Senior Care
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ADLs vs. IADLs: Helping Older Adults Stay Independent

Learn how ADLs and IADLs help assess and support daily independence in caregiving, enhancing quality of life and care.
Published on
April 12, 2024
Presented by Givers
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Understanding the Activities of Daily Living (ADLs) and their instrumental counterparts (IADLs) is crucial for anyone caring for a loved one who needs support maintaining independence. These activities encompass everything from basic self-care to more complex tasks required for living autonomously, serving as fundamental indicators in healthcare to evaluate an individual's ability to function day-to-day without assistance. Whether you are a professional caregiver or a family member, grasping the significance of ADLs and IADLs can empower you to provide better support and improve the quality of care for your loved ones.

What are the Activities of Daily Living (ADLs)?

As a family caregiver, you naturally want your loved one to be as independent as possible. That's where ADLs, or Activities of Daily Living, come in. 

Activities of daily living (ADLs) refer to the basic tasks that people commonly perform daily to take care of themselves and maintain their independence. These activities are essential for personal well-being and involve routine actions fundamental to managing one's health and hygiene. ADLs are often used in healthcare and social services to assess an individual's ability to live independently and identify any need for assistance or adjustments in care. Essentially, ADLs encompass the skills needed to handle day-to-day self-care tasks effectively.

Common ADLs include: 

  • Dressing: Putting on and removing clothes without help with buttons, zippers, or getting arms and legs into sleeves.
  • Eating: Being able to feed yourself without assistance, which could involve using utensils or managing adaptive equipment.
  • Toileting: Using the bathroom independently, including getting on and off the toilet, dressing, and cleaning up.
  • Bathing: Taking a shower or bath safely without needing someone to help wash, dry, or get in and out of the tub or shower.
  • Grooming: This includes brushing teeth, combing hair, shaving, and taking care of other personal hygiene needs.
  • Mobility: Getting around safely, whether by walking independently, using a wheelchair, or relying on another assistive device.

We recommend you work with your care recipient's doctor or therapist to determine the level of care they might need. Ask about programs to assist with daily tasks and chores. 

Contact your Office of the Aging or case manager to see what resources you can use. Your case manager can help you plan for the future and access support. Become a more confident and prepared caregiver. Help your loved one feel supported and empowered on their journey towards independence.

History of ADLs

The term "Activities of Daily Living" was first coined by Dr. Sidney Katz and his team in the 1950s. Dr. Katz, a physician at the Benjamin Rose Hospital in Cleveland, Ohio, developed an index to measure the functional status of elderly patients. This index was first published in 1963 and included a systematic scale to assess individual capacities in performing basic self-care tasks.

The original Katz Index of Independence in Activities of Daily Living focused on six fundamental areas: bathing, dressing, toileting, transferring, continence, and feeding. The Katz Index helped in understanding how medical interventions could improve or maintain a patient's independence in these areas.


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What are the Instrumental Activities of Daily Living (IADLs)?

What if your loved one can handle daily tasks but struggles with driving a car or paying credit card bills? How can you help them? While ADLs focus on the essential functions of daily living, iADLs, or Instrumental Activities of Daily Living, delve deeper. 

Instrumental activities of daily living (IADLs) are more complex than basic activities of daily living (ADLs). While ADLs focus on fundamental self-care tasks, IADLs involve the skills and abilities needed to manage one's household and engage in community life. These activities are crucial for living independently but are not necessarily fundamental to basic functioning. They encompass the ability to perform tasks that require cognitive and organizational skills, such as managing finances, handling transportation, shopping for groceries, preparing meals, and maintaining a household. IADLs are often used as a measure in healthcare to determine an individual's level of functioning in more complex real-world settings and to assess their ability to live independently without assistance.

Common IADLs include: 

  • Managing finances: This includes paying bills on time, balancing a checkbook, and making sound financial decisions.
  • Cooking and meal preparation: Planning meals, shopping for groceries, and safely preparing food are all part of this IADL.
  • Medical management: Taking medications as prescribed, refilling prescriptions on schedule, and attending doctor's appointments all fall under this category.
  • Transportation: Getting around independently, whether through public transit, driving a car, or arranging for rides, is a crucial IADL.
  • Housework: Keeping a clean and organized home environment often requires laundry, vacuuming, and dusting.

Talk with your loved one about the difficult tasks for them. They can give you valuable insight into their overall level of independence. Talk with their therapist and other healthcare professionals. Provide the proper support, communicate effectively with healthcare professionals, and plan for the future. 

Remember, even minor adjustments or assistive devices can significantly improve your loved one's ability to manage these IADLs and maintain their independence in the community.

History of IADLs

The concept of Instrumental Activities of Daily Living was introduced later to address more complex skills required for living independently but not necessarily for fundamental functioning.

M. Powell Lawton and Elaine M. Brody defined IADLs in 1969. They expanded Katz's ADLs to include tasks such as handling finances, managing transportation, shopping, preparing meals, and maintaining a household. These activities are crucial for evaluating an individual's ability to live independently in the community.


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Why ADLs and IADLs matter

Over time, the concepts of ADLs and IADLs have become critical tools in geriatrics, rehabilitation, and community health. They assess the impact of aging, illness, or disability on an individual's capability to live independently.

These measures are crucial for evaluating an individual's functional status and determining their need for assistance or intervention. Here are some key aspects of their clinical importance:

  1. Assessment of independence and care needs: ADLs and IADLs help healthcare professionals assess how independently a person can live and what level of support they might need. For example, difficulties with ADLs indicate a need for personal care support, while challenges with IADLs suggest the need for community services or family support.
  2. Guiding rehabilitation goals: For patients recovering from illness, surgery, or injury, assessing ADLs and IADLs can help set realistic goals. Improvement in these areas is often a key indicator of recovery and can guide the intensity and focus of rehabilitation therapies.
  3. Monitoring disease progression: In chronic conditions or progressive diseases like Parkinson's, Alzheimer's, or multiple sclerosis, changes in the ability to perform ADLs and IADLs can indicate disease progression and help in adjusting treatment plans.
  4. Long-term care planning: Evaluating ADLs and IADLs is essential in planning for long-term care, whether that involves home health services, assisted living, or nursing home care. This ensures that individuals receive the appropriate level of care corresponding to their needs.
  5. Insurance and Legal Relevance: These assessments are often required for insurance claims and to qualify for certain health benefits or legal arrangements such as guardianship or power of attorney.
  6. Quality of life: Beyond the physical aspects of care, ADL and IADL capabilities are closely linked to quality of life. Being able to perform these activities is often directly related to an individual's sense of independence and self-esteem.

ADLs and IADLs also play a significant role in public health policy, influencing decisions on resource allocation, the design of eldercare programs, insurance coverage, and legal matters concerning the care of incapacitated individuals.

How ADLs and IADLs determine eligibility for Medicaid waivers

Medicaid waivers provide alternatives to nursing home care, allowing individuals to receive supportive services in their homes or community settings. To qualify for a Medicaid waiver, an individual often must demonstrate a lack of independence in multiple ADLs or IADLs. This assessment shows a need for a level of care that might otherwise require a nursing home or similar facility. By proving these difficulties, individuals can access various supports funded through Medicaid waivers, such as personal care assistance, home modifications, and other services that facilitate living independently. 

How are ADLs and IADLs assessed?

Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are typically assessed through self-reports and healthcare providers' observations. The assessment process determines a person's independence and need for assistance. 

ADL assessment

  1. Structured interviews: Individuals or their caregivers are asked about the person's ability to perform tasks such as bathing, dressing, using the toilet, transferring, eating, and maintaining continence.
  2. Direct observation: Healthcare professionals may observe patients performing these tasks in a clinical setting or at home to verify the accuracy of self-reported data and get a clearer picture of the individual's capabilities.
  3. Standardized assessment tools: Several tools, such as the Katz Index of Independence in Activities of Daily Living and the Barthel Index, are used to assess ADLs.

IADL assessment

  1. Questionnaires and interviews: Similar to ADLs, IADLs are often assessed through detailed interviews with the individual or their caregivers. Topics include the person's ability to complete tasks like shopping, cooking, managing medications, handling finances, using the phone or computer, and managing transportation.
  2. Observation: Observing the individual in their home environment is particularly useful for IADL assessment, as these tasks often require interactions with multiple elements and more complex decision-making.
  3. Standardized tools: Tools like the Lawton-Brody IADL Scale help evaluate a person's ability to perform tasks independently and identify areas where support may be needed.

These assessments are crucial in multiple settings, including hospitals, outpatient clinics, long-term care facilities, and home health services. They help determine the level of care an individual requires and play a critical role in care planning, rehabilitation, and monitoring the progression of disabilities or recovery from injuries.

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