appropriate clothing from closets or drawers and putting them onto your body in the right order. Using zippers, buttons, snaps and Velcro as needed. Putting on or removing prosthetic devices or splints.
  6. Moving/transferring/ambulating. Moving from one spot to another to complete your daily routine (for example, from your bed to the bathroom, or from your couch to the kitchen).

Keep in mind there’s a difference between doing a basic ADL and doing it safely without a caregiver. You might be able to move from one spot to another in your home, but if you feel off balance as you do so, or have near misses where you almost fall, it’s important to tell a healthcare provider.

Instrumental activities of daily living (IADLs).

Instrumental activities of daily living (IADLs), created under the Lawton IADL scale, require more high function skills than basic ADLs. IADLs support your overall well-being on a day-to-day basis, not just your basic physical needs. You have to think in complex ways and stay organized in order to do IADLs. You also need to be able to navigate your home and spaces outside your home. The ability to perform these functions suggest a higher level of independence.

Examples of instrumental activities of daily living
  1. Managing money. Making a budget and planning for expenses. Using bank accounts, credit cards and other financial resources. Paying bills.
  2. Managing a household. Doing chores like dishes, laundry and cleaning. Take care of personal belongings, including appliances, furniture and cars. Knowing who to contact for repairs or home maintenance.
  3. Managing health. Communicating with healthcare providers and scheduling appointments. Getting prescriptions filled. Understanding medication instructions and taking medications as prescribed.
  4. Meal preparation. Planning and making meals using kitchen supplies (pots, pans, stove, etc.). Cleaning up afterward.
  5. Communicating with others. Using phones, computers and other communication devices to reach out to others and receive calls or messages.
  6. Managing transportation. Driving, walking or using other forms of public transportation (like buses) to travel from place to place.
  7. Shopping. Making lists and selecting items (like food, clothing and household supplies) to buy. Choosing how to pay and completing transactions.

IADLs are often the first tasks that people ask for help with when they realize they can’t do them on their own. In other cases, a person may not realize they need help with IADLs until a loved one or healthcare provider points it out. Many people who need help with IADLs can still do basic ADLs just fine.

A person’s needs may also change over time, and a person’s care plan can adjust over time (particularly for older adults). For example, someone with mild cognitive impairment or early-stage Alzheimer’s Disease might have trouble performing some IADLs but need no assistance with basic ADLs. As their condition progresses, they might start to find basic ADLs difficult, too. Additionally, ADLs and IADLs can be often restored with the assistance of occupational therapists.

This is why assessing ADLs usually isn’t a one-and-done task. Instead, healthcare providers may assess your ability to do basic and/or instrumental tasks on a routine basis. They’ll look for changes that suggest the need for further support, perhaps determining when a person may need a move to senior living, an assisted living facility or nursing home, depending upon the person’s ability.

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