Activities of Daily Living (ADL):

ADL, or activities of daily living, includes the necessary and standard daily activities that a person needs to perform to survive. Most healthy people can accomplish these self-care activities independently and without much thought. These skills are developmentally learned throughout childhood and early adulthood. Activities of daily living examples include feeding oneself and brushing one’s teeth, among other activities.

People develop the ability to feed themselves around 6 to 12 months of age by holding a cup and other utensils to independently eat. Around this time, about 12 months of age, a child will begin to work on their mobility by independently walking from one area to another. When a child reaches about 3 years of age, they will begin to have control of their toileting schedule, another important aspect of ADLs. At around 5 years of age, a child will be able to independently dress themselves in weather-appropriate clothing and will begin showering independently. These skills are fine-tuned as people reach adulthood and include paying bills and other more complex skills. Activities of daily life are essential skills that are a routine part of an adult’s life and are learned in early childhood.

Why Are ADLs Important?

ADLs are important because they allow a person to thrive independently in their home environment. This provides a level of human dignity that is salient to a person’s happiness and health. A person who can easily feed themselves, dress, and move without mobility restrictions, is healthier than a person who needs assistance in these areas.

If a person is declining in their ADLs, it is an indication of an extreme progression of disease processes. ADLs can be thought of as the most basic form of living and thriving. If a person needs assistance with ADLs, their health is dramatically decreased.

Examples of disorders that may limit a sufferer’s ability to perform certain ADLs include:

• migraine headaches
• Multiple sclerosis
• Parkinson’s disease
• Alzheimer’s disease
• Cancer

Any disease process that can disorient or cause a disruption in physical activity can cause a decrease in a person’s ability to independently perform ADLs.

Basic and Instrumental Activities of Daily Living
ADL examples include ways in which a person can live independently and manage their life successfully.

There are two categories of ADLs, or activities of daily living:

Basic Activities of Daily Living, or BADLs
Instrumental Activities of Daily Living, or IADLs.
BADLs

Basic Activities of Daily Living, or BADLs, refer to the basic activities a person needs to perform to stay alive and healthy. These activities need to be performed every day and are learned when a person is a toddler.

Instrumental activities of daily living or IADLs, examples include:

• driving or arranging public transportation
• paying bills and other personal financial obligations
• meal preparation
• housework such as cleaning and laundry
• medication regimen management
• making appropriate shopping decisions
• communication through email or telephone

IADLs are another essential component of managing an independent household. These activities are more complicated than BADLs. IADLs are often compromised earlier in an illness than BADLs. They may be the first warning sign of declining overall health status.

IADLs

Instrumental activities of daily living, or IADLs, are the more complex life skills needed to live independently. These skills are developed through early adulthood and are not necessarily accomplished every day.

Instrumental activities of daily living or IADLs, examples include:

• driving or arranging public transportation
• paying bills and other personal financial obligations
• meal preparation
• housework such as cleaning and laundry
• medication regimen management
• making appropriate shopping decisions
• communication through email or telephone

IADLs are another essential component of managing an independent household. These activities are more complicated than BADLs. IADLs are often compromised earlier in an illness than BADLs. They may be the first warning sign of declining overall health status.

ADL Assessment

Activities of daily living are an indication of a person’s overall health and ability to maintain a household independently. While health professionals can assess a person’s ADLs using several methods, the person suffering from the ailment or the family is often the first to recognize the decline in independence. These are the people who are witnessing the person in their home environment and noticing the decrease in functionality.

Functional assessments are used to document the skills a person struggles with.

Katz Index of Independence

The Katz Index of Independence is an observational tool used by healthcare professionals to assess a person’s basic activities of daily living level. It does not measure IADLs. It assesses bathing, dressing, toileting, transferring, continence, and feeding.

A patient is given a score of 1-6, 6 being able to complete all tasks independently. A score of 2 would indicate severe impairment of BADL tasks. It is used primarily with older adults and has been in use for over 35 years. Its limitations include the inability to assess IADLs and not being sensitive to small changes in health status.

Barthel Index

The Barthel Index is used for health care professionals to measure the BADLs of a patient through patient and nurse interviews. This assessment refers to the past 48 hours and covers ten areas of ADLs.

Each of the ten categories is rated 0-2, 0 being unable to complete the activity and 2 being able to complete it independently. The final score is multiplied by 5 and out of a total score of 100. A score of 0-20 means total independence for another person for BADLs, while a score of 91-99 would indicate slight independence. If a person needs supervision, they are considered not independent. If they need to use an assistive device to accomplish the task, they are considered independent in that area. This is a commonly used, accurate assessment took for BADLs.

Lawton IADL Scale

The Lawton Instrumental Activities of Daily Living Scale was developed in 1929 to measure a person’s ability of independence with regard to IADLs. This quick assessment takes 15 minutes and is done through a written questionnaire or an interview with the subject or someone familiar with the person. Eight areas are assessed, and the higher the score is, the more independent the subject is.

It is used by healthcare professionals to assess older adults who live within the community. It is not used for those who are already dependent on others for care, such as those living in an elderly community, because it is assumed that they are not capable of performing IADLs.

Others

Other, more fine-grained scales are used to measure more specific competencies of ADLs.

These include the following tests:

The Wolf Motor Function Test:
Measures upper strength ability through timed functional tasks. A 6 point scale is used to assess 21 specific upper extremity movement activities. The maximum score indicating independence is 75.

The Functional Reach Test:
Measures the risk of falling in a patient by assessing their ability to reach outward while maintaining their balance. If they are unwilling to reach outwards, this is an indication of an increased risk of falling. If they can reach 10 inches or more while maintaining their stability, they have a reduced risk of falling.

The Executive Function Performance Test:
Is an assessment based on the observation of the patient while they perform four IADL tasks. The tasks are basic cooking, telephone use, bill payment, and medication management. It assesses the patient’s ability to initiate the task, complete the task, and perform the task. It can be used on a broad population.

Assistance With Activities of Daily Living

Some patients will need assistance while performing basic activities of daily living. This includes equipment, devices, and other kinds of technology to aid them in their ability to live independently and maintain their health.

The following list includes examples of equipment to assist in basic activities of daily living:

• Mobility devices such as canes, wheelchairs, and walkers
• Special utensils with longer handles to aid in independent feeding
• Medication reminders and alarms
• Daily medication organizers
• Shower seats
• Long-handled shoe horns
• Button hooks
• Velcro
• Dressing sticks
• Reachers
• Handheld shower
• Plate guard
• Hearing aids
• Reachers can be used to help a person with their BADL.

Reasons for Assessments

Due to birth defects, accidents, disease, or simply aging, people may lose these self-care skills to varying degrees. In older populations, changes in behavior may indicate loss of ADLs. Perhaps bills are going unpaid, the house is not as tidy as usual, medications are not taken, or the refrigerator contains only a few foods and they may be obviously past their prime. Maybe the individual is getting lost in familiar places or having car accidents, his clothes appear dirty, or there is some unpleasant body odor. People who are losing their BADLs may have difficulty walking or experience frequent falls.

When these concerns are brought to the attention of a physician, the health care team will do a functional assessment to document the areas of concern. This assessment helps them identify possible root problems, like dementia, an acute physical condition, or the worsening of a chronic disease, and determine what diagnostic studies are needed to figure out why the person is having these problems, especially if they are new problems. The functional assessment also helps clarify for the family the specific kinds of help their loved one needs in order to live as independently as possible.

Physicians, nurses, and medical social workers use the functional assessment to assess their patients’ needs in outpatient settings, but a functional assessment of BADLs and IADLs can also be used by hospitals to determine if a patient is ready for discharge and able to care for himself after hospitalization for surgery or other treatments. Care agencies, rehabilitation, and care facilities use functional assessments to determine appropriate placement for patients. A functional assessment can also influence insurance coverage. For example, if the individual has long term care insurance, most companies require impairment in three or more BADLs before they will provide benefits, helping with the costs of care.

Lesson Summary

Let’s review. Everyone, to the best of their ability, must learn activities of daily living (ADLs) in order to live as independently as possible because they’re the common, everyday self-care skills we all need to live safely and independently. Most of us learn BADLs, or basic ADLs, including feeding ourselves and using the toilet, as infants, toddlers, and preschoolers. By the time we finish high school, we’ve learned our IADLs, or instrumental ADLs, including driving, cooking, handling money, and more. Health care professionals use functional assessments to measure our skills in these areas to help identify problems and clarify solutions to enable us to live as independently and safely as possible.

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