adl and iadl

Independence is something we attain early in life, some earlier than others. From that point on, we feel empowered, in control of our own destiny. But what happens when we are no longer able to maintain our independence? How can we tell when it’s time to ask for help or, in the case of a loved one, intervene on their behalf? Together, ADLs and IADLs represent the skills that older adults must be able to manage in order to live at home independently.

How to Start the Conversation: ADLs and IADLs

Even just starting the discussion can be daunting.

What level of assistance does Mom need? Where do I even begin with care planning? How can I be the one to tell a family member they no longer have the ability to perform a task they’ve done their whole life?

These are the skills that are learned during childhood. ADLs are important to note because many programs and services that assist seniors usually provide assistance based on how few of these a senior can perform on a daily basis.

In short, they are the basic activities necessary for survival and well-being.

Activities of Daily Living (ADLs)

adls and iadls

They include the following:

  • Eating: The ability to feed themselves, use utensils, cut up food, etc.
  • Toileting: The ability to get to the toilet ‘in time’, get on and off the toilet, cleanse self and arrange clothing afterward.
  • Dressing: The ability to select appropriate clothing, put the clothes on, manage buttons/clasps/zippers.
  • Bathing and Grooming: The ability to wash themselves, get in and out of shower/tub, comb hair, brush teeth, shave.
  • Mobility: The ability to move about in bed, move from bed to chair, to walk or propel self in wheelchair.

At Aware Senior Care, we discuss each task with clients and family to determine the level of assistance the person needs. Maintaining as much independence as possible is always a primary goal.

Examples of levels of assistance are:

  • Supervision: Someone present to make sure the person has everything they need to complete the task, monitor for safety, provide cues if needed. Example for bathing- the caregiver assures the water temperature in the shower is appropriate, the soap, shampoo and towels are all within reach for the client.
  • Limited Assistance: The person needs help for less than 50% of the task. Example for bathing: The client needs the caregiver to wash and dry their back and the client completes everything else.
  • Extensive Assistance: Client needs assistance for more than 50% of the task. Example for bathing: the client can wash/dry their face and hands, otherwise the caregiver bathes the client.
We find that adding a small amount of support can keep a person safe and living independently.

Instrumental Activities of Daily Living (IADLs)

IADLs are the complex skills needed to successfully live independently. These skills are usually learned during the teenage years and refined in adulthood. One who can perform their IADLs without assistance are a part of their community and can manage their own living space. These may be more difficult to define. Asking questions may help determine if there may be a problem.
  • Managing finances: Are there unpaid bills? Bounced checks? Messages from creditors?
  • Handling transportation: Have there been traffic accidents, including fender benders? Are you uncomfortable as a passenger in their car? Have they stopped driving at all?
  • Shopping: Are they continually missing essential household items or do they have large amounts of the same item?
  • Meal Preparation: Have they stopped making meals? Are they making poor decisions in what they eat on a consistent basis? Is there spoiled food in the refrigerator or cabinets?
  • Using the telephone: Do they answer the phone when you call? Do phone messages go unanswered?
  • Managing medications: Are they taking too many or too few of their prescribed medicines? Are they unsure what to take or why they are taking it?
  • Housework and basic home maintenance: Is the home so cluttered you are concerned they may fall? Has the furniture been dusted and floors vacuumed or mopped? Are there dirty dishes? Are there safety issues due to lack of maintenance, such as burned-out lightbulbs, or shaky hand railings?

What ADLs vs IADLs Can Teach Us

Difficulty managing IADLs is particularly common in early Alzheimer’s and other dementias. Assessing IADLs and ADLs can help guide a diagnostic evaluation, as well as determine what kind of assistance an older person may need on a day-to-day basis. For example, failing to perform ADLs due to pain may signal a need for an appointment with the physician and medical intervention.
Generally speaking, ADLs and IADLs determine how well a person is functioning. Family members and/or caregivers can anticipate needs in order to make the senior’s daily routine as unencumbered as possible.
We hope you found this resource helpful. We recommend using the Home Care Self-Assessment tool if you are concerned about a loved one and want to know specifically what care they might need.