Understanding ‘activities of daily living’
When looking into what senior living options are available and their different levels of care, it is important to empower yourself by getting to know different key words and phrases used in the field.
For example, in senior living communities, caregivers need to know what types of assistance a resident might need to stay healthy and safe. One way to identify needs and challenges is by assessing what are known as “activities of daily living,” or ADLs.
Activities of daily living, in general terms, are the daily tasks we all complete to care for ourselves. [See detailed descriptions below.]
As we get older, we might need some support with these tasks due to mobility challenges, cognitive decline, pain issues or other conditions. Senior living communities often base their type of care on how many activities of daily living the potential new resident needs assistance with.
Let’s review more about ADLs, which are sometimes called basic activities of daily living, domestic activities of daily living, or instrumental activities of daily living (IADLs) — and how these activities can help senior living communities assess what living option might be best for a new resident.
Why ADLs and IADLs are important
When a senior living community determines if it can provide the support and services a potential new resident needs to stay healthy and safe, a team member will use certain markers during their assessment.
ADLs and IADLs are universal sets of tasks that help to measure if an adult can manage basic self-care tasks on their own or if they could use a little extra support.
But it’s not just senior living communities that use these tasks as a measuring tool. Sometimes, a family member can evaluate if there are certain tasks or chores their loved one is not able to complete safely or thoroughly. Then, they can seek out assistance with those specific activities. [Ed note: Such assessments are also helpful for those caring for older adults at home, whether family members or hired aides.]
Insurance and government reimbursement programs, such as Medicare and Medicaid, also use ADLs to determine eligibility. By looking at what type of ADLs and IADLs require support, insurance companies can determine what type of caregiving assistance is needed and pay for those services accordingly.
However, seniors’ abilities to complete ADLs and IADLs change over time as they age and conditions progress. This means that monitoring those activities can give senior living communities, family caregivers and insurance agencies a heads-up that more support is needed.
What are the activities of daily living?
Activities of daily living are defined as specific tasks that are necessary for independent living at home or within a community.
For a senior living community, the level of independence with ADL tasks is based on whether someone can perform the activities on their own. If they need help from a professional or family caregiver, they likely need a higher level of care.
What do activities of daily living measure?
In general, ADLs are used as indicators of a person’s functional status. Depending on how many ADLs the adult can perform on their own, they might be considered totally independent, requiring minimal or moderate assistance, or completely dependent. This information assists caregivers as they prepare to provide personalized support throughout the day and evening.
Knowing more about ADLs can also help caregivers determine the living option that will best meet the resident’s needs, and develop a care plan that addresses their specific challenges and abilities.
What are some basic activities of daily living? (ADLs)
Generally speaking, six ADLs are used in senior living assessments:
Dressing, which includes the physical task of dressing and undressing. This includes effectively using zippers, buttons and clasps, as well as pulling on socks and shoes. The dressing task also includes choosing seasonally appropriate clothing.
Eating, which includes the physical task of feeding themselves independently. This includes using a fork and other utensils while eating, but does not necessarily include meal preparation, which is considered an IADL (see more below).
Continence management, which includes the ability to understand when they need to go to the bathroom, to get to the restroom on time, and to control their bladder and bowel movements.
Toileting, which includes the ability to get on and off the toilet on their own and to perform hygiene care after using the restroom.
Personal hygiene and grooming, which includes bathing or showering, nail care and oral care.
Ambulating or mobility, which is sometimes referred to as transferring. This means that the person can stand from a sitting position, get in and out of bed, and walk safely from one place to another.
Instrumental activities of daily living (IADLs)
Instrumental activities of daily living, or IADLs, also give insight into how someone is living at home. However, instead of covering basic care tasks, these tasks often require more complex planning or thinking.
What are instrumental activities of daily living? IADLs are self-care tasks that are more complex than simple ADLs. These tasks require more critical thinking, organization and communication skills. They include:
Transportation, which includes either driving themselves places or coordinating transportation by arranging rides or using public transportation services.
Communication skills, which includes safely using cell phones and computers.
Meal preparation, which includes meal planning, grocery shopping, cooking, cleaning up, safely storing food, and using kitchen equipment and utensils.
Shopping, which includes the ability to use good judgment and make good purchasing decisions.
Housework, which includes keeping up with household tasks such as doing laundry, tidying up, dusting, or washing dishes.
Managing medications, which includes taking the correct medications in the correct dose and at the correct time of day. This task also includes managing any medication refills or follow-ups.
Managing personal finances, which entails operating within a budget, writing checks, paying bills on time and avoiding scams.
What is the difference between ADLs and IADLs?
Whereas both IADLs and ADLs are related to tasks, IADLs are considered “hands-off” care tasks because a family or professional caregiver can assist with the tasks without physically touching the person who needs assistance. In contrast, ADLs require “hands-on” assistance or more thorough verbal cueing.
It’s also important to note that IADLs are often the first tasks that seniors can no longer do — especially in the face of early cognitive decline — but family members might not notice.
In contrast, when a senior can no longer independently complete ADLs, family members tend to observe that change in condition quickly.
Domestic activities of daily living (DADLs)
Domestic activities of daily living, sometimes referred to as DADLs, refer to a set of activities that contribute to quality of life. DADLs are sometimes the first activities people lose the ability to perform as they age because they may not know different ways to adapt their favorite activities to suit their changing abilities and needs.
What are domestic activities of daily living? Domestic activities of daily living include any type of activity that falls into the following categories:
Physical exercise, such as walking, jogging, hiking or swimming.
Cognitive exercise, such as working on a crossword puzzle, completing a trivia contest, or trying out Wordle.
Fine motor skill work, such as gardening, knitting or playing a musical instrument.
Art, which can include playing music, writing poetry, painting, sculpting or making pottery.
Caring for others, which can include a pet, plant or grandchild.
In most senior living communities, including long-term care and assisted living, clinicians perform an ADL assessment to gauge the potential resident’s needs. There isn’t a standard ADL test that every senior living community uses; most use their own assessment process.
But it’s not just clinicians who can perform an assessment of ADLs (sometimes referred to as a geriatric assessment). Family members can assess their loved one’s ability to function independently by using online tools or by simply observing their loved one’s ability to complete the six major activities of daily living.
For a more formal ADL assessment, families can choose to enlist the assistance of their family doctor or an occupational therapist.
Having this information about their loved one can help family members choose the right next step as well as seek out insurance or government assistance to offset costs of care.
Who is qualified to perform an ADL assessment?
For a more formal assessment of ability, certified clinicians can utilize the Katz Index of Independence, a commonly used tool to measure functional status and detect challenges. The tool ranks performance in the six major ADLs: bathing/hygiene, dressing, toileting, transferring/mobility, continence management and eating.
Additionally, physiotherapists can assess ADLs and IADLs as a part of their initial assessment.
How often should ADLs be evaluated?
ADLs should be evaluated regularly to ensure that the adult is receiving the support they need. As conditions progress, challenges might increase, which means the senior might require additional personalized assistance to stay healthy and well.
Is there an informal tool caregivers can use at home?
Family caregivers can detect minor changes in their loved one’s functional abilities by performing an informal ADL assessment.
A checklist format can help family members and friends observe changes in their loved one’s abilities, giving them time to find assistance before those slight changes become major obstacles. Early intervention can ensure the senior receives the additional support they need to stay safe and healthy.
Older adults can adapt their habits and routines to have more independence with their ADLs. Using adaptive tools and technology is one way an adult can preserve energy and time while independently performing ADL tasks.
Adaptive equipment for dressing assistance can include reachers, long-handled shoehorns, button hooks, Velcro, sock aids, leg straps and dressing sticks.
Adaptive equipment for bathing can include transfer boards, grab bars, shower chairs or seats, long-handled sponges and handheld showerheads.
Adaptive equipment for toileting can include bedside commodes and bidets.
Adaptive equipment for eating can include wrist splints, non-skid bowls, plate guards, utensil cuffs, long straws and adaptive utensils.
Adaptive equipment for basic mobility can include a walker, cane, crutch, rollator, wheelchair or lift. Your physician or therapist can recommend the best mobility aid for your specific situation.
ADL support in senior living
Activities of daily living can be a good indication of how an adult is doing at home. If they are unable to safely and confidently keep up with their ADLs, it is time to find them the assistance they need.
In many cases, a senior living community can provide the right amount of personalized support. Learn more about what senior living can offer by downloading “The Journey to Senior Living: A Step-by-Step Guide for Seniors” at bit.ly/SeniorLivingJourney.
This article from The Arbor Company is edited and reprinted with permission.