As we age, sometimes the toughest decisions we have to make surround our independence. The goal is to live a full, happy, and independent life while also remaining safe.
Part of maintaining a high quality of life is determined by our ability to complete daily tasks. These daily tasks were originally dubbed ADLs (Activities of Daily Living) and IADLS (Instrumental Activities of Daily Living), by doctor Sidney Katz, and have become a common way to gauge someone’s ability to live without assistance. If you (or perhaps a neighbor or someone you love and care about) struggle with these daily tasks, there are many ways to receive help while living independently (more on this below).
So what are ADLs and IADLs, and why are they important? How do you gauge your own ability to complete ADLs and IADLs? If an aging loved one seems incapable of performing ADLs or IADLs without assistance, how do you approach this difficult conversation? Below, we'll address your concerns, and help you map out an approach that works best for your family.
What Are ADLs and IADLs?
ADLS and IADLs help determine whether an older adult is safe living at home independently or requires long-term care. If you're a family caregiver or an aging adult yourself, it's important to familiarize yourself with these terms.
What Are ADLs?
ADLs are considered essential, basic tasks required to live. As humans, we start learning these tasks as children — how to bathe, get dressed, and feed ourselves. As we age, these tasks prove to be more difficult. According to the CDC (Center for Disease Control), older adults aged 75 years and older are roughly three times more likely to have limitations with ADLs than someone aged 65-74 years old.
ADL tasks include:
Showering and bathing
Maintaining personal hygiene
Dressing and selecting appropriate clothing
Feeding or maintaining the ability to place food in one's mouth
Maintaining functional mobility, including the ability to stand up from a seated position
Toileting or using the bathroom without assistance
What Are IADLs and How Do They Differ From ADLs?
IADLs are self-care tasks that are slightly more complex than ADLs. They sometimes require organizational, spatial, or critical thinking, or are more physically demanding. These tasks include the household chores and communication skills you learn in elementary school and into your teenage years.
While IADLs are not considered necessary for basic survival, they are a large determinant of whether someone can continue to live independently without assistance. Sample IADL tasks include:
Managing personal finances, such as paying bills, monitoring assets, and performing other aspects of financial management
Performing household chores and home maintenance, such as cleaning, doing laundry, and keeping the living space tidy
Conducting meal preparation, including grocery shopping, food preparation, cooking, and serving
Managing daily mail, answering the telephone, using the computer, or maintaining other forms of communication
Being able to transport oneself to and from appointments, including calling taxis, Ubers, or public transportation
Managing medications, including knowing which medications to take and when
Why Are ADLs and IADLs Important?
ADLs and IADLs are important because they help determine if an individual is able to manage basic self-care tasks on their own. If there are certain chores that an aging family member can't complete without help, you may need to think about hiring help or moving them to a care facility.
Remember, "independent living" does not have a concrete definition — there are plenty of scenarios, options, and possibilities for determining whether someone is safe living at home alone or whether they require assistance. Therefore, when looking at a list of ADLs and IADLs, use a sliding scale to decide if your loved one is equipped to perform each task.
For example, a basic ADLs scale (Activities of Daily Living Scale) might use the following categories to evaluate how capable someone is of performing an essential bathing task:
Independent: Your loved one can get in and out of the tub on their own, brush their own hair, and keep up with other activities related to personal care.
Needs help: Your loved one can give themselves a sponge bath, but would benefit from having a caregiver stop by 2-4 times a week to help them bathe or shower.
Dependent: Your loved one can still perform some bathing activities, but only under the supervision of a caregiver.
Cannot do: Your loved one cannot bathe or maintain personal hygiene without an occupational therapist or caregiver, and should be moved to an assisted living facility.
Do IADLs Indicate Whether Someone Should Be Moved to Assisted Living?
Not necessarily. While basic activities of daily living — the ability to eat, bathe, and go to the bathroom — are essential to the survival and wellbeing of the individual, IADLs are in more of a gray area.
While limitations within IADLs will impact daily life to a degree, they do not directly threaten the individual's safety. Therefore, these constraints should not spur you to immediately move your loved one into a nursing home (especially if your IADL scale shows they are still within the "needs help" or other preliminary category).
Instead, you and other family members may want to put together a care plan to help your loved one maintain some normalcy and independence. For example, if signs show the person needs help in certain areas, you may want to hire a home health aid or ask a family member to assist with the following:
Finances: If you worry about your loved one's ability to keep up with finances, you may want to set their bills up on autopay, and save the login and password so you can check the status of payments. In addition, you may want to meet with a financial advisor and an attorney to set up a plan in case of an emergency.
Food preparation: You can set up your loved one with InstaCart or another grocery delivery service if they no longer drive. If cooking is becoming difficult, you may want to subscribe to a meal delivery service.
Home care: While daily tidying up might be possible, somewhat strenuous tasks like dusting, pushing a vacuum, or scrubbing bathrooms can be challenging for older people. You may want to hire a cleaning person to stop by every 4-8 weeks for a thorough cleaning.
General health: Are you worried about your loved one living at home by themselves? Have them install the Snug App on their phone so they can do a daily check-in, confirming that they're safe and sound. If your loved one misses a check-in, Snug will send a text or have a dispatcher call you as their emergency contact, so you can check in on them yourself. Or, if you prefer, you can elect to receive daily notifications stating that your loved one completed their check-in, letting you know they’re safe.
How to Talk to an Aging Loved One About Their ADLs and IADLs
It can be difficult to talk to an older adult about their limitations — particularly if that person is your parent. These conversations are never easy, but they are necessary.
Take comfort knowing that every family struggles with these discussions. If you approach an ADL or IADL conversation and immediately find your aging family member becoming defensive, you may want to bring in an industry professional. While an aging parent may always look at you as "their child," they might be more receptive to the advice of an insurance analyst, financial advisor, or healthcare provider.
Be sure to approach these conversations by focusing on solutions, not just problems. Make a point to address all viable solutions, and allow them to take part in the discussion. Finally, while it's important to be firm in these conversations, do not make your loved one feel as though they're being ambushed. Focus on mapping out a plan that helps them maintain their independence — if that’s their wish — while keeping them safe.
The Snug App Can Help You Check-In on Your Loved One
As a friend, neighbor, or family member ages, it’s important to monitor their ability to complete daily tasks. Limitations with ADLs, such as the inability to bathe or feed themselves, are clear signs the person needs long-term, assisted care. However, if your loved one struggles with a few IADLs, there may be ways for them to maintain their independence, while getting the assistance they need.
Discussing ADLs and IADLs is tough — not just on your aging loved one, but on you and other family members. At Snug, we understand that you only want the best for your loved one, and constant worry can weigh heavily on your family. To help alleviate some of your concerns, install the Snug App on your loved one’s phone.
With Snug, your loved one can do a daily check-in, letting you know they’re alright. This helps them live more independently while giving you peace of mind.