IADLs Vs ADLs | What Decline In Them Means
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
December 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. 

Knowing about ADLs and IADLs is essential 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.

Examples of ADLs:

  • 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.

Friends or family members must 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 be unable to dress fully without assistance because they can’t tie their shoes. 

In that case, getting Velcro sneakers would be a good idea 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 healthcare 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, evidence-based screening tools like the Montreal Cognitive Assessment (MoCA).

What does IADL stand for?

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 examples:

  • 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:

  • Getting dressed independently
  • Bathing
  • Using the toilet
  • Taking medications properly
  • Turning off stove burners when finished cooking

Why would these be life-threatening?

Well, imagine tripping over oneself while trying to put their pants on and sustaining a hip fracture, which then leads to increased mortality, or double-dosing on one’s insulin.

Things can go very badly, very quickly.

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

 The short but to-the-point video below clearly explains the concepts behind IADLs vs ADLs:

IADLs vs ADLS: Why is understanding ADLs and IADLs important?

Older adults must be able to complete their ADLs and IADLs without difficulty or hesitation 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 physical or cognitive health decline. 

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.

This happens more often than we think – I have seen this many times in my clinical practice.  

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

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.   

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. 

For a quick overview of the 4 different types of dementia, I recommend reading my article here.

For an in-depth review of dementia, diagnosis, and available management strategies, I recommend reading my pillar article here.

You may have heard of the term “reversible dementia.”

This name is more of a misnomer, in my opinion, since dementia is not reversible.

However, this term refers to lifestyle, medication, or medical reasons contributing to a person’s declining or impaired cognitive function.

These factors can be medically managed or reversed, resulting in the individual returning to full cognitive functioning.

I talk about this extensively in my article, Reversible Dementia.

How to assess ADLs and IADLs for your senior

There are more than 15 IADLs vs ADLs checklists, ranging from seven items per checklist to 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!

Pay attention to your loved one’s ability to perform IADLs vs ADLs

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. 

Your loved one’s ability  to perform IADLs vs ADLs is directly related to their quality of life, risk of hospitalization, and more serious consequences.

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