Last month, a co-worker’s mother-in-law fell and broke her hip. After surgery and a stay in a rehabilitation facility, she headed home. Before she could do that, her medical team assessed her ability to care for herself and set in place support necessary to bridge the gap between what she could do herself and what she would need help with during her recovery.
The first step in these assessments was determining her level of independence in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Understanding these terms and what a powerful role they play in understanding a loved one’s ability to care for themselves is key in the rehabilitation, recovery and treatment of health conditions, both acute and chronic.
What are ADLs?
Activities of Daily Living (ADL) are activities related to personal care. This term is used to collectively describe fundamental skills necessary to independently care for oneself.
ADLs include six categories including:
- Ambulating: The extent of an individual’s ability to move from one position to another and walk independently.
- Feeding: The ability of a person to feed oneself.
- Dressing: The ability to select appropriate clothes and to put the clothes on.
- Personal hygiene: The ability to bathe and groom oneself and maintain dental hygiene, nail, and hair care.
- Continence: The ability to control bladder and bowel function
- Toileting: The ability to get to and from the toilet, using it appropriately, and cleaning oneself.
In addition to ADLs, IADLs are important skills necessary for independent daily functioning. Instrumental Activities of Daily Living (IADL) include more complex activities. IADLs include higher level thinking and organizational skills.
What are IADLs?
IADLs include the following six categories:
- Transportation and shopping: Ability to procure groceries, attend events Managing transportation, either via driving or by organizing other means of transport.
- Managing finances: This includes the ability to pay bills and managing financial assets.
- Shopping and meal preparation, i.e., everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
- Housecleaning and home maintenance. Cleaning kitchens after eating, maintaining living areas reasonably clean and tidy, and keeping up with home maintenance.
- Managing communication with others: The ability to manage telephone and mail.
- Managing medications: Ability to obtain medications and taking them as directed.
The History of ADL and IADL Indexes:
The term Activities of Daily Living was first by Dr. Sidney Katz in 1950. Katz and his colleagues created a measurable index for functional assessment of older adults with chronic health conditions, many of which require long-term care, services and support. This was a major contribution for healthcare and older adults, as it provided a way for doctors and medical providers to assess a patient’s ability to care for themselves and which services and supports are necessary to assist in this care.
The ADL index was based on a study of 64 hip fracture patients who were admitted to the Benjamin Rose Hospital. The study occurred over an 18-month period, and the goal of treatment was to restore patients to as much independent functioning as possible. Measures of independence in the six categories were clearly defined. For example, being able to independently dress oneself included being able to “get all the clothes from the closet or drawer, put them on and fasten them without supervision, direction or active assistance.”The researchers also found that ADLs had a hierarchy, with bathing being the most complex task and feeding the least complex.
With more research, time and scientific development, the concept and index of ADLs was expanded to include IADLs with Lawton’s and Brody’s 1969 research and publications. Today, we use both the ADL and IADL indexes to measure a person’s ability to independently care for him or herself.
Measuring ADLs and IADLs for Care and Support:
Medical professionals and healthcare providers can assess for independent living using multiple measures and assessments. Two of the most common and valid measures include the Katz ADL and the Lawton-Brody IADL assessments.
The Katx Index of Independence in Activities of Daily Living (Katz ADL) is a one-page assessment of an individual’s ability to perform ADLs either independently or dependently. A score of 6 indicates a highly independent patient, and a score of 0 indicates a patient who is very dependent.
The Lawton-Brody Instrumental Activities of Daily Living Scale (I.A.D.L.) is a one-page, 8-section evaluation of a patient’s ability to perform tasks and activities in the following categories: ability to use the telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility of own medications and ability to handle finances. Each category has a range of scoring options to determine the level of functioning for this category of tasks. The assessment is simple, short and clear.
Assessing for ADLs and IADLs is helpful in determining rehabilitation needs and plans for specific in-home services such as meal preparation, personal care and nursing care, among others.
Where and How to Get Help and Support with ADLs and IADLs:
Medical professionals and healthcare workers are often the starting point for assessing one’s ability to perform ADLs and IADLs. However, many other professional services and resources exist to coordinate care, offer assessment and provide continued support.
Aging Life Care™ Professionals (Geriatric Care Managers) can help families prepare for the support and services necessary for rehabilitation and recovery after a health crisis and as on-going support for chronic health conditions. Their professional support and expertise may, for example, help clients identify solutions to problems such as where to find meal delivery services, how to manage finances and where to hire help for bathing and grooming needs as the client continues to recovery.
Aging Life Care™ Professionals also help families navigate a move into a care community when living independently in their private home is no longer the best option. They have extensive knowledge about the costs, quality, and availability of resources in their communities.
For more information and support, reach out to one of our Aging Life Care™ Professionals.
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