Activities of daily living (ADL)

Activities of daily living (ADL) include everyday routines that a person must be able to perform to live independently. While the ADL are very basic, the instrumental activities of daily living (IADL) are a bit more complex. Personal care and functional mobility are fundamental aspects of the ADL, which include independently feeding oneself, using the restroom, bathing, dressing, and moving from one place to another. The IADL are more complicated but are also necessary for living independently. The IADL include managing personal finances, coordinating and using transportation, making and receiving telephone calls, cooking, and performing chores such as grocery shopping, laundry, and cleaning.

Background

Sidney Katz first defined daily self-care activities while working as a physician at Benjamin Rose Rehabilitation Hospital in Cleveland, Ohio. He was a pioneer in gerontology, or the study of aging and the problems that often afflict the elderly. Katz developed the Index of Independence in Activities of Daily Living, commonly referred to as the Katz ADL, in the 1950s. This tool is still widely used and accepted by health care professionals to determine the functional independence of individuals. Although it is often used to assess the elderly, it may be used to evaluate people suffering from chronic illnesses or individuals who have suffered accidents. Katz's ideas regarding aging and the ADL have been expanded upon and improved by other doctors and health care professionals since their original publication.

Health professionals often complete an ADL checklist before a patient's release from a hospital or rehabilitative setting. The list acknowledges what the patient is and is not capable of doing for him- or herself. The ADL checklist benefits family members and/or health care professionals responsible for patient care. This tool allows them to make necessary arrangements so that patients can have their needs met after their release. A major goal of both occupational and physical therapists is to help patients relearn how to perform the ADL so that they can live as independently as possible.

Overview

The ADL are actions that a person must be able to perform to live independently, and they serve as a basic measure of independence. The ADL fall into five basic categories:

• Maintaining personal hygiene. Patients are able to bathe or shower almost entirely on their own. (They may require assistance with difficult-to-reach places, such as the back.) They do not need help getting into or out of the tub or shower. They are able to brush their teeth, comb their hair, and perform other acts of personal grooming on their own.
• Dressing. Patients are not only able to put on clothes independently but also able to select weather-appropriate clothing, such as a coat and hat on cold winter days.
• Eating. Patients are able to feed themselves. They have the ability to move food from their plate to their mouth without assistance. (This does not include cooking or otherwise preparing food.)
• Maintaining continence. Patients are both mentally able to know when to use the restroom and physically able to use the restroom independently.
• Transferring. Patients have a basic level of functional mobility and are able to move from place to place. They have the ability to move from a sitting position to a standing position and vice versa. They also are able to get into and out of bed on their own. (It is acceptable for patients to use a transfer aid, such as a handle, a railing, or a cane, to help them move.)

The IADL are more complex but are also important for independent living. Many of these activities are not performed on a daily basis. The IADL are divided into the following seven categories:

• Communication skills. Patients are able to communicate effectively in person, on the telephone (either a landline or a mobile phone), or even on a computer (email).
• Transportation. Patients have the ability to effectively navigate and use public transportation, organize rides and/or transportation, or drive themselves to and from various locations.
• Meal preparation. Patients are able to safely use kitchen tools and appliances to prepare meals. They prepare meals that meet their nutritional needs. They also have the ability to properly store food and clean up the kitchen after cooking.
• Shopping. Patients have the ability to shop for groceries or other basic needs, such as clothing, on their own and to make appropriate choices when doing so.
• Housework. Patients have the ability to keep their home or apartment clean and safe. They are able to complete light housekeeping tasks, such as washing and drying dishes, making the bed, and doing laundry.
• Managing medications. Patients are able to take the right medications in the right doses at the right times without help from others. Patients can remember to refill prescriptions at regular intervals.
• Managing personal finances. Patients have the ability to effectively manage personal finances. They are able to set a budget and stick to it, writer personal checks, and pay bills on time. They are able to recognize and avoid scams.

The IADL offer details about the level of care that a patient might need. A patient who is able to perform the ADL but unable to perform the IADL will need a different level of care than a person who is unable to perform both the ADL and the IADL.

ADL and IADL checklists provide valuable information to health care professionals, insurance companies, and family members. These checklists may determine the amount of care and financial assistance available to a patient. For example, California's In-Home Supportive Services uses the ADL checklist to determine a patient's eligibility for in-home help. If a person is unable to perform two or three items on the ADL checklist, he or she is eligible for support services.

Long-term care insurance companies evaluate which ADL a person can accomplish when they determine benefit eligibility. Social Security Disability Insurance (SSDI) also uses the ADL to determine benefit eligibility.

Bibliography

"Activities of Daily Living." Family Practice Notebook, www.fpnotebook.com/Geri/Prevent/ActvtsOfDlyLvng.htm. Accessed 29 Dec. 2016.

"Activities & Instrumental Activities of Daily Living – Definitions, Importance and Assessments.gtermcare/activities-of-daily-living.html" " Paying for Senior Care, Feb. 2016, www.payingforseniorcare.com/longtermcare/activities-of-daily-living.html. Accessed 29 Dec. 2016.

"Aging-In-Place: The Importance of Activities of Daily Living." Centre for Elder Research, 24 June 2015, serclab.wordpress.com/2015/06/24/aging-in-place-the-importance-of-activities-of-daily-living/. Accessed 29 Dec. 2016.

"Checklist of Activities of Daily Living (ADL)." PBS, http://www-tc.pbs.org/wgbh/caringforyourparents/caregiver/pdf/cfyp‗adl‗checklist.pdf. Accessed 29 Dec. 2016.

" "http://www.benrose.org/KPI/KatzTribute.cfm" \h Dr. Sidney Katz." Benjamin Rose Institute on Aging, www.benrose.org/KPI/KatzTribute.cfm"http://www.benrose.org/KPI/KatzTribute.cfm" \h . Accessed 29 Dec. 2016.

"Katz Index of Independence in Activities of Daily Living." MaineHealth, http://www.mainehealth.org/workfiles/mh‗PFHA/Katz%20ADL‗LawtonIADL.pdf. Accessed 29 Dec. 2016.

Kernisan, Leslie. "Activities of Daily Living: What Are ADLs and IADLs?" Caring.com, www.caring.com/articles/activities-of-daily-living-what-are-adls-and-iadls. Accessed 29 Dec. 2016.

Noelker, Linda, and Browdie, Richard. "Sidney Katz, MD: A New Paradigm for Chronic Illness and Long-Term Care." Gerontologist, vol. 54, no. 1, Feb. 2014, pp. 13–20.