Activities of Daily Living (ADLs): What Are They?
When you wake up and get ready for the day, you spend time performing personal care tasks such as getting dressed, brushing your teeth, showering, combing and styling your hair, and eating breakfast. These personal care tasks are examples of activities of daily living, or ADLs, which are the basic tasks we all do to care for ourselves. As we age, keeping up with activities of daily living can become a bit more challenging due to mobility issues, pain, or cognitive decline. Activities of daily living are often used to assess how seniors are functioning at home or at a senior living community. Understanding which activities of daily living are difficult for them can help a care team appropriately plan for support, as well as forecast future needs. Here’s what you need to know about activities of daily living, including IADLs, and how those skills are typically used to assess needs and support plans.What Are Activities of Daily Living (ADLs)?
Activities of daily living (ADLs) are the basic tasks that we all complete to care for ourselves and our hygiene. Challenges that come with aging can make activities of daily living more difficult, which is why it is common for adult children to notice that their loved one is wearing the same clothing over and over again or that their loved one is not showering. These concerns often drive the family member to seek counsel from their loved one’s physician. The better a senior can perform ADLs, whether completely independently or with some support, the safer and healthier they will be.The 6 Standard Activities of Daily Living
Activities of daily living are broken into six main tasks. Just because a senior has challenges completing one of these tasks does not mean they will have challenges completing all of them.1. Bathing
Bathing or showering includes all the tasks leading up to the actual shower or bath, such as gathering the supplies, running the water (and the water is at a safe temperature), completing the shower or bath, drying off, and safely exiting the shower. Bathing can be challenging due to mobility, strength, or balance issues. It can also be quite scary for someone who has fallen or had an almost-fall in the past. However, without showering or bathing regularly, the senior is at increased risk for skin breakdown, infection, and body odor.2. Dressing and Grooming
Another activity of daily living is dressing and grooming. This activity includes not only the act of dressing oneself and grooming, but all the steps that go along with it, such as choosing a seasonally appropriate outfit, gathering grooming supplies, and staying safe while performing these activities. Seniors who struggle with dressing and grooming might have cognitive issues that make choosing an outfit or remembering a grooming routine more difficult. Other challenges can come from mobility, as bending over to pull on a pair of socks or maneuvering a button through a button hole can be difficult when living with neurological conditions or arthritis.3. Toileting
Toileting is an activity that includes getting to and from the toilet safely, as well as performing appropriate perineal care in order to decrease the risk of skin infections, breakdown, or odor. Getting to and from the bathroom safely can be difficult if the senior has trouble ambulating or if there is a sense of urgency that makes every trip feel like an emergency.4. Transferring
Transferring is the act of getting from one position to another. For example, moving from sitting in your favorite recliner to standing up is a transfer, as is moving from the bed to a chair or getting in and out of the car. Research points to transfers as a particularly risky activity when it comes to falls. Many falls happen when in a rising position (from sitting to standing), and additional injury can occur when the senior or caregiver is then trying to stabilize the senior after a rising incident.5. Continence
Incontinence, whether urinary or bowel, is not a normal sign of aging. However, if a senior is incontinent, managing that incontinence becomes an activity of daily living. This includes keeping up with incontinence supplies and managing skin care appropriately.6. Feeding
Finally, eating is an activity of daily living that can be challenging for some older adults. In this case, the activity of daily living includes tasks related to eating and drinking independently. This activity of daily living does not include meal planning, grocery shopping, or preparation. Instead, it is being able to get the food and drink to the mouth and to swallow safely.What Are Instrumental Activities of Daily Living (IADLs)?
While activities of daily living are basic tasks for caring for ourselves, instrumental activities of daily living, or ADLs, are tasks that are a bit more advanced. These tasks require more critical thinking and planning. Typically, seniors will struggle with IADLs before they begin to struggle with ADLs. Family members might still notice gaps in IADL completion. For example, they may notice bills are going unpaid, or the fridge is empty more than usual.Common Examples of IADLs
Instrumental activities of daily living can include tasks such as:- Meal planning and grocery shopping
- Preparing meals and safely storing leftovers
- Managing medications
- Getting to and from appointments, whether driving independently or scheduling transportation services
- Managing money and paying bills on time
- Housekeeping and tidying up
- Keeping up with laundry
ADLs vs. IADLs: What’s the Difference?
ADLs are basic care tasks that we complete on a daily basis that help to maintain health and hygiene. IADLs require additional planning, judgment, and critical thinking; most IADLs are multi-step tasks that we might perform daily, weekly, or monthly, depending on our routine. If a family member notices their loved one is not keeping up with IADLs, support might include making those tasks easier for the senior. For example, a senior who is struggling to make healthy meals each day might benefit from a Meals on Wheels service or from a family member who grocery shops and meal preps for them. When a family member notices their loved one is not keeping up with ADLs, support typically needs to be a person or service that helps out with those tasks, such as a home care service or a senior living community caregiver.Why ADLs Matter in Senior Care
When it comes to senior care, activities of daily living can be a key driver for a senior living community. As families notice their senior loved one is struggling with independently completing one or more ADLs, their doctor will typically recommend some type of support service, including a move to a senior living community. Activities of daily living are used to assess the independence of a senior as well as in the care planning process. Senior living communities want to be sure they are meeting the needs of each individual resident, and understanding how to support residents during their ADLs is the first step in personalized care.How ADLs and IADLs Are Assessed
Self-Assessment
Physicians and senior living communities can have the senior assess their own needs when it comes to ADLs and IADLs. They might ask questions or start conversations that will allow the senior to talk about what they are struggling with each day, which task or tasks feel more difficult now than a few months ago, and what they wish they had a little extra support with. For example, a senior might identify that going downstairs to complete laundry a few times per week is exhausting and depletes them for hours after their trek to the basement with their laundry basket. They might note that if someone could do their laundry, they would have more energy for other tasks throughout the day. Self-reporting is an excellent way of assessing a senior, but the senior needs to be honest and reflective, which can sometimes be too vulnerable. Self-assessment should not be the only assessment, as it can often be incomplete.Family Caregiver Observation
Family caregivers can be excellent reporters when it comes to understanding what IADLs and ADLs their loved one is struggling with. They can bring their observations to a senior living community or physician and give examples of what they notice. For example, they might note that their loved one hasn’t changed out of their favorite sweater for a week or that they notice body odor that was never there before. They might also report that their mom never wears makeup anymore, even though she always had a full face of makeup on throughout her life. Family caregivers can give information and observations, as well as give important clues about previous habits and preferences.Professional Assessment Tools
Physicians and senior living communities may also use assessment tools to determine what type of support might be best for a senior. For example, the Lawton Instrumental Activities of Daily Living Scale or the Katz ADL Scale can give caregivers a good idea of how the senior is functioning and where there are gaps that can affect health and safety. Senior living communities might also have their own assessment tool that they use exclusively or in tandem with others. Scores on these professional assessments can help the care team determine the level of care and support needed. This can mean the care team might recommend assisted living versus skilled nursing, or a level 2 care in assisted living versus a level 3. The care team then uses those scores to help develop a personalized care plan so that caregivers know how and when to support the resident during personal care.Signs It May Be Time to Assess ADLs
It might be time to assess ADLs for your loved one if you have noticed:- A fall or almost-fall in the past 2 months
- Signs of poor hygiene (body odor, wearing the same clothing)
- Constantly pushing back or putting off showering or bathing
- Anxiety around any activity of daily living
- Unplanned and recent weight loss or weight gain
- Recurring urinary tract infections
- Trouble keeping up with housekeeping and/or laundry
- Difficulty managing their medication schedule, taking wrong doses of medication, or having a medication error
- Decreased motivation to keep up with household tasks or personal care tasks
- Signs of cognitive decline or a diagnosis of dementia
What It Means to “Need Help” With ADLs
When it comes to getting support with activities of daily living, the care team approach will be highly personalized. The goal is to have any senior perform as much of the activity as independently as possible, and not all seniors need the same amount of support. Examples of how a senior living care team could provide support with ADLs include:- Offering verbal cues for the task (“It’s time to brush your teeth, Bill.”)
- Laying out supplies for the task
- Using physical cues during the task (pointing at the toothbrush and toothpaste, miming brushing teeth motions to keep Bill on task)
- Offering physical support with the task (helping to hold the sleeve of a blouse so the senior can maneuver their arm through)
- Offering hand-over-hand full support with the task (the caregiver is performing the task for the senior, but the senior still feels included)
How Senior Living Communities Use ADLs
Senior living communities pay close attention to ADLs. First, they assess ADLs prior to move-in so that they can refer the potential resident to the best level of care. This level of care can change after the resident moves in, but it is helpful to assess ahead of time so that the risk of an additional move is reduced. Once the resident moves into the senior living community, caregivers provide support with ADLs per the personalized care plan. If more or less help is required, or if the caregiver finds an approach that works better based on the resident’s preferences (perhaps Evelyn enjoys a shower more if the caregiver uses her favorite citrus soap), they document it, and the care team will add this approach to the care plan. This way, other caregivers know the new approach, and it makes care more cohesive. Throughout the stay, especially after any significant health changes, the care team will reassess the resident’s support needs for ADLs. This way, each resident is receiving the best support they need for their challenges at any given moment. Senior living leadership is also able to change staffing ratios based on ADL support needed by the people who live in their community. This can also mean that residents who require more support with ADLs can be charged more for their monthly fee, as that money goes toward more staff support.How Assisted Living Helps With ADLs
Assisted living communities are designed to support seniors with ADLs. Caregivers are available around-the-clock to help with bathing, dressing, grooming, mobility, and more. In addition, caregivers and other support staff help out with IADLs like medication management, housekeeping, and laundry. Thanks to this extra support, seniors often find themselves with more energy and stamina to pursue their own interests and passions throughout the day. For example, if Bill has caregiver help with his laundry and showering, he can have more time and energy to go down to the game room to watch basketball with his friends. The right support with ADLs can enhance quality of life and self-esteem for residents who live in a senior living community.Home Care vs. Assisted Living for ADL Support
If your senior loved one needs extra support for ADLs, both home care and assisted living could be a potential solution. In-home care, provided by a nonmedical home care agency, will bring a caregiver into the home to help with specific activities of daily living during a scheduled shift time. For example, if your loved one needs help with showering a few times a week in the morning, a caregiver could come in for a 4-hour shift three times per week. During that shift, the caregiver would support your loved one with showering and other ADL or IADL needs. Assisted living provides around-the-clock support for ADLs and IADLs, which might be more realistic for a senior who could use help with two or more ADLs each day. Families need to compare costs and preferences when determining which works best for their situation, in addition to forecasting for the future.Insurance and Benefits: Why ADLs Matter Financially Too
Activities of daily living are also used to determine financial support, specifically with long-term care insurance, Veterans benefits, and even Medicare or Medicaid. If your loved one is struggling with ADLs, it is important you bring it up to their doctor sooner rather than later so that it can be documented in the medical record. The more documentation about their ADL needs and how those needs have progressed, the better, so that there is evidence when a third-party requires it.Common Myths About ADLs
- Myth: Needing help with ADLs means total dependence
- Fact: ADL support comes in many styles, including simple verbal cueing
- Myth: Only physical limitations affect ADLs
- Fact: ADLs can become more difficult when cognitive decline is in play
- Myth: ADLs only matter once someone moves into assisted living
- Fact: Understanding the challenges a senior has with ADLs can help family members better advocate for them with physicians and other members of the care team
- Myth: If a senior can do a task slowly, they automatically don’t need help
- Fact: While any independence (slow or not) is important, some tasks can become unsafe when completed too slowly. For example, someone who can shower independently but very slowly might be at risk for a fall if their physical endurance and balance are not adequate.
