ACTIVITIES OF DAILY LIVING (ADL)

Without assistance are you able:
Dress? ____  Feed yourself? ____  Prepare meals? ____  Walk independently? ____  Toilet yourself? ____  Do own hygiene? ____

INSTRUMENTAL ACTIVITIES OF DAILY LIVING(IADL's)

Can the pt. independently: Prepare meals? ____ shop? ____  Do housekeeping? ____  Use telephone? ____Transport self? ____ 
Manage: Meds? ____   Finances? ____

The assessment of activities of daily living are divided into two levels, from the more basic Activities of Daily Living (ADL's) to the more advanced Instrumental Activities of Daily Living (IADL's) and both are very necessary for self-care. These questions lead to evaluation areas of critical function in both ADL's and IADL's. This screen helps the examiner to pick up problem areas of function, which assists in targeting interventions. Abnormalities here should lead to a full ADL and IADL's assessment.

Activities of Daily Living (ADL)
These are the activities that are fundamental for self care. Elders who maintain their ADL's  have a higher level of independence. Declines in these functions are predictive of poor outcomes in hospitalization, illness and higher mortality. The easiest way to remember these is that they are the functions you had to do in order to leave home to go to "kindergarten". You had to be able to; dress, feed, ambulate, toilet, and perform your own hygiene. Another way to remember the ADL's is to think of this mnemonic: "DEATH"D ress, E at, A mbulate, T ransfer/T oilet, H ygiene. "If you can't do your ADL's, your dead".

Normally these activities are performed independently. As the frail elderly becomes progressively unable to do these tasks, they require more and more caregiving assistance. The amount of assistance depends on the type of help needed; an older adult who only needs help with bathing may require assistance every few days, whereas someone who has difficulty transferring might require full-time help. The loss of independence in the performance of an ADL may be a sign of a chronic illness such as dementia, depression or heart failure. The loss of continence is a predictor for placement in long term care facilities.

Data can be collected by trained office staff from the patient, family member or other caregiver. The information can be  obtained through history from the patient/caregivers or by observation.

Click here to review/print ADL's screening form.

An alternative form for assessment of ADL's is the Katz Index of Independence in Activities of Daily Living (ADL) 3 .

Instrumental Activities of Daily Living (IADL's)
The IADL screening instrument can uncover more subtle disabilities. These are tasks necessary for independent functioning in the community. They include cooking, cleaning, doing laundry, shopping, using the telephone and accessing means of transportation, taking medicines, and managing money. The IADL's are more influenced by a person's cultural background to a greater degree than are the basic tasks of everyday living.

For example, some older women may never have managed the household's money, and some men were never expected to do laundry. Therefore, it is more important to assess whether the individual could complete the task if needed than to determine whether he or she is currently doing it. It is also important to determine whether there is a substitute either a family member or aide or a social program, such as Meals on Wheels that could perform the task if the individual could not do so.

The IADL's are assessed using the Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale 4  which can also be administered by trained office staff. If a patient is not able to perform one or more IADL's, assistance will be needed for activities such as shopping, meal preparation, housework, medicine organization and paying bills. If caregiver supports are not adequate and the patient becomes a risk, a change in living situation (assisted living or nursing home) may be needed. Through the use of the attached screening tool, the clinician can target specific areas for intervention.

Click here to review/print an IADL's screening form. This screening tool can be based on history from the patient/caregivers or by observation.

Significance
In 1997, there were over 4.5 million (14.2%) elders who reported having difficulty carrying out activities of daily living (ADL's) and 6.9 million (21.6%) who indicated difficulties with instrumental activities of daily living (IADL's). Impairments in ADL's leads to further functional decline, declines in quality of life, and loss of independence. Early intervention through detection of functional decline leads to reductions in negative outcomes.