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It’s easy for a lot of us to take certain things for granted, such as dressing and feeding ourselves. However, for some people, such as those with disabilities or older adults, these things are not always as simple.
What are Activities of Daily Living (ADLs)?
Activities of daily living is a term used in the healthcare industry to refer to a set of activities that help to determine a person’s ability to take care of themselves. These activities are spread across six areas, which we will address in the following section. These activities should be performed by a person so that they can live independently.
What are the 6 Activities of Daily Living?
As we have mentioned, there are six different areas covered by the term activities of daily living. These cover basic skills that a person should have in order to practice daily self-care.
- Personal hygiene relates to all aspects of bathing and taking care of oneself. This might include being able to bathe or shower without assistance as well as getting into and out of the bath safely. It also includes being able to perform good oral hygiene, nail care, and personal grooming, such as shaving.
- Dressing refers to the person’s ability to dress by using things like buttons, zippers, and other fastenings. It also relates to whether the person is able to choose appropriate clothing such as layers in winter, matching outfits, and loungewear for in the home only, etc.
- Feeding talks about the person’s ability to eat independently. This includes the safe and effective use of cutlery as well as being able to get the food into their mouth without any problems.
- Toileting covers the person’s ability to use the bathroom. This can include getting to the toilet, knowing when they need to use it, and cleaning themselves appropriately after using the toilet.
- Continence refers to the person’s ability to control their bladder/bowel function without having an accident when they are unable to immediately get to a bathroom.
- Mobility and transfers talk about how well a person can move around their home or outside. This might include the use of stairs, getting in and out of chairs, walking, and getting in and out of bed, among other things.
What are Instrumental Activities of Daily Living (IADLs)?
While ADLs are considered to be essential to independent living, instrumental activities of daily living are not. However, they are considered to be important but won’t be used as part of daily self-care. A person may be able to live independently but may need assistance when it comes to IADLs, and assessing these gives healthcare providers a better picture of the individual’s abilities.
- Shopping and meal preparation covers how well a person is able to choose appropriate foods, clothing, and other essential items. It also looks at how well a person is able to prepare, cook and clean up after meals.
- Transportation relates to whether the person is able to get themselves to and from locations. This could be by driving their own car or making arrangements to use public transport.
- Medication management looks at how well the person is able to manage doses, organize refills of medication and avoid dangerous interactions between medications and other substances.
- Managing finances discusses the person’s ability to pay bills on time, manage a budget, and their ability to avoid becoming the victim of a financial scam.
- Home maintenance covers how well they are able to take care of the home including things like dusting, vacuuming, doing laundry, washing dishes, and other important household tasks.
- Communication looks at how well the person is able to use a telephone, mail, or the internet to communicate with others. It also covers how well they can remember essential phone numbers and addresses.
What is the Importance of ADLs & IADLs?
ADLs and IADLs can be affected by various factors, including changes in health. When a senior is unable to perform ADLs as well as they once were, this can affect their quality of life. A person may no longer be able to practice good personal hygiene, feed themselves, and do other things that many of us take for granted.
Not only does this reduce their quality of life, but it can also lead to further health problems. This might include things like malnutrition, falls, UTIs, and other related problems. What’s more, when these things begin to happen, they can affect the mental health of the individual.
However, there are some very simple steps that can be taken to improve a person’s ability to live independently and that’s why it is so important to assess ADLs and IADLs. These criteria allow healthcare professionals to figure out how best to provide support for an individual without the need for them to enter into a care facility or non-independent living.
How Can ADLs & IADLs be Assessed?
There are several different methods that are used to assess the ADLs and IADLs of an individual. The two most commonly used are the KATZ Index of Independence in ADLs and the Lawton IADL Scale.
KATZ Index of Independence in Activities of Daily Living (Katz ADL)
The KATZ ADL is used all across the world to determine someone’s ability when it comes to ADLs, and the assessment is performed in a checklist format. This list covers the different areas of ADLs that we discussed earlier.
In each of these areas, the person is given a score of 0, showing that they are highly dependent, whereas a score of 6 demonstrates complete independence.
Lawton Instrumental Activities of Daily Living (IADL) Scale
The Lawton Scale is very similar to the KATZ ADL but instead focuses on the Instrumental ADLs of a particular person. Similarly again, this scale uses a scoring system. Each category will earn the person a score of either 0 or 1. The total they can score is 8; if they achieve this, then it shows that they are fully independent.
When scoring a Lawton assessment, there are several statements relating to each category, and the assessor should choose the one that most closely matches the abilities of the individual. However, it’s important to note that not every test will include every category. For example, if a man has spent most of his life having his wife complete household chores, it would not be fair to mark him on this as it would not necessarily determine independence but maybe a lack of general knowledge in this area.
Aids to Assist with Activities of Daily Living
Just because a person achieves a lower score on their assessment, that isn’t to say that they cannot still function in their own home. It may sometimes mean that they simply require assistive devices and accessories to help them better take care of themselves.
- Bath lifts safely transfer the person into and out of the bath through a powered lifting device. They allow users to independently bathe provided that they can sit unassisted in the lift during transfer.
- Walk-in bathtubs are excellent for seniors who don’t want to or cannot use a lift. The bathtub features a door that has a watertight seal so the person can walk in, fill up the tub and bathe before emptying the water, and opening the door to walk back out again.
- Grab bars are suitable for people whose balance is lacking and gives them something to hold onto while using the bath or shower. They can also be used to steady the person as they step into the tub.
- Shower chairs can be used by people who are unable to stand for prolonged periods of time. They are made from waterproof materials and provide a place for the person to sit while they wash in the shower.
- Long-handled brushes are great for people who cannot reach certain parts of their body to clean them.
- Adaptive clothing can take many forms but is primarily designed to allow the person to more easily put it on and take it off. This might include features such as magnetic fastenings, clothes with access points for medication, sensory-friendly clothing, and pants cut in a way that makes them more comfortable for wheelchair users.
- Velcro shoes are far less fiddly than laces and other types of fastening and can be useful for seniors who have problems with dexterity.
- Dressing sticks are used to get items of clothing such as pants and tights on without the need for assistance.
- A zipper grip is a simple device that attaches to the zipper, giving the person something larger to grip onto and improving leverage. This is again ideal for people whose dexterity isn’t as good as well as people with strength problems.
- Easy Grip Cutlery is a specially adapted set of cutlery that is designed for people whose grip strength is lacking. For those with reduced hand and arm function, the thicker, screw-on handles make using cutlery much less of a challenge.
- Adaptive cups can come in all shapes and sizes but their primary function is to make drinking easier. Some may have specially designed handles to improve grip while others prevent spills.
- Scoop & suction plates have a raised side that allows the user to scoop out food without the risk of it spilling over the sides. They have a suction cup on the bottom to hold the plate in place, so it doesn’t move around while the person is eating. These plates make mealtimes far less frustrating and are suitable for people with limited dexterity.
- A commode is a portable item of furniture that has a concealed pot and is used for toileting. This can be kept in a bedroom, for example, so that the person does not have to move far when needing to use the bathroom during the night.
- Raised toilet seats are great for people who struggle to get up and down as easily. The seat is typically raised by a few inches and not only makes it more comfortable and easy to use the toilet but can also reduce the risk of falls.
- Disposable pads can be worn inside the underwear or there are products that have pads built into disposable underwear. They are a protective measure in the case of an accident and can help an older adult to feel more confident when going about their day if they may struggle to get to the toilet on time.
- Reusable bed & chair pads are absorbent and can be placed on chairs and beds offering protection against accidents, preventing the need to clean the whole item of furniture. The pads can be washed and reused so they’re cost-effective as well.
- Plastic bed covers are a good alternative to reusable pads and are fully waterproof and easy to clean.
Mobility & Transfers
- Wheelchair: There are manual and electric wheelchairs which provide a way for people to move around if they find it difficult to walk. It’s important to look at the features of the wheelchair to determine whether it is right for the user. This includes things like whether the material is waterproof, how much cushioning there is, storage, whether a head rest is needed and lots of other things. Electric wheelchairs are great for users that rely more heavily on a wheelchair, but they aren’t as easy to transport in a car. Manual wheelchairs are more portable and great for light use.
- Mobility scooters provide independence for seniors who are unable to get about as easily as they once could. They are brilliant for running errands and days out and come in a range of styles, such as portable scooters.
- Walkers are metal frames that provide stability for users with balance problems. They give the person something to hold onto as they walk and can prevent falls.
- Rollators are very similar to walkers, but instead of having four static legs, the front two are fitted with wheels. These benefit people who do not have the strength to lift the walker with each step.
- Walking cane/crutches: these mobility aids are suitable for people who need a little extra balance or for those who have pain or weakness on one side of the body. They’re also often used during recovery from surgery or injuries.
- Patient lift: These devices can come in two forms; sit to stand lifts or a sling lift. The former is used to aid people in getting up from a sitting position and back down again, which is something that many older adults struggle with. They can sometimes be used independently. A sling lift usually requires a caregiver to operate and can be used for people with more severe mobility needs, including getting in and out of bed, a chair, a wheelchair and many other places. There are both powered and manual lifts, with the obvious benefit being to the caregiver when using a powered lift. However, these are typically not as portable and require a connection to power.
- Stair lifts are attached to the stairs and can transport the user up and down the stairs if they find it difficult. The person must be able to sit unaided in order to safely use the lift, and they can be costly to install. However, if the senior wishes to remain in their own home, they are a wonderful addition.
- Home elevators are another way of moving between floors for people who find it challenging to use the stairs. They are more expensive than stair lifts and may require some structural alterations, although not always. However, for people who intend on staying in their home for the long term, they’re a worthwhile investment.
- Bed rails are installed on the sides of the bed and can help to prevent the person from falling out while they are sleeping.
How to Get an Activities of Daily Living Assessment
If you are worried about a friend or loved one who is getting older and may no longer be able to take care of themselves the way they once could, it is possible to get an ADL assessment.
While there are online checklists you can use as a base assessment at home, it is better to work with a professional. You can complete a home assessment using one of the many online tools and then present your findings to a healthcare professional.
Your first port of call should be your family doctor. They are the most qualified person to assess all aspects of the person’s wellbeing and can refer you to other services if required. You may also work with people like social workers, nurses, professional caregivers, and many others who are trained to perform ADL assessments with the highest level of accuracy.
Once the assessment has been completed, you and the professionals you are working with can come together to create the best plan for the adult in question.
How Can I Get Help with Activities of Daily Living?
The type of help that you can get for your activities of daily living will depend on how much assistance you need. One of the most common types of help involves somebody coming into your home to provide assistance with various tasks.
It can be difficult for people to accept that they need this type of help but once established, it can boost their independence and enable them to stay in their own homes for longer.
In-home assistance can take many forms, and you and your caregiver will develop a plan that best meets your needs. Having someone in the home can improve the quality of life for the senior, and there are even some organizations that send a fellow senior to provide support which can feel less intimidating.
Many people feel that they cannot age in place if help is needed, but that is not the case. An in-home assistance plan can involve numerous things, such as help with bathing and dressing through to preparing meals and feeding. But the benefit is that the older person will be able to remain in the comfort of their own home, and the caregiver will come and go as needed.