Activities of Daily Living and Instrumental Activities of Daily Living

Photo by Erich Ferdinand

While people of every age might have trouble with Activities of Daily Living (ADLs), I encounter this phrase or its acronym almost daily as applied to older adults, particularly those 85 plus. 

“Activities of daily living” is a phrase describes some of the basic tasks necessary for self-care such as eating, bathing, dressing, transferring, grooming, and continence.  ADLs are one of many areas for measuring a person’s overall wellness.

This phrase is used by social workers, health care workers, insurance companies, judges, assisted living administrators, and caregivers.   While the phrase is fairly widespread, various instruments for assessing ADLs yield different results for the same populations when applied. 



Even though there are several tools for measuring ADLs, the Katz index has achieved a degree of prevalence. This tool measures six ADLs (bathing, dressing, toileting, transferring, continence and feeding) using a scale of 2 to 6, with 6 showing full function for that activity and 2 showing severe impairment.  

A related phrase is Instrumental Activities of Daily Living (IADLs), which refers to tasks such as managing finances, using a telephone, preparing meals, and administering one’s own medications.  One of the most common assessment tools for IADLs is the Lawson IADL Scale.

A person’s score on assessment tools for ADLs and IADLs could determine whether a beneficiary will receive a home health aide from an insurer, whether a judge will determine an aging relative legally incompetent, or whether a resident must move from assisted living to skilled nursing.   Initially, the older adult him- or herself will informally assess their own ability to perform ADLs and IADLs. Sometimes family members might gently offer feedback about the need for extra assistance.   

Sometimes the changes come on slowly as with normal aging or with the onset and progression of Alzheimer’s Disease or Parkinson’s Disease.  For others, the problems with performing ADLs and IADLs may be the result of a sudden change in health that accompanies a stroke or a fall.  Sometime older adults regain their abilities to perform ADLs and IADLS with physical therapy and occupational therapy.   

Whatever the situation, it’s vital for caregivers to emphasize the benefits of getting appropriate help. 

It’s also vital to emphasize remaining abilities.  I have seen older adults of various abilities and limitations achieve goals and make positive contributions.   Having trouble with some ADLs and IADLs does not have to mean “NO, you can't.”  It can mean, “With a little help, YES!”