What Are Activities of Daily Living and How Are They Assessed?

Activities of daily living (ADLs) are basic tasks needed for everyday life, while instrumental activities of daily living (IADLs) are more complex tasks needed to function independently and manage one’s own affairs.

Research shows that individuals over age 85 generally need assistance with daily living, with more than 20% of seniors over 85 requiring help with ADLs.^[01]

Activities of daily living examples

Here’s a standard list of activities of daily living, as outlined by the Katz Index of Independence in Activities of Daily Living:^[02]

1. Bathing and showering — the ability to bathe and maintain personal hygiene
2. Continence — having complete control of the bowels and bladder
3. Dressing — the ability to select appropriate clothes and outerwear for the weather or occasion and get dressed independently
4. Mobility — the ability to walk or transfer from one place to another, specifically in and out of a bed or chair
5. Feeding (excluding meal preparation) — the ability to get food from plate to mouth and to chew and swallow
6. Toileting — the ability to get on and off the toilet and clean oneself without assistance

Instrumental activities of daily living examples

Instrumental activities of daily living (IADLs) require planning, problem-solving, and organizational skills. While ADLs are very fundamental, IADLs are skills that allow seniors to function independently and manage their own affairs. IADLs, as outlined by the Lawton-Brody scale, include the following:^[03]

1. Housekeeping and home maintenance — the ability to maintain a clean and safe home by mopping, doing laundry, or fixing minor things
2. Managing money — the ability to budget and pay bills on time
3. Managing medications — taking medications correctly and refilling them on time
4. Preparing meals — the ability to plan, cook, and serve one’s own meals
5. Shopping for groceries and other necessities — remembering to get all the things one needs to eat and live properly on time
6. Transportation — the ability to get around by driving oneself, arranging a pickup, or using public transportation
7. Using the phone or computer — the ability to answer phone calls, call others, or email others, if it’s something one has always done

Caregivers can assess ADLs and IADLs in a variety of ways. You can use health care professional assessments, use caregiver input, or simply ask your loved one whether they’ve noticed changes in their abilities.

Professional ADL assessments

Health care professionals typically use one of the following three types of ADL assessments:

• The Katz Index of Independence in Activities of Daily Living. This is generally for seniors in long-term care settings, where disability is generally more severe but stable. In this assessment, one point is gained for each ADL your loved one can complete independently. The total number of points at the end of the assessment shows how independent your loved one is and what level of assistance they may need.^[02]
• The Barthel ADL Index. This assessment covers two additional activities, including grooming and ability to climb stairs. It’s also for care settings and can detect subtle changes in a person’s health. In this assessment, the task levels are on a scaled point system. As with the Katz assessment, the more points you have in total, the more independent your loved one likely is.^[04]
• The Functional Independence Measure (FIM). This option is more comprehensive, combining ADLs with IADLs and other social activities. This assessment tool comprises 18 items divided into physical and mental categories. Each item is scored on a scale. The higher the score, the more independent your loved one is at performing the task.^[05]

Caregiver input

Caregiver input can help create a bigger picture of your loved one’s functional abilities. Family or hired caregivers often notice when a senior needs more assistance than they used to. For example, a parent may start asking for help in situations they could once tackle alone.

Self-reporting

Self-reporting can also help get the conversation about ADLs and IADLs started. No one understands a situation better than the person experiencing it.

Self-reporting is especially helpful when individuals have minimal cognitive decline. A senior may be more honest about their struggles or remember situations better if their memory is working well. Keep in mind that self-reporting can introduce bias, as your loved one may not feel an incident is worth recording when it really is.

Professional opinion

Families rarely ask about ADLs until a parent or senior loved one is going through the process of assessment for long-term care, says Dr. Leslie Kernisan, a geriatrician. According to Kernisan, it’s a good idea to share changes in ADLs or IADLs with your loved one’s medical team. Often, a change in a senior’s ability to perform them requires evaluations that may uncover a medical issue. This can help doctors identify the root cause of the problem or change in ability.

Understanding the root cause can help your doctor identify ways to improve function, including medical treatment, mobility devices, and various therapies. A deeper understanding of your loved one’s ability to perform ADLs and IADLs can also help doctors create an accurate care plan that supports their needs.

Let our care assessment guide you

To help you assess and monitor your loved one’s activities of daily living, use A Place for Mom’s ADL and IADL checklists. After assessing your loved one, consider taking the results with you the next time your loved one has a medical checkup.

Click on the respective images below to download the ADL and IADL checklists.

Tips for assessing your loved one’s ADLS and IADLs

As you assess your loved one’s ability to complete ADLs and IADLs, follow these tips:

• Ask for other opinions. Check with your loved one’s neighbors, family, and friends. Inquire about any changes in your loved one’s abilities. Pick two or three people to discuss your concerns with.
• Assess on a spectrum. Ask yourself whether your loved one can do the task a little bit, sometimes, or often rather than a simple “yes, they can do the task,” or “no, they can’t.”
• Be patient with slow activities. “If a person is doing a task more slowly than they used to, it doesn’t mean they can’t do the task,” Kernisan notes.
• Consider the time of day and how tired they are. Many seniors have sharper cognitive abilities and more energy in the morning.
• Consider their health. If they’re fatigued or fighting a virus, your loved one’s abilities can be momentarily impaired.
• Find the time. “It’s common to be in a hurry, and it’s difficult to find the time to observe, but it’s important to take the time, and when you do, be patient,” Kernisan says.
• Look at your own preconceived notions about your loved one. Are they interfering with your ability to make an objective assessment?
• Make the effort to help correct what you can. Ensure your loved one can live life to the best of their abilities and as independently as possible.

“It’s very challenging to have people see you as less able,” Kernisan says. Family caregivers should “be discreet and empathetic” when assessing for ADLs and IADLs, she suggests.

If your loved one is unable to independently perform daily ADLs and IADLs, or if you have other safety concerns, it may be time to discuss senior care. Increasing support with home care or moving to an assisted living community can help them to live safely and continue their activities with assistance.

Talk with a Senior Living Advisor

After you’ve performed ADLs and IADLs assessments, you can begin to think about what level of care your loved one needs. For instance, the level of care needed by someone who can’t complete IADLs is different from the care needed by someone who can’t complete basic ADLs.

Questions to help you identify your loved one’s level of care

The following questions can help you assess your parent’s current needs and routine to identify potential care options:

• Do you or a neighbor need to check on your aging parent routinely?
• Does your aging loved one need physical, occupational, or speech therapy?
• Is your aging parent able to continue living independently?
• Would senior care options eliminate chores and tasks that frustrate or are beyond your loved one’s ability?

As you track your loved one’s status and plan for future steps, keep in mind that ADL assistance requires more intensive, hands-on care than IADL assistance. In some cases, IADL deficiencies may be managed by different service providers, like a meal delivery service, a housekeeper, or an accountant. If in-home care services aren’t enough to help your parent complete all their ADLs, assisted living communities offer full ADL support for seniors.

If you’re worried about your loved one’s ability to perform everyday tasks, connect with their doctor to discuss your concerns. It’s important to identify any limitations your aging parent may have, but it’s even more critical to support them by finding solutions to help solve or alleviate those limitations. If your loved one needs help with even one ADL, assisted living or home care services could be helpful possibilities to consider.

By definition, assisted living communities offer residents assistance with ADLs and some IADLs. Here are some specific ADLs and IADLs that assisted living communities within A Place for Mom’s network help with:^[06]

• Over 95% of communities provide meals.
• Nearly 88% of communities offer incontinence care.
• Almost 83% of communities offer medication management services.
• Over 80% of communities offer housekeeping services.
• About 77% of communities offer laundry or dry-cleaning services.
• Over 85% of communities offer transportation services.

If you’re ready to explore senior support options, reach out to one of A Place for Mom’s Senior Living Advisors. At no cost to your family, an advisor will work to understand your parent’s unique situation and needs, compare different senior living options, and offer personalized referrals.