Activities of Daily Living

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Activities of Daily Living (ADLs)

Activities of daily living (ADLs or ADL) is a term used in healthcare to refer to the basic and everyday skills that are essential to live independently. Sidney Katz is credited as the first to use this term to in 1950. Physiotherapists and other health professionals often put considerable interest toward a person's ability or inability to perform ADLs as such status can be used as an indicator of such aspects as functional ability, fall risk, degree of dependence on caretakers, safety, and quality of life. Additionally, the ability to complete ADLs has been shown to be a predictor of nursing home admissions, hospitalizations, and utilization of other healthcare services.

Data from the 2016 National Health Interview Survey conducted in the USA outlines the increased need for assistance completing ADLs that is increasingly apparent among older individuals of the population. Assistance completing these tasks among adults >85 years was as high as approximately 21%. For those adults between the ages of 75 and 84, the need was approximately 7%, and for those 65 to 74 years old, the need fell to around 3.5%. When looking at personal care tasks alone in individuals 65 and older, the need for assistance was approximately 6.5% overall.

Many aspects such as declines in physical ability, function, and mental status all effect an individuals ability to complete daily tasks. While these limitations do tend to increase with an increase in years lived, age alone should not be seen as a the primary driver for reduced independence in daily life. That being said, it is important to recognize that trends to suggest an increase need for assistance from caregivers among older adults, with close to 60% of adults age 80 to 89, and over 75% of adults over the age of 90, requiring the support of caregivers as a result of limitations due to declining health or function. One example is individuals who develop dementia; in a 2011 study that provided an estimate of roughly 4.9 million older adults requiring caregiver assistance for self care tasks, 3.5 million me the classification of 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 organizational skills.

• Managing finances, such as paying bills and managing financial assets.
• Managing transportation, either via driving or by organizing 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.

Physiotherapy

While assessment of overall ADL function, as well as treatment addressing certain ADLs and IADLs (eg. eating and toileting) generally falls to occupational therapists, physiotherapists still play an integral role addressing ADL and IADLs performance in patients. As members of an interdisciplinary team, physiotherapists will treat aspects of ADL function as part of a plan of care, however these treatments may be more focused on areas such as ambulation or transfers depending on the specific setting or the availability a patient has to occupational therapy services.

A 2014 systematic review explored the effectiveness of different interventions on performance of ADLs in older adults. The study compared the functional training and traditional muscle strength training, looking at the impact that each had on participants ADL function. Functional training was defined as training focused on specificity (see Principles of Exercise), or for this case, activities similar to ADL tasks. Results suggested that functional training may be a better option than muscle strength training alone if the goal is to reduce ADL disability in older adults.

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.

The prevalence of frailty is increasing in the older adult population, and an assessment of their activities of daily living for optimal function is required for this group of people to function optimally. Therefore, it is important to measure the functional capacity of older adults and assess the degree of impairment in their activities of daily living. Recent evidence has shown that defining dependence and independencey level based on activities of daily living may be a prognosticator for in-hospital mortality among older adults. Consequently, it is important to define dependence and independency in activities of daily living among older adults to improve their functional capacity

Outcome Measures

Various outcome measures are available. Both 1. ADL specific outcomes and 2. General outcome measures

ADL specific: eg Katz ADL, Barthel index, Lawton IADL scale, Bristol Activities of Daily Living Scale, FIM.

General: eg TUG, 10 metre walk, grip strength, Berg balance scale, Romberg test, BOOMER.

Links

American Occupational Therapy Association classification of occupations including ADLs and IADLs