Table of Contents
- Definitions
- Activities of Daily Living (ADLs)
- Instrumental Activities of Daily Living (IADLs)
- Why ADLs and IADLs matter
- How ADLs and IADLs are used
- ADL and IADL assessment tools
- How to get help with ADLs and IADLs
Definitions
ADLs stands for Activities of Daily Living, occasionally called Basic Activities of Daily Living (BADLs) or physical ADLs. These are essential physical tasks that people need to perform every day to take care of themselves and survive independently at home. They are typically learned in early childhood.
IADLs stands for Instrumental Activities of Daily Living. These are more complex life tasks that enable people to enjoy a higher quality of life and thrive in their communities. These skills are typically learned in the teenage years and may not necessarily be required every day.
Activities of Daily Living (ADLs)
The list of ADLs typically includes the tasks below. There isn’t one official, industry-standard list, so some organizations may use modified labels or group these differently.
- Eating/feeding: Using utensils to move food from a plate to your mouth. This does not include preparing food or meals, which is an IADL. This also does not refer to the ability to swallow food, which if cannot be performed, would need medical or skilled nursing care.
- Toileting: Getting on and off the toilet, using it appropriately, arranging your clothes, cleaning yourself afterwards
- Continence: Controlling your bladder and bowel functions (sometimes included with toileting)
- Bathing/showering: Washing your face and body in the bathtub or shower
- Grooming/oral care/personal hygiene: Taking care of your appearance, shaving, brushing your hair, clipping your nails, brushing your teeth (sometimes bundled together with bathing/showering)
- Dressing: Selecting clothes, getting them out of closets and drawers, putting them on, taking them off, managing buttons and zippers
- Walking: Moving about at home and outside, also called ambulating
- Transferring: Changing positions, including standing up, sitting down, and getting in and out of beds, bathtubs, showers, vehicles (sometimes included with walking)
- Stairs: Climbing up and down stairs (sometimes bundled together with walking or with transferring)
Instrumental Activities of Daily Living (IADLs)
As with ADLs, there isn’t one standard list of IADLs, but it usually includes the tasks below.
- Communication: Communicating with others by phone, computer, paper
- Meal preparation: Planning and preparing food and meals
- Housecleaning/home maintenance: Keeping your home reasonably clean, keeping up with basic home maintenance, doing laundry
- Transportation: Organizing your own transportation, whether by driving, arranging rides, using public transportation, etc.
- Shopping: Purchasing groceries, supplies, clothing
- Health/medication management: Obtaining needed medications, taking them as appropriate, attending medical appointments
- Financial management: Paying bills, managing your personal financial assets
A few IADL lists are more expansive and add the activities below:
- Caring for others in your household, such as children, pets
- Managing safety and emergency procedures
- Managing social, extracurricular, and spiritual activities
Why ADLs and IADLs matter
A person’s ability to perform ADLs and IADLs indicates their ability to function on their own. As people age, some of these abilities may deteriorate, with IADLs often – but not always – declining before ADLs. This typically reflects an underlying physical or cognitive health issue. Many IADLs can be delegated or outsourced to others, but once people start to have trouble with ADLs, they may no longer be able to live alone safely.
How ADLs and IADLs are used
ADLs and IADLs provide people with a common language they can use to discuss senior care needs. You will see these terms used by the following groups for different purposes:
- Caregivers and home care agencies: Identify the level of home care that someone needs
- Senior living facilities: Determine whether someone can age in place safely at home or would be better suited for assisted living, memory care, or skilled nursing facilities, and what levels of assistance they would need there
- Healthcare professionals: Assess someone’s overall function, and whether more diagnostics or medical intervention may be needed, or medical treatment is succeeding, or additional support may be needed after being discharged
- Health insurance, including Medicare, Medicaid: Determine whether someone qualifies for coverage of home care or skilled nursing (nursing home) services
- Government plans: Determine if someone qualifies for state assistance programs, Social Security Disability Insurance (SSDI), or the Veteran Affairs Aid and Attendance pension
- Long-term care insurance: Decide whether someone is eligible to be paid out on their policy. Many plans start paying once someone cannot perform two or more ADLs, but pay attention to how each insurance company defines and counts ADLs.
This article, ADLs Vs. IADLs: What Are They? Why Do They Matter?, has been written and published by Senior Wing.
ADL and IADL assessment tools
Similar to how there is no standard list of ADLs or IADLs, there is no standard assessment tool for how well someone can perform these activities. Which one you’ll want to use depends on why you want it and what group it is for. For informational purposes, you can use an online self-administered tool. To qualify for insurance coverage, you’ll need to follow their assessment process.
Katz Index of Independence in ADLs (Katz ADL)
The most well-known ADL assessment tool is the Katz Index of Independence in ADLs (1963). This tool assigns 1 point for each of the following six activities that a person can complete on their own. A score of 4 indicates moderate impairment; a score of 2 or less indicates severe impairment.
- Bathing (can have help bathing one part of the body)
- Dressing (can have help tying shoes)
- Toileting
- Transferring (can have help with manual transfer aids)
- Continence
- Feeding
The list does not include grooming or walking.
Barthel Index for ADLs
The Barthel Index for ADLs (1965) assigns up to 5, 10, or 15 points for each of 10 dimensions, with a possible high score of 100. A score of 61 to 90 indicates moderate dependency; a score of 21 to 60 indicates severe dependency.
- Feeding (10 pts)
- Bathing (5 pts)
- Grooming (5 pts)
- Dressing (10 pts)
- Bowels (10 pts)
- Bladder (10 pts)
- Toileting (10 pts)
- Transfers (15 pts)
- Mobility on level surfaces (15 pts) (can use wheelchair, mobility aids)
- Stairs (10 pts)
Klein-Bell ADL Scale
The Klein-Bell ADL Scale is a more involved test that assigns up to 313 points across each of six categories:
- Dressing, can use adaptive equipment (103 pts)
- Mobility, walking, transferring (68 pts)
- Toileting and continence (46 pts)
- Bathing and grooming (56 pts)
- Eating (30 pts)
- Emergency communication and phone use (10 pts)
Lawton-Brody Instrumental Activities of Daily Living Scale
This most commonly used IADL assessment tool is the Lawton-Brody Instrumental Activities of Daily Living Scale (1969). It assigns 1 point for each of the following eight activities that someone can perform to a certain degree.
- Communication: Can answer a telephone call
- Shopping: Handles all shopping needs independently
- Food preparation: Plans, prepares, and serves meals independently
- Housekeeping: Can perform some light daily tasks, even if they cannot keep their home sufficiently clean or need help with home maintenance
- Laundry: Can launder and rinse small items
- Transportation: Can arrange own transportation independently or can use public transportation with help
- Medication: Can take medication properly
- Finances: Can manage day-to-day purchases
How to get help with ADLs and IADLs
If someone is struggling with ADLs, they may benefit from getting the following assistive equipment, devices, and technology and making home updates:
- Walking and mobility aids and home modifications for mobility
- Transfer and stair climbing home modifications and aids
- Toileting home modifications and aids
- Bathing home modifications and aids
- Grooming aids
- Dressing aids
- Eating and drinking aids
- Medication management devices
For help with the IADL of transportation, check out our comprehensive guide to senior transportation services.
For more hands-on assistance with ADLs and IADLs, seek out these types of providers:
- Caregivers and home care agencies
- Independent living communities (these help with some IADLs, but not ADLs)
- Assisted living, memory care, skilled nursing facilities (nursing homes), continuing care retirement communities (which help with both ADLs and IADLs)
