Activities of daily living (ADLs)
Activities of daily living (ADLs or ADL) is a term used in healthcare to refer to people's daily self-care activities. Sidney Katz et al first came up with the term in the 1950s and the term has been revised since. Physiotherapists and other health professionals often use a person's ability or inability to perform ADLs as a measurement of their functional status, particularly in regard to people post-injury, with disabilities and the elderly.
A 2016 National Health Interview Survey in the USA found that 20.7% of adults 85 or older, 7% of those aged 75 to 84 and 3.4% of those aged 65 to 74 needed help with ADLs. Overall, 6.4% of adults aged more than 65 years needed help with personal care in 2016.
A clear trend is emerging of increased caregiving due to rapid growth in the number of older adults and because of the faster-growing cohort of older adults are those age 80 and older. More than half of 85- to 89-year-olds (59 per cent) need caregiving because of health or functioning reasons. From age 90 on, only a minority of individuals (24 per cent) do not need help from others. Dementia is a reason often for needing a family caregiver. In 2011 in the USA, 3.5 million of the 4.9 million older adults who received help for health or functioning reasons were classified as having probable dementia.
Basic and Instrumental ADLs
Generally, older adults need to be able to manage ADLs and IADLs in order to live independently without the assistance of another person.
Basic ADLs- these are the basic self-care tasks
- Walking (ambulating) ability to get around the home or outside.
- Feeding, ability to get food from a plate into one’s mouth.
- Dressing and grooming, ability to select clothes, putting them on, and adequately managing one’s personal appearance.
- Toileting, ability to get to and from the toilet, using it appropriately, and cleaning oneself.
- Bathing, ability to wash one’s face and body in the bath or shower.
- Transferring, ability to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.
Instrumental ADLs- require more complex thinking skills, including organisational skills.
- Managing finances, such as paying bills and managing financial assets.
- Managing transportation, either via driving or by organising other means of transport.
- Shopping and meal preparation. ie everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
- Housecleaning and home maintenance. Cleaning kitchens after eating, maintaining living areas reasonably clean and tidy, and keeping up with home maintenance.
- Managing communication, eg telephone and mail.
- Managing medications, ie obtaining medications and taking them as directed.
Physiotherapists assess ADLs and IADLs as part of assessing an older person’s “function.” Problems with ADLs and IADLs usually reflect problems with physical health and/or cognitive health. Identifying functional difficulties can help us diagnose and manage problems affecting their everyday life.
Physiotherapists help people perform ADLs through exercise therapy and improving strength and joint mobility. Improving gait speed, grip strength, pain reduction, improved balance etc all improve a persons ability to perform ADLs. A physiotherapists role is also to encourage exercise, prescribe exercises and were appropriate refer to exercise programs eg Otago exercise program. These activities can all help in the performance of ADL. Help is also achieved through advice and teaching the use of assistive devices eg 4 wheel walkers, orthotics
A 2016 study on the effects of inpatient physiotherapy on the ADL status of elderly persons demonstrated the high effectiveness of the hospital physical therapy program in terms of reducing the risk of falls, improving physical ability, increasing handgrip strength, and improving subjective parameters such as pain intensity, self-reported well-being and mobility. 
A 2014 systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults concluded that functional training may be a better option than muscle strength training alone if the goal is to reduce ADL disability in older adults.Thus to improve ADLs balance programs are a good option.
Various outcome measures are available. Both 1. ADL specific outcomes and 2. General outcome measures
- Wikipedia. Activities of daily living. Available from: https://en.wikipedia.org/wiki/Activities_of_daily_living (last accessed 6.5.2019)
- McKnights Senior Living. Dec. 20 2017. CDC: More than 20% of 85+ adults need ADL assistance Available from: https://www.mcknightsseniorliving.com/home/news/cdc-more-than-20-of-85-adults-need-adl-assistance/ (last accessed 6.5.2019)
- Committee on Family Caregiving for Older Adults; Board on Health Care Services; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine; Schulz R, Eden J, editors. Families Caring for an Aging America. Washington (DC): National Academies Press (US); 2016 Nov 8. 2, Older Adults Who Need Caregiving and the Family Caregivers Who Help Them. Available from: https://www.ncbi.nlm.nih.gov/books/NBK396397/ (last accessed 6.5.2019)
- Audiopedia ADL. Available from: https://www.youtube.com/watch?v=7C0FFUG0Bk4 (last accessed 6.5.2019)
- Better health while aging. What are Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs)? Available from: https://betterhealthwhileaging.net/what-are-adls-and-iadls/ (last accessed 6.5.2019)
- Zasadzka E, Kropińska S, Pawlaczyk M, Krzymińska-Siemaszko R, Lisiński P, Wieczorowska-Tobis K. Effects of inpatient physical therapy on the functional status of elderly individuals. Journal of physical therapy science. 2016;28(2):426-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792984/ (last accessed 7.5.2019)
- Liu CJ, Shiroy DM, Jones LY, Clark DO. Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. European review of aging and physical activity. 2014 Oct;11(2):95. Available from: https://eurapa.biomedcentral.com/articles/10.1007/s11556-014-0144-1#Abs1 (last accessed 7.5.2019)