Activities of Daily Living

When a typical person gets up in the morning, they sit up and throw their feet over the edge of the bed. Then they stand and walk to the bathroom. They take care of toileting, then shower, brush their teeth and many other activities to prepare themselves for the day.

When it comes time to think about food, they plan a menu, shop for the foods they want to eat and prepare their meals. Next, they sit down to eat. After the meal, they clean up the kitchen and wash the dishes.

All these activities, and many others, are referred to as Activities of Daily Living.

What are Activities of Daily Living (ADLs)?
Activities of Daily Living or ADLs is a term used by healthcare professionals to refer to the basic self-care tasks an individual does on a day-to-day basis.

These activities are fundamental in caring for oneself and maintaining independence. An individual's ability or inability to perform ADLs is often used by health professionals as a way of measuring an individual’s functional status, especially that of older adults or those with disabilities.

Basic ADLs, sometimes referred to as BADLs, are self-care activities routinely performed which include, but are not limited to:

• Functional mobility, which includes the ability to walk and transfer in and out of a chair or bed. Essentially, it's the ability to move from one place to another as a person goes through their daily routines.
• Personal hygiene, oral care and grooming, including skin and hair care
• Showering and/or bathing
• Toileting, which includes getting on/off toilet and cleaning oneself
• Dressing, which includes selecting appropriate attire and putting it on
• Self-feeding

One way to look at basic ADLs is to think of them as the activities a person does when they get up in the morning preparing to leave the house and those they do regularly day in and day out.

As a person ages, ADLs slowly become more difficult to accomplish independently and gradually take more time to complete. Certain health issues, such as a stroke, or accidents, such as a fall, also affect a person’s ability to accomplish ADLs, sometimes dramatically.

Instrumental Activities of Daily Living
Instrumental Activities of Daily Living or IADLs are not essential for basic functioning; however, they enable a person to live independently within a community. They’re generally more complex than basic ADLs.

IADLs are made up of activities which include, but are not limited to:

• Housekeeping, laundry and other home care chores
• Money management
• Meal preparation
• Moving/changing residences
• Shopping for groceries and other necessities
• Medication management
• Using the telephone or computer

Being able to perform both ADLs and IADLs is important for seniors to be able to successfully and safely live independently.

How are the ADLs Used in Senior Care?
Together, ADLs and IADLs make up the skills a person generally needs to successfully and safely live independently.

Therefore, a person’s ability or inability to perform ADLs and IADLs is used to gauge their need for care and/or occupational or physical therapy. Most healthcare service models use evaluations such as the Katz ADL Index to determine and evaluate their patient’s proficiencies and to then develop appropriate care plans to ensure all care needs are met.

Physical therapists prescribe exercise to help patients gain and/or maintain their independence based on ADL proficiencies. Prescribed exercises are based on an individual’s problematic ADLs. For example, slow walking speed is associated with an increased risk for falls; therefore, exercises are prescribed to impact and improve ambulation (an ADL proficiency) to reduce fall risk. 

When completing patient assessments, occupational therapists often assess a patient's proficiency of IADLs. There are twelve types of IADLs that the American Occupational Therapy Association recognizes as necessary to live in co-occupation with others:

• Home establishment and maintenance
• Meal preparation, including clean-up
• Care of others, including being able to select and supervise caregivers
• Communication management, includes telephone and computer usage
• Financial management
• Management and maintenance of health and health-related issues
• Shopping
• Maintaining and observing religious practices
• Child rearing
• Community mobility
• Pet care
• Safety procedures and emergency responses

​Physicians, geriatric social workers, rehabilitation specialists and others in senior care often evaluate a person’s ability to perform ADLs and IADLs as part of a functional assessment. Difficulties performing IADLs may signal early dementia and Alzheimer's. Evaluations of IADLs are used to make a diagnostic evaluation and influence decisions on the type of care an older adult may require.

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