Activities & Instrumental Activities of Daily Living - Definitions, Importance and Assessments

Page Reviewed / Updated - May 2018

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Table of Contents

What are the Activities of Daily Living

What are the Instrumental Activities of Daily Living

Why are the ADLs and IADLs Important

Activities of Daily Living Checklist

Other ADL and IADL Scales

Getting ADL Assessments

What are the Activities of Daily Living (ADLs)?

The Activities of Daily Living are a series of basic activities performed by individuals on a daily basis
necessary for independent living at home or in the community. There are many variations on the
definition of the activities of daily living, but most organizations agree there are 5 basic categories.

1. Personal hygiene – bathing/showering, grooming, nail care, and oral care

2. Dressing - the ability to make appropriate clothing decisions and physically dress/undress oneself
3. Eating - the ability to feed oneself, though not necessarily the capability to prepare food

4. Maintaining continence - both the mental and physical capacity to use a restroom, including the ability
to get on and off the toilet and cleaning oneself

5. Transferring/Mobility- moving oneself from seated to standing, getting in and out of bed, and the
ability to walk independently from one location to another

Whether or not an individual is capable of performing these activities on their own or if they rely on a
family caregiver for assistance to perform them serves a comparative measure of their independence.

What are the Instrumental Activities of Daily Living (IADLs)?

Instrumental Activities of Daily Living are actions that are important to being able to live independently,
but are not necessarily required activities on a daily basis. The instrumental activities are not as
noticeable as the Activities of Daily Living when it comes to loss of functioning, but functional ability for
IADLs is generally lost prior to ADLs. IADLs can help determine with greater detail the level of assistance
required by an elderly or disabled person. The IADLs include:

1. Basic communication skills - such as using a regular phone, mobile phone, email, or the Internet

2. Transportation - either by driving oneself, arranging rides, or the ability to use public transportation

3. Meal preparation - meal planning, cooking, clean up, storage, and the ability to safely use kitchen
equipment and utensils

4. Shopping - the ability to make appropriate food and clothing purchase decisions

5. Housework - doing laundry, washing dishes, dusting, vacuuming, and maintaining a hygienic place of
residence

6. Managing medications - taking accurate dosages at the appropriate times, managing re-fills, and
avoiding conflicts
7. Managing personal finances - operating within a budget, writing checks, paying bills, and avoiding
scams

Why are the ADLs and IADLs Important?

Many eldercare financial assistance programs use the inability to perform a specific number of the
activities of daily living as eligibility criteria.

Measuring an individual’s inability to perform the ADLs and IADLs is important not just in determining
the level of assistance required, but as a metric for a variety of services and programs related to caring
for the elderly and for those with disabilities.

Many state-funded, non-Medicaid programs, such as Texas Community Care for the Aged/Disabled and
New York’s EISEP Program use an inability to perform 2 or 3 activities of daily living as one of the
eligibility criteria for participation in their assistance programs.

Medicaid often requires elderly participants to be qualified for nursing home care, and often nursing
home care qualification is partially determined by how much assistance one requires with ADLs. While
Medicare doesn’t pay for custodial or personal care, which most of the ADLs are considered, Medicare
PACE programs, which provide all-inclusive care for the elderly, do consider them a factor.

Long-term care insurance often uses an inability to perform ADLs as a trigger for paying out on a policy.
Social Security Disability Insurance (SSDI) also considers ADLs as a qualification factor.
Activities of Daily Living Checklist

PBS.org and the AARP developed the following Checklist of Activities of Daily Living worksheet as a tool
to help families determine with which ADLs and IADLs their loved ones require assistance and how much
assistance is needed. To complete the checklist, mark one of the four categories, indicating how much
assistance your loved one requires to perform the activities listed in the left hand column.

Did You Know? There are over 500 programs nationwide that provide financial assistance to help care for
an aging loved one. Find programs which can help your family.

ADLs / IADLs Requires No

Assistance Some

Assistance

NeededComplete

Assistance

NeededNot

Applicable

Bathing

Dressing

Grooming

Oral Care

Toileting

Transferring

Walking

Climbing Stairs

Eating
Shopping

Cooking

Managing Medications

Uses the Phone

Housework

Laundry

Driving

Managing Finances

Totals

Other ADL and IADL Scales

There are other related ADL / IADL measurement scales and tests. Two of which provide point-scoring
systems to help families to determine the types and extent of care necessary. One can learn more about
these at the links below.

Lawton IADL Scale - measures on a scale of low functioning to high functioning

Katz Index of Independence in ADLs – measures on a scale of dependency to independency

Getting ADL Assessments

Some Area Agencies on Aging offer free activities of daily living assessments.

There are several options available to families who wish to have an assessment of their loved one's
ability to complete the activities of daily living. Choosing amongst these options largely depends on the
purpose for which one wants an assessment of ADLs (also called a geriatric assessment).

For families who simply wish to have a scale by which to judge the ability of their loved one to function
independently, there are multiple online geriatric assessment tools. Many of these are intended for use
by untrained professionals and are easy to complete. A family member answers a series of questions
about their loved one who requires assistance, tallies up a point total, and compares their results to
other individuals. A free, self-administered test for cognitive impairment is available here.

For a more formal ADL assessment, many families turn either to their family doctor or to an occupational
therapist. This type of assessment is more focused on one’s medical well being than the free online
tools, which tend to focus on non-medical care needs. Depending on the situation, Medicare may pay for
an ADL assessment.
The third objective families often have when getting an ADL assessment is to determine if a loved one is
functionally eligible for a government assistance program, such as Medicaid. Local Area Agencies on
Aging (AAAs) often serve as the gateway to assistance programs, and many of these will provide activities
of daily living assessments as part of the application process. One should contact their local area
agencies on aging and inquire.