What Are Activities of Daily Living (ADLs)?

Medically Reviewed by Dany Paul Baby, MD on October 04, 2022

• What Are ADLs and IADLs?
• How to Assess ADLs
• How Are ADLs Used to Provide Care?
• What to Do if an Adult Can’t Perform ADLs?

Aging is a natural part of life. One of the inevitable consequences of aging is a gradual decrease in your ability to do things you could effortlessly do before. You may even forget things randomly or get tired easily.

The effects of aging aren’t uniform and differ from person to person. Sometimes, it’s not age but illness, injury, or disability that can make it challenging to perform normal activities. The clinical manifestations of these conditions are varied, ranging from mild to debilitating.

To provide effective care and assistance, doctors may have to quantify a person’s ability to perform day-to-day tasks to determine how much help they need. They do this by measuring activities of daily living (ADLs) or instrumental ADLs (IADLs).

Read on to learn more about what ADLs involve, ADL examples, ADLs vs IADLs, the importance of ADLs, and how to assess them.

What Are ADLs and IADLs?

The term ADL was first introduced by Sidney Katz in 1950. It’s a collective term for all the basic skills you need in regular daily life. These include:

1. Ambulating. This includes the ability to walk, sit, stand, lie down and get up, and climb up and down stairs, both inside and outside your home.
2. Grooming. This includes all activities necessary to maintain personal hygiene, like brushing your teeth, bathing, shaving, and hair and nail care.
3. Toileting. This includes the ability to control your bladder and bowels (continence), use the toilet safely, and clean yourself after use.
4. Dressing. This involves the ability to dress yourself properly, including using buttons and zippers.
5. Eating. This includes the ability to use cutlery and feed yourself.

ADLs essentially indicate your ability to care for yourself without assistance. According to a 2011 U.S. National Health Interview Survey, more than 20% of adults older than 85 years require assistance with ADLs.

IADLs include more complex activities that are essential to live independently. These are important activities that you don’t need to do every day, unlike ADLs. The American Occupational Therapy Association lists 12 essential IADLs:

1. Managing your finances, including paying your bills, using bank facilities, and planning your expenses
2. Taking care of your health, including regular doctor visits and following medical prescriptions correctly
3. Doing your own shopping, including groceries, toiletries, clothing, and other necessities
4. Prepping and cooking your meals
5. Managing your transport, including driving vehicles, taking cabs, and using public transport
6. Using the telephone, post, email, and other communication devices
7. Doing household chores like cleaning, gardening, and laundry
8. Taking care of pets
9. Caring for children
10. Looking after others, including supervising caregivers
11. Maintaining religious practices, hobbies, or other interests
12. Knowing safety procedures and emergency contacts and responses

How to Assess ADLs

Health care professionals use functional assessments of ADLs and IADLs to determine an individual’s ability to live independently without harming themselves. While there are no universal assessments, here are six of the most commonly used ADL assessment tools:

Katz Index

This is a simple checklist that's mainly used for older adults to assess whether they can perform ADLs independently. It comprises a score from 0 to 6. Activities that can be done alone are scored 1, whereas activities that required supervision, direction, or assistance are scored 0. A high score indicates a greater degree of independence.

Lawton-Brody Scale

This scale assesses eight categories of IADLs. Under each category, several statements are listed, and you have to select the statement that most closely reflects your situation. The score ranges from 0 to 8, with a high score indicating high function.

Klein-Bell Scale

This scale has a 170-item list that assesses six ADL categories. Each item is scored 0 (when you can't perform the activity) or 1 (when you can perform the activity), and the score is totaled to determine your functional status. High scores indicate high independence.

Cleveland Scale

This checklist is used to assess the independence levels of people with dementia or Alzheimer’s. It has 47 items that are scored from 0 to 3 as follows:

0 = never dependent

1 = sometimes dependent

2 = usually dependent

3 = always dependent

Bristol Scale

This is a 20-item questionnaire that assesses ADLs and IADLs in people with dementia. Each item is scored from 0 to 3, with a low score indicating high dependence. A full score of 60 points indicates complete independence.

Barthel Index

This 100-point scale assesses 10 activities in people who have had a stroke. Each activity is scored between 0 and 10 or 0 and 15 points to assess your independence level. A high score indicates a greater level of independence.

How Are ADLs Used to Provide Care?

Once health care providers have assessed your ability to perform ADLs and IADLs, they can design an appropriate care plan to compensate for your deficiencies and provide adequate help. For example, occupational therapists can recommend exercises to improve ambulation and minimize the risk of falls.

Your ADL and IADL levels are also indicators of whether you’re able to live alone safely and successfully or if you require constant care. Your ADL proficiencies reveal which aspects of your daily living require additional assistance.

You may need help with only certain things like preparing meals, using the computer, managing your medications, or handling your finances. A part-time caregiver can then assist you accordingly.

The inability to perform ADLs can also indicate the development of dementia and other degenerative diseases. So, regular evaluations of ADLs in older adults and high-risk individuals can aid in providing timely care.

What to Do if an Adult Can’t Perform ADLs?

You might notice yourself or an adult you know struggling to perform ADLs satisfactorily. If you’re wondering what the best course of action is in such a situation, here are a few tips:

• Seek medical advice from your primary care physician or the nearest healthcare organization.
• Based on the health care provider’s assessment, consider making lifestyle changes to lower the difficulty level of certain daily activities and increase the safety level of your surroundings.
• Consider hiring a part-time or full-time caregiver, depending on the amount of assistance required.
• If your living conditions are too challenging or inaccessible, consider moving to a care facility to ensure safe living conditions.
• You could also contact professionals to design a care plan that will help you maintain your quality of life and monitor your progress so that any negative changes can be handled promptly.

The Bottom Line

If you or your loved ones require assistance with ADLs, don’t hesitate to seek help. Caregivers and assisted living facilities can significantly improve your quality of life by supporting you, cheering you on, tracking your progress, providing timely assistance, and helping you maintain your independence.

Regular ADL evaluations can help you catch any unnoticed symptoms early on and receive prompt treatment for a better prognosis.