ADLs And IADLs – A Guide For Caregivers

Are you a caregiver to an older adult or an elderly family member? Learn about ADLs and IADLs to provide the best care for them. 

As people grow old, their physical and mental conditions start to decline. They begin to need more help with daily activities. 

ADLs and IADLs help measure their abilities to complete the tasks and take care of themselves. As a caregiver, you need to monitor these functions to ensure that an older adult is safe and comfortable. Take a look at the following sections to learn more about ADLs and IADLs. 

ADLs And IADLs

ADLs vs. IADLs: What is the Difference?

In 1950, Sidney Catz coined the term “activities of daily living” (ADLs). These activities, concerning the elderly, help to understand their functional ability. 

The term “instrumental activities of daily living” (IADLs), on the other hand, is related to the person being able to live without assistance. It does fall under the ADLs system but is another category for which it is essential to monitor every older adult. 

ADLs are tasks that every adult should be able to complete. When people grow old, they may find it challenging to do the simplest tasks. 

This usually happens due to issues with motor skills or cognitive function but may also result from both. If you are a caregiver, you can monitor every aspect of ADLs and ensure that your family member is safe at all times. 

Categories of ADLs

Maintenance of Personal Hygiene

Usually, a healthy elderly person can maintain their hygiene. You need to check if they are grooming themselves, maintaining oral hygiene, taking care of their nails and hair, and bathing. Personal hygiene is something that needs to be maintained every day. 

Ability to Dress

A part of ADLs dependency includes not being able to dress oneself. Suppose your loved one or the elderly patient in your care is facing difficulty finding and wearing appropriate clothes.

In that case, you need to intervene and provide assistance. The ability to dress is not just about putting clothes on, but also about knowing what dress to choose for what occasion. 

ADLs And IADLs

Ability to Self-Feed

An older adult living unassisted should be able to eat on their own. While they may not be able to prepare meals or arrange them, they need to feed themselves without making a mess. 

Continence Management

Continence management as a category of ADLs means using the bathroom. It does not only point towards the physical ability to go into the bathroom and use the available facilities. It also means understanding when they need to use the bathroom. 

Ambulating

As one grows older, likely, their limbs will not be as mobile as before. Ambulating means the ability to move independently and change position.

Suppose it takes considerable effort for a person to move on their own. In that case, you may need to check other ADLs categories to determine if they need assistance. 

Categories of IADLs

IADLs are a part of the ADLs system, but they are more complex. These activities are primarily focused on independent movements and functions. As a caregiver, you need to monitor IADLs in elderly individuals who live alone. 

Suppose an elderly family member or patient wants to live without assistance. In that case, their IADLs must prove their ability to do so. IADLs are usually challenging skills for older adults, and these are the first activities that require assistance. 

ADLs And IADLs

However, they are not essential for survival like ADLs. IADLs offer enrichment and help older individuals to take care of themselves better. Following are some of the categories of IADLs that caregivers should assess to ensure that the person can live unassisted. 

Shopping

Elderly people living alone and unassisted should be able to shop for themselves. Now, shopping includes knowing when to buy what and where to shop, and it also includes finding the correct items and then purchasing them. 

Preparation of Food

Caregivers should test an older adult’s ability to prepare food for themselves when assessing IADLs. An independent elderly person must be able to find the right ingredients and safely cook food. 

Management of Finances

If an elderly individual lives on their own, they will need to manage their finances. This includes paying for utilities on time, budgeting, managing the bank account and all financial assets.

Being unable to take care of one’s finances due to forgetfulness or not understanding personal finances are usually signs of IADLs dependency. 

Following Prescriptions

As your family members grow older, they will need more medications for various illnesses. You will usually notice this in elderly patients with pre-existing medical conditions.

However, suppose someone is living independently, despite health deterioration due to age. In that case, they need to take their medicines on time. If you are a caregiver, you need to ensure that the elderly person can take medications as per the prescription.

They should also be able to visit a pharmacy and fill up the prescription when necessary and without any delay. 

ADLs And IADLs

Finding Transport

Unassisted older adults need to move around, and therefore, they need to arrange for transport. This is an important aspect to note for IADL dependency.

If you see that an older person can commute and is comfortable traveling in public or private transport, then it is alright. However, if the person struggles when outside, it may be dangerous, leading to accidents. 

Communication

It is essential to be able to communicate with friends and family. Elderly individuals living alone need to communicate via telephone or mobile or any other means with their friends, families, and neighbors.

While the ability to communicate with ease helps them stay cheerful, it also helps them during an emergency. 

Home Maintenance

Most elderly people living unassisted will have housekeeping or other maintenance services. However, like personal hygiene in ADLs, home hygiene is essential when assessing IADLs. They must keep their home well-maintained, clean, and comfortable for visitors. 

ADLs And IADLs

Occupational Therapy and Unassisted Living

These are two commonly associated terms with ADLs. Let us understand them in more detail below.

Occupational Therapy

Occupational therapy is for people who struggle with ADLs. Occupational therapists will help elderly individuals perform tasks that are essential for daily living, making them more comfortable at home or when in an assisted living facility. 

Unassisted Living

While unassisted living is not the best option for older adults, they can opt for it if they are not IADLs assistance dependent. They must also perform daily living activities to ensure that they are safe and comfortable. 

Why Should Caregivers Focus On ADLs And IADLs?

Caregivers need to focus on ADLs and IADLs as they help to determine an older adult’s physical abilities and cognitive functions. They also help determine what kind of care is necessary for an individual. 

If an elderly person is struggling with ADLs, they will require constant assistance. However, if they are struggling with IADLs, then a family member or a caregiver can come in once in a while to help out. 

But, some older adults deal with both ADLs and IADLs limitations. They require assisted living services and 24/7 care. 

ADLs And IADLs

Factors That Affect ADLs And IADLs

As one grows older, health starts to deteriorate, which affects ADLs and IADLs to some extent. However, even older adults who are primarily healthy may need help with mobility or tasks like shopping and cooking once in a while.

Now, these are common issues that aren’t causes of concern. But, ADLs and IADLs can become severely affected due to specific physical and mental conditions. 

Following are some of the factors that may limit ADLs and IADLs. As a caregiver, you must monitor senior people for these signs.

Age

Age is the first and most obvious factor in ADLs and IADLs dependency. You will notice limitations in the elderly members of your family, and they are likely to need some assistance. 

Side Effects of Medications

Seniors who have certain illnesses or pre-existing medical conditions need to take different medications. These drugs may have specific side effects that limit ADLs and IADLs. 

Cognitive Issues

Cognitive issues include memory problems or dementia. The onset of dementia is a sign of cognitive decline, and elderly people who suffer from the condition should not be living unassisted. 

They become very dependent due to most ADLs and IADLs aspects failing and, therefore, needing round-the-clock care. 

ADLs And IADLs

Chronic Medical Conditions

If an older adult has a chronic condition, it may stop them from doing daily activities. They may become IADLs assistance dependent first before dealing with ADLs dependency as well. 

Pain

Older adults often suffer from joint pains, and they may also have pain in other parts of the body. It becomes challenging to move and complete simple tasks on a daily basis, and therefore, they require assistance. 

Mental Health

Mental health can deteriorate with age. Seniors may suffer from bouts of depression, especially if they are ill or cannot communicate with family or friends. ADLs and IADLs may also be affected if there is any untreated mental illness. 

There are also specific social factors like isolation that affect mental health and result in seniors becoming dependent. 

Disability

If an elderly individual is differently-abled, they will find it challenging to complete daily activities. They are likely to need assistance for ADLs and IADLs, and as a caregiver, you need to provide constant support.

ADLs And IADLs

Assessing ADLs And IADLs

There is no singular or universal method of assessment for ADLs and IADLs. Those who are qualified to conduct evaluations can use different methods. 

Assessment of an elderly individual’s ability to perform daily activities can be done by caregivers, social workers, physical and occupational therapists, primary care physicians, skilled nurses, government agencies, or LTC insurance agencies. 

To assess the ability to perform all activities of daily living, qualified individuals and caregivers will have to monitor the elderly person. It is essential to observe and keep detailed notes on their physical and mental conditions so that you can quickly identify any changes. 

Once all information is collected, you can evaluate whether the person is ADLs and IADLs assistance dependent or not. 

When are Assessments Necessary? 

Caregivers need to be aware of all changes in the physical and mental conditions of the elderly. If you are not a full-time caregiver, keep an eye out for symptoms that point towards dependency when you go over for a visit.

It is best to monitor the following signs to understand if any ADLs and IADLs assessments are necessary. 

Deterioration of Health

As people grow old, they may develop health problems. These may be due to pre-existing conditions or newer illnesses.

Suppose one’s health continues to deteriorate at old age, and there are frequent visits to the ER or stays at the hospital. In that case, an assessment may be necessary. 

Abuse

Many families or even assisted living facilities to exploit and abuse older people. If you are concerned about your loved one being subjected to physical, verbal, or emotional abuse, you must act immediately. As a part of rehabilitation, ADLs and IADLs assessment will have to be conducted. 

ADLs And IADLs

Memory Issues

Elderly people often have trouble remembering. They may forget events that happened a long time ago, but what is most concerning is forgetting their name or address or failing to recognize known people and places. If this happens, you must schedule an assessment. 

Difficulty in Driving

If an older adult is driving, it is best to monitor their abilities. They may have caused or been in an accident while driving, or passengers may have felt unsafe while being in the car.

It is essential to look into these matters and test the abilities of the elderly person to ensure that the situations do not get worse. 

Improper Management of Finances

If an older family member lives alone and unassisted, keep an eye on their finances. They may not be able to meet payment requirements or may get involved in scams without realizing the dangers of such transactions. This is a sign of IADL dependency and needs to be addressed immediately. 

ADLs And IADLs

Final Words

Caregiving depends on the needs of every individual. Therefore, you must analyze every aspect of ADLs and IADLs assistance dependency to determine what kind of care you need to provide. 

We hope this guide was able to give you all the necessary information to assess the ability of those in your care to perform various activities, and therefore what kind of support they need.

You can come back to this guide whenever you want and learn more about ADLs and IADLs care. Don’t forget to share the information with other caregivers, and on your social media profiles!