ADLs: What are Activities of Daily Living?

The last few decades have seen a steady increase in public concern for the quality of life of individuals, who either through serious illness, injury or old age, have suffered disabilities. A lot of focus is placed on a patient’s inability to perform Activities of Daily Living (ADLs.) ADLs have been medically classified as daily self care activities such as eating and bathing, which are essential to a patient's quality of life (according to MedicineNet.) There are five primary ADLs for which there exists many health care programs, in-home assisted living specialists and caregiver services at your disposal. If you are having difficulty performing one of these activities, or are the caregiver of a patient suffering as such, the amount of resources and information available on ADLs should offer some peace of mind.

Photo by Gable Denims

Photo by Gable Denims

Primary Activities of Daily Living (ADLs)

Serious illnesses such as Alzheimer’s disease, heart disease, cancer, and Parkinson’s disease can all lead to difficulties performing ADLs, as can debilitating injuries and old age. A 2009 study by the National Center for Assisted Living (NCAL) indicates that a patient's inability to perform ADLs typically follow an accumulative pattern, wherein bathing is the first ability to be lost. A further categorization of IADLs is used for Instrumental Activities of Daily Living, tasks which have been deemed important for independent and community living, but not essential for day to day functionality.

  • Bathing encompasses general hygiene and grooming tasks, such as showering, drying off and teeth brushing. It is commonly the first ADL to be lost by the patient because it tends to be physically demanding, requiring stretching and balancing on a slippery surface.
  • Dressing can be a precarious activity due to similar physical limitations as those required by bathing. Patients who have only recently lost the ability to perform ADLs may feel embarrassed about admitting it, and instead they may forgo bathing and dressing. This behavior can lead to complications from the accumulation of bacteria and the development of skin rashes.
  • Mobility may encompass several tasks, the most important of which are a patient’s ability to walk to the bathroom or attend healthcare appointments. In-home medical equipment that could considerably aid in the patient's mobility are covered by most insurance plans.
  • Toileting assistance for disabled patients requires the constant attention of an in-home caregiver or assisted living service. Incontinence can be emotionally difficult for the patient. The psychological symptoms associated with the inability to perform ADLs could merit the assistance of a social worker, psychologist or spiritual assistant.
  • Eating is typically the last ADL to be lost to the patient. Assistance with eating can be as simple as spoon feeding the patient, or as intensive as the application of a feeding tube. This categorization does not include the preparation of meals, which is classified as an IADL.
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Instrumental Activities of Daily Living (IADLs)

IADLs are categorized as being functions necessary for life as an independent adult, but not absolutely essential for daily living. Studies performed by the NCAL have found no accumulative pattern in the loss of ability to perform IADLs.

  • Finance Management like bank transactions or checkbook balancing.
  • Travel Assistance such as driving or guidance with public transportation.
  • Shopping for groceries or acquisition of medications.
  • Cooking is one of the more important IADLs.
  • Communication via telephone calls, internet or post.
  • Managing Medications and scheduling doctor’s appointments.
  • Housework such as cleaning, dish washing and home maintenance.
Photo by Gable Denims

Photo by Gable Denims

The In-Home Caregiver’s Role

If you are the caregiver for a loved one or family member, your role is essential to their quality of life. The degenerative nature of many serious illnesses and old age mean that the caregiver’s role can becoming more taxing over time, but as the patient's ability to perform ADLs diminishes the amount of services and options available to you both increase. The Wisconsin Department of Health Services acknowledges that patients often overstate their independence. It’s imperative to determine the level of assistance necessary by more than just a diagnosis or the patient’s report. Observation of the patient’s behaviour is important, but also an assessment of their living situations. Oftentimes an adequately installed bar or seat in the bathtub, or similar fixes, can help them perform the simpler ADLs independently for a time. Dressing and mobility are ADLs that can often be overseen or assisted by multiple family members in an effort to share the cumbersome task. Training for toileting and eating assistance are widely available. These courses may offer certification which could be useful in receiving insurance coverage as a caregiver.

Photo by Gable Denims

Photo by Gable Denims

In-Home Assisted Living

In home assistance for a disabled patient has become an incredibly diversified field in recent years. The categorization includes a perpetually growing number of professions and specialization, but is always concerned with assistance to patient's suffering from the inability to perform ADLs and IADLs. Professional and family caregivers play perhaps the most crucial role and dedicate the most amount of time to a patient's care, but there are only so many skills that a caregiver can learn. Physical therapists are often utilized on a per session basis and can help some patients regain the ability to perform primary activities through rehabilitation. Motivation tends to be very important for patients to avert a rapid subsequent loss of abilities. Unfortunately, many patients suffering from disabilities experience depression, making friends, family members, community leaders, social workers and spiritual figures a useful addition to the in-home assisted living team. Doctor and nurse visits are essential to maintain an accurate understanding of the patient's condition, they will also be instrumental in helping the you formulate a caregiver's strategy.

A deterioration in the ability to perform Activities of Daily Living undoubtedly comes with hardships for both the patient and caregiver. Training for in-home caregivers is available for those of you taking on the responsibility of helping these patients perform ADLs while specialists for specific conditions abound. If you have become the primary caregiver for a loved one or family member it is imperative to remain patient and take each step as it comes. It will be a trying time for both yourself and the patient, who is probably dealing with emotional distress alongside their physical impairment.


Sources:

Medicinenet (2012, September). Definition of ADLs (activities of daily living). http://www.medicinenet.com/script/main/art.asp?articlekey=2152

Wisconsin Department of Health Services (2015, November). LTC FS Instructions Module 4 - Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). https://www.dhs.wisconsin.gov/functionalscreen/ltcfs/instructions4.htm#2

Polzer, Karl (2009, March). Assisted Living State Regulatory Review 2009. http://www.ahcancal.org/ncal/resources/documents/2009_reg_review.pdf

Kernisan, Leslie (2011). Activities of Daily Living: What Are ADLs and IADLs?. https://www.caring.com/articles/activities-of-daily-living-what-are-adls-and-iadls