What’s the Difference Between ADLs and IADLs?
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
February 3, 2023

“ADL” stands for Activities of Daily Living, and “IADL” stands for Instrumental Activities of Daily Living. 

These two categories define a person’s daily activities to live independently at home without assistance from others. 

It’s essential to know about ADLs and IADLs because they give you a basic idea of what your loved one needs to live safely at home, whether it’s paying bills, cooking, shopping, or cleaning their apartment.

What are Activities of Daily Living (ADLs)?

ADLs are basic self-care daily activities that everyone learns as a young child and performs independently. These essential activities include:

  • Moving around (walking without difficulty, getting up from bed or chair, etc.)
  • Getting dressed and groomed
  • Using the toilet
  • Taking a shower
  • Eating without assistance

When there is an inability to perform ADLs, older adults can face complications living independently at home. 

In my clinical practice, people struggling with an ADL indicate needing a higher level of care. 

At this point, I am actively talking to my patients’ caregivers about transferring their loved ones to an assisted living or long-term care facility or applying for in-home care.

It’s important for friends or family members to look after seniors needing assistance with ADLs to ensure they have what they need – including medication reminders – so they can continue doing these things independently. 

For example, a senior may not be able to dress fully without assistance because they can’t tie their shoes. 

In that case, it would be a good idea to get Velcro sneakers so they can still easily put on their clothes. 

The above is an example of how knowing about ADLs can help you take steps to keep your loved one safe.

The diagnosis of dementia or mild cognitive impairment requires specially trained health care professionals to evaluate an older adult thoroughly.

Our clinical practice employs an easy but incredibly accurate way to determine if someone has dementia. 

Suppose our patient has difficulty completing ADLS, such as struggling with toileting or getting dressed. In that case, we initially determine with reasonable certainty that our patient has moderate dementia, at the very least. 

We follow up with more formal, tested, and evidence-based screening tools such as the Montreal Cognitive Assessment (MoCA).

What are Instrumental Activities of Daily Living (IADLs)?

IADLs are more complex activities that, while they may not be considered life or death by some people, are important to one’s ability to live independently. 

These tasks require more complex thinking and planning skills accumulated during our teenage years. 

Most of us complete these tasks on “auto-pilot” without giving them a second thought. 

IADLs include:

  • Cooking and meal preparation
  • Cleaning up after meals
  • Managing medications
  • Using the telephone and directories
  • Grocery shopping
  • Banking/using ATMs, and driving. 

ADLs are different from IADLs in that they are more directly life-threatening if done incorrectly: dressing oneself; bathing; using a toilet; taking medications properly; turning off stove burners when finished cooking. 

Many people erroneously refer to IADLs as Independent Activities of Daily Living.

 

Why is understanding ADLs and IADLs important?

Older adults must be able to complete their ADLs and IADLs without difficulty or hesitation in order to live independently. 

Geriatric-trained providers link the ability to perform ADLs and IADLs with “functional ability.” 

An older adult struggling with ADLs or IADLs usually has some level of decline in physical or cognitive health. 

Hence, the decline in function helps providers and caregivers identify, assess, plan for, and implement corrective or preventative steps to help manage their older adults’ health problems. 

Being informed about and recognizing deficits in IADLs, especially in your loved one, is vital because you could prevent a potentially life-threatening fall or traumatic head injury. 

Imagine that your elderly mother is struggling to get dressed in the bathroom, falls, and hits her head against the side of the bathtub or toilet. The result could be catastrophic.  

ADLs and IADLs are intricately related to dementia and its progression. 

While not wholly diagnostic due to the many variables involved when assessing someone for dementia, in my clinical practice, I can reasonably conclude that a patient has moderate dementia when they are struggling with their ADLs. 

When an older adult struggles with these essential life skills, a clinician can discover a decline in other areas of the individual’s medical and cognitive history, such as progressing frailty, urinary incontinence, unhealthy weight loss, etc.   

 

How to assess ADLs and IADLs for your senior

There are more than 15 ADL/IADL checklists, ranging from seven items per checklist or more. 

Why so many? Defining a list that encompasses everything needed in a checklist takes a lot of work. 

Be wary of any checklist that doesn’t include eating or bathing. These are universal activities we all do every day! 

Checklists get tricky when they include walking across a room or getting dressed by yourself as they begin calling into question an individual’s ability level. 

You should not assume the worst when your loved one has trouble completing a task—if you aren’t sure whether someone can walk unassisted, ask her. Or, observe her!

Why you should pay attention to your loved one’s ability to perform ADLs and IADLs

Ultimately, it all comes down to the person’s ability to live independently and SAFELY. When your loved one starts slipping in any of these areas, it is most likely that there are problems with their functional status, physical health, and cognitive health.

These signs tell us that our loved ones need help and support now. We must prioritize this for our loved one’s health and safety. 

 

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