ADLs, IADLs, and aging: Knowing when your parent needs help with daily life

It’s easy to take for granted the ability to perform standard tasks throughout the day. Getting dressed, paying a utility bill, or answering the telephone are things that we tend to do without much thought or effort.

But it’s important to realize that for many older adults, doing some of those daily tasks isn’t always easy.

Health care professionals and those who work in the field of older adult care have a system for determining whether or not a person can perform the basic tasks associated with adult independence. That’s where Activities of Daily Living, or ADLs, and Instrumental Activities of Daily Living, or IADLs, come into play. These two categories are related, but they’re comprised of different things.

As a caregiver for your aging parent, it’s good to be aware of both ADLs and IADLs so that you know how much help and hands-on care your mom or dad might need as they get older.

So what exactly are ADLs and IADLs? This guide answers that question and explains how these activities can help determine what kind of living situation your mom or dad might benefit from as they age.

Activities of daily living (ADLs)

Activities of daily living originate from the work of Sidney Katz, an American physician whose Katz Index of Independence from the 1960s form the basis for today’s modern ADLs. Activities of daily living are used as a measurement of a person’s ability to perform basic self-care tasks. In fact, they’re sometimes referred to as Basic Activities of Daily Living, or BADLs.

ADLs generally include things like:

• Walking — This involves a person’s ability to walk or otherwise get around their living space without assistance. Health care professionals may refer to walking by the technical term, ambulating.
• Bathing — This ADL refers to washing one’s face and body, either in a shower or bathtub.
• Dressing — Dressing involves selecting clothing and putting it on without assistance.
• Grooming — Grooming includes the various elements of maintaining personal hygiene like hair care, trimming nails, and brushing teeth. Sometimes, showering and/or bathing is included in the grooming category as well.
• Feeding — This involves a person’s ability to physically feed themselves without help from another person.
• Toileting — Toileting means getting to and from the toilet and using it properly without incident. This may also be referred to as continence.
• Transferring — Transferring means moving from one body position to another. Movements like going from a bed into a chair, or from a chair into a wheelchair, are common examples.

As you can see, ADLs typically include the basic tasks needed to function in daily life with a measure of independence. IADLs, on the other hand, are a bit more complex.

Instrumental activities of daily living (IADLs)

IADLs, or instrumental activities of daily living, move beyond the basic functions of caring for oneself and get into more of the critical-thinking and organizational skills. IADLs typically include things like:

• Transportation — This involves getting to and from places outside of the home, either by driving a car or organizing some other mode of transportation.
• Meal preparation — Feeding is a basic ADL involving the physical act of getting food into one’s mouth, while meal preparation is the corresponding IADL and is a bit more complex. It covers the steps in planning and preparing a meal, from the procurement of food and supplies to the actual cooking stage.
• Communication — This IADL refers to managing one’s communication with others via telephone, mail, or sometimes by electronic means like email.
• Home maintenance and cleaning — Home maintenance includes things like keeping the home reasonably tidy, removing trash, and cleaning up after meals. Washing laundry and folding clothing is sometimes included in this category.
• Managing finances — This means paying bills on time, balancing checkbooks, managing financial assets, and handling other money matters.
• Managing medications — Medication management involves things like taking medications on time and in the right dosages, getting prescriptions filled, and making sure medications are up to date.

You might notice your mom or dad start to struggle more with these kinds of tasks as they get older, especially if they’re dealing with physical health issues or cognitive impairment, perhaps from Alzheimer’s disease or another form of dementia.

IADLs aren’t necessarily needed for the fundamentals of daily life and basic survival, but they are necessary for a person to safely live on their own.

The importance of ADLs and IADLs

Older adults need to be able to manage ADLs and IADLs in order to live independently and generally look after their own well-being. It’s important to realize that your parent might not make it verbally clear if and when they’re having trouble. That’s the reason ADLs and IADls exist: They’re used as assessment tools to determine an older adult’s functional status.

There are many different scales and measurement methods that might be used to determine an older adult’s ADL or IADL “score,” including the Katz ADL scale, the Lawton IADL scale, and the Bristol Activities of Daily Living Scale. These are questionnaires used by care providers, family members and family caregivers, and health care professionals to determine whether or not an individual can live independently in a safe way.

ADL/IADL scales are also used to determine the level of care services that someone might need now or in the future to maintain a good quality of life. In this way, a person’s score can help determine if they might benefit from living in an assisted living community or a nursing home. It can help identify whether or not a person would benefit from physical therapy, assistive devices to improve functional mobility, or home care by a family caregiver or a healthcare professional.

Keep in mind that evaluating ADLs and IADLs can be, to some extent, a subjective process. Take the home maintenance and cleanliness IADL, for instance. One person’s standard for a clean, tidy home might be different than another person’s, and one person’s opinion doesn’t necessarily mean that the individual in question can’t take care of themselves.

This is why it’s imperative for ADL/IADL evaluation to be an inclusive process that involves family members and caregivers, health care professionals such as doctors, and — most importantly — your mom or dad themselves.

What do ADLs or IADLs mean for caregivers?

For you, the caregiver to your aging parent, ADLs and IADLs can offer insight into whether or not your mom or dad are able to safely live independently. If they cannot, ADLs and IADLs can help determine what level and type of care might be needed for them to live comfortably and safely.

Many older adults who need help with basic ADLs or IADLs can remain in their homes, receiving home care from various types of professionals (occupational therapists, nurses, companion caregivers, and even social workers) or a family caregiver like yourself. In other cases, the person benefits from living in an assisted living community.

Do you have experience helping to evaluate a parent or other person on their ADL or IADL capabilities? How did it affect the way you think about personal care? We would love to hear from you.