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The activities of daily living (ADL) is a term used to describe all of the day-to-day tasks and skills someone needs to perform in order to properly care for themselves. If someone is unable to perform the activities of daily living in any capacity, they are considered unsafe/unable to live alone. They will be more dependent on others for their quality of life. In this article, we’re going to explore what the activities of daily living are, how to measure them, and what to do if an adult is unable to meet their own needs.

What are the Activities of Daily Living (ADL)?

There are two different classifications for activities of daily living: there are basic activities of daily living (basic ADL) and instrumental activities of daily living (instrumental ADL). The basic ADL are the skills needed to manage basic needs, such as maintaining personal hygiene. The instrumental activities of daily living cover the more complicated activities, such as paying bills and food preparation.

Basic ADL

Here are the Basic ADL categories according to the National Institute of Health:

  • Ambulating: Their ability to get from one position or place to another and walk independently.
  • Feeding: Their ability to feed themselves.
  • Dressing: Their ability to select appropriate clothes and put the clothes on themselves.
  • Personal hygiene: Their ability to bathe and groom themselves, including things like maintaining dental hygiene, nail, and hair care.
  • Continence: Their ability to control bladder and bowel function (remain accident-free).
  • Toileting: The ability to get to and from the toilet, use it appropriately, and clean themselves after.

Someone who is unable to manage one or a few of these may still be able to care for themselves, it will depend on the task and severity of impairment. These are the basic categories of measurement to determine whether or not someone may need assistance from a caregiver on a daily basis. 

Instrumental ADLs

The instrumental ADLs require a bit more complexity of thought and effort, so they may be indicative of a problem, or the beginning signs of a chronic and/or debilitating condition.

Here are the instrumental ADLs according to the National Institute of Health:

  • Transportation and shopping: Their ability to run errands, attend events, manage personal transportation, (either via driving or by successfully organizing other means of transport).
  • Managing finances: Their ability to remember and pay their bills and manage their financial assets.
  • Shopping and meal preparation: i.e., can they do everything required to get a meal on the table? This also includes things like shopping for clothing, caring for pets, and other items required for daily life.
  • Housecleaning and home maintenance: Can they clean the kitchen after eating, maintain living areas and keep them reasonably clean and tidy, and keep up with home maintenance?
  • Managing communication with others: Their ability to manage telephone and mail.
  • Managing medications: Their ability to obtain medications and take them as directed.

Someone that is unable to manage these tasks will likely ask for help (sometimes sooner than someone that needs assistance with some of the basic ADL).

How do you Measure Activities of Daily Living?

There are many reasons you may want to measure someone’s ability to care for themselves using the ADL criteria. Aging or debilitating, chronic, or worsening conditions are all legitimate causes for concern. You may want to consider regularly testing your loved one as their age or condition progresses.

ADL Measuring Tool 1: Katz Index

To measure the basic ADL, the Katz scale is a commonly used point of reference. Click here to download the Katz Index of Independence in Activities of Daily Living. This checklist will walk you through tasks of daily living and help you score yourself or a loved one. Your score will then be a useful indication of what next steps to take.

This index will give you a useful idea of where on the scale you or your loved one falls, but this scale has some limitations in that it is very high-level, so some of the more complex tasks or nuanced answers are unaccounted for.

ADL Measuring Tool 2: Lawton Instrumental Activities of Daily Living (IADL) Scale

To measure the instrumental ADLs, the Lawton Instrumental Activities of Daily Living (IADL) Scale is a bit more accurate. The Lawton Instrumental Activities of Daily Living (IADL) Scale is more nuanced and should help you see exactly how well your loved one is functioning currently, and can be used as a benchmark to identify changes (whether conditions improve or deteriorate) over time.

Click here to download the Lawton Instrumental Activities of Daily Living (IADL) Scale.

Next Steps if an Adult is Unable to Meet a Satisfactory Level of the Activities of Daily Living

If an adult is unable to meet a satisfactory level of the activities of daily living, here’s what to do next:

  • Contact the loved one’s doctor or care team.
  • Make any needed immediate changes to accommodate for any deficiencies and ensure they have safe living conditions.
  • Hire a caregiver or become a caregiver for your loved one.
  • Consult a professional for further assessment to pinpoint needs and prevent deterioration in their quality of life.
  • Create a care plan.

About the California Caregiver Resource Centers

Finding out you may need to become or hire a caregiver can be a terrifying realization. Rest assured that you are not alone in this–we’re here for you.

The 11 nonprofit California Caregiver Resource Centers (CRCs), serve family caregivers of adults (18+) affected by chronic and debilitating health conditions.

Combined, the CRCs serve every county in California. Each CRC tailors its services to its geographic area, and each offers family caregivers a range of core programs from counseling and care planning, to legal/financial consulting and respite, at low to no cost.

Click here to find your local CRC.

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