Activities of Daily Living
Activities of Daily Living (ADLs)[edit | edit source]
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 living independently. Sidney Katz is credited as the first to use this term 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 outlined the increased need for assistance completing ADLs which is now more apparent among older individuals of the population. Assistance is required in completing these tasks among adults >85 years old was as high as 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 years and older, the need for assistance was approximately 6.5% overall.
Many aspects such as declines in physical ability, function, and mental status all affect an individual's 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 the primary driver for reduced independence in daily life. That being said, it is important to recognize that trends do suggest an increased 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 met the classification for probable dementia.
Basic and Instrumental ADLs[edit | edit source]
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. i.e. 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, i.e. telephone and mail.
- Managing medications, i.e. obtaining medications and taking them as directed.
Physiotherapy[edit | edit source]
While assessment of overall ADL function, as well as treatment addressing certain ADLs and IADLs (i.e. eating and toileting) generally falls to occupational therapists, physiotherapists still play an integral role in addressing ADL and IADL 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 the performance of ADLs in older adults. The study compared functional training and traditional muscle strength training, looking at the impact that each had on the participant's ADL function. Functional training was defined as training focused on specificity (see Principles of Exercise), or in this case, training with exercises 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 independence 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 independence in activities of daily living among older adults to improve their functional capacity
Outcome Measures[edit | edit source]
Assessment of ADL and IADL function and independence is integral for practitioners to identify areas of need, as well as assess the effectiveness of interventions and quantify the level of disability. Below are some common outcome measures addressing ADLs and IADLs which were identified by Pashmdarfard and Azad in a 2020 systematic review as being effective for use in the older adult population.
- Barthel Index (BI) - Assesses 10 basic ADL activities to produce a 0 to 20 rating where 0 is maximal disability and 20 is maximal independence.
- Katz Index of Independence in Activities of Daily Living (ADL) - Assesses 8 ADL tasks, rating each on a 0 (unable) to 6 (maximal function) scale.
- Functional Independence Measure (FIM) - An assessment tool based on the Barthel Index that assesses 6 areas of function. Consisting of 18 items total, the FIM can be divided into the Motor-FIM (13 items) and the Cognitive-FIM (5 items) based on the focus of the individual items. Special training is required to properly conduct the FIM.
- Activities of Daily Living (ADL) Profile - Originally developed for traumatic brain injury patients, the ADL profile uses both observation and interview to assess function in tasks completed in the personal, home, and community environments.
- Activities of Daily Living Questionnaire (ADLQ) - A questionnaire aimed for use with patients diagnosed with cognitive impairments, which assesses function in ADL tasks across 6 areas of life. The questionnaire can be completed by the patient or the caregiver.
- Australian Therapy Outcome Measures (AusTOMs) - An evaluation tool based on the International Classification of Functioning, Disability, and Health (ICF) model designed to be used across the interdisciplinary team by PT, OT, and Speech Therapists.
- Melbourne Low-Vision ADL Index (MLVAI) - An ADL assessment tool designed for patients with low vision.
- Self-Assessment Parkinson's disease Disability Scale (SPDDS) - An ADL assessment tool for use with individuals diagnosed with Parkinson's disease. The tool assesses 24 individual items.
- Frenchay Activities Index (FAI) - Designed for use with patients diagnosed with stroke; 15 tasks specific to the areas of home, work/leisure, and outdoor activity are assessed. Each item is scored on a 1 (low) to 4 (high) scale, for a 15 to 60 total score.
- Activities of Daily Living (IADL) Profile Instrumental - This tool is an updated version of the ADL profile (see above) that looks at tasks relating to a variety of more complex leisure and home activities (i.e. shopping or putting on outdoor clothes)
- Lawton Instrumental Activities of Daily Living Scale - This scale assesses 8 IADL activities scoring on a 0 (low function) to 8 (high function) scale. A unique aspect of this scale is that it does not require men to be assessed on several items related to domestic activity, however, recent research now promotes the assessment of all items for men also.
- Performance Assessment of Self-care Skills (PASS) - This is an extensive scale that measures 26 items, along with 163 sub-items, covering the 4 major areas of functional mobility, basic ADLs, ADLs focusing on physical performance, and ADLs focusing on cognitive performance.
- Texas Functional Living Scale (TFLS) - An IADL scale designed for older individuals including those diagnosed with Alzheimer's Disease and other cognitive impairments.
Links[edit | edit source]
References[edit | edit source]
- Edemekong PF, Bomgaars DL, Sukumaran S, et al. Activities of Daily Living - StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470404/
- Bowers, LA. CDC: More than 20% of 85+ adults need ADL assistance. 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, ed. Families Caring for an Aging America. Washington (DC): National Academies Press (US); 2016. https://www.ncbi.nlm.nih.gov/books/NBK396397/
- Black BS, Johnston D, Rabins PV, Morrison A, Lyketsos C, Samus QM. Unmet needs of community-residing persons with dementia and their informal caregivers: Findings from the Maximizing Independence at Home Study. Journal of the American Geriatrics Society. 2013;61(12):2087–2095.
- Audiopedia. Activities of daily living. Available from: https://www.youtube.com/watch?v=7C0FFUG0Bk4 [last accessed 6/5/2019]
- Kari Berit. Caregiver Minute: ADLs vs. IADLs. Available from: https://www.youtube.com/watch?v=5exjfG9tiZI [Last accessed 12/19/2012]
- 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)
- 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)
- Faye AS, Wen T, Soroush A, Ananthakrishnan AN, Ungaro R, Lawlor G, Attenello FJ, Mack WJ, Colombel JF, Lebwohl B. Increasing prevalence of frailty and its association with readmission and mortality among hospitalized patients with IBD. Digestive Diseases and Sciences. 2021 Jan 1:1-3.
- Bruno RR, Wernly B, Flaatten H, Fjølner J, Artigas A, Baldia PH, Binneboessel S, Bollen Pinto B, Schefold JC, Wolff G, Kelm M. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19. Annals of intensive care. 2022 Mar 18;12(1):26.
- Pashmdarfard M, Azad A. Assessment tools to evaluate Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older adults: A systematic review. Med J Islam Repub Iran. 2020; 34:33: n.p.