As we age, our ability to perform some tasks may diminish. What was easy enough to do at 35 – reading a newspaper without corrective lenses, for example – may be next to impossible at 65.
While some diminished skills are annoying or inconvenient, others can make it difficult for people to live independently without care. There are daily tasks that everyone needs to be able to perform in order to live independently, known as activities of daily living (ADLs). Activities that aren’t as crucial but are still important to older adults for managing on their own are referred to as instrumental activities of daily living (IADLs).
Yet, according to the CDC, 10.6% of those 75 and over need help with ADLs, and 18.8% need help with IADLs. While your loved one may be falling short in some areas, you can still help improve their ability to perform ADLs and IADLs and enjoy a more fulfilling feeling of independence.
What are ADLs and IADLs?
ADLs are the daily tasks required to live a safe and healthy life:
- Mobility, including getting up and down from a chair and in and out of bed without assistance
- Personal hygiene and grooming, such as bathing, brushing teeth, hair care and general tidiness
- Toileting without help (both getting on and off the toilet and cleanliness)
- Dressing in weather-appropriate clothes and the ability to button, zip and tie as needed
Families and caregivers will need to adjust the level of attention their loved one requires as their ability to perform these basic tasks becomes more challenging. For some older adults, the loss of these skills is because of serious illness, dementia or mobility challenges, while for others, it may be a matter of their advanced age.
Instrumental activities of daily living (IADLs) include tasks necessary to living independently but don’t require the same level of caregiver attention or time as ADLs do. These include:
- Managing finances, including paying bills on time and keeping track of money
- Using transportation on their own, whether driving a car or taking a bus
- Preparing meals correctly, including cleaning up and turning off appliances
- Managing daily medications and taking them as directed
- Performing basic housework and maintenance, such as emptying the trash, making the bed, or unloading the dishwasher
What can be done to improve ADL and IADL performance?
Caregivers and loved ones can encourage older adults to work to improve their ADL and IADL performance. Still, success will depend greatly on the physical and mental abilities of the person they’re trying to help. An occupational therapist can be brought in to assess the situation and work one-on-one with your senior to improve their ADL skills.
For day-to-day activities, there are ways to make ADLs easier and the home more functional, including:
- Installation of safety devices to help with walking, such as grab bars, transfer poles, handrails and non-skid mats
- Mobility tools like walkers, wheelchairs and adjustable chairs
- Adjustable beds, or pulleys for getting in and out of bed (or lifts for larger people) in the bedroom
- Eating and drinking aids like non-tip cups, adjustable-height tables, and easy-grip silverware
- Devices for washing and bathing such as portable commodes, shower seats, transfer benches, or completely rehabbing the shower for walk-in or roll-in use
- Kitchen upgrades to make life easier like adjustable-height cupboards, grabber tools, easy-grip appliance controls, and pull-out shelves or pull-down shelves
Determining the level of care your senior needs
The Katz Index of Independent Living is one of the most widely used tools health professionals employ to assess a patient’s ADL skills and determine what level of care is needed to keep your loved one safe and healthy. Another assessment scale is the Lawton-Brody Instrumental Activities of Daily Living Scale, which measures IADL skills.
These assessment tools are essential when an older adult is transitioning from a hospital stay (due to illness, surgery or other medical issues) to their living situation, whether a private home or a senior living community. Many older patients have difficulty regaining their basic living skills after a lengthy hospitalization or severe illness, and caregivers should be clear if they’ll need to bring in additional help to manage the extra care required.
If ADLs and IADLs are not manageable, it may be that you and your loved one – if they’re still living on their own – will need to have a conversation about relocating to a senior care community where they can get more of the attention they need.