ADLs, IADLs, and Dementia: Definition, Importance & Online Assessments
The effect of dementia on a person’s life can be measured in their ability to perform Activities of Daily Living and Instrumental Activities of Daily Living. ADLs and IADLs are tasks that one completes in their day-to-day life. These become progressively more difficult for someone with Alzheimer’s disease or another form of dementia.
The association between ADLs, IADLs, and dementia has been proven in numerous studies. Basic ADLs require complex thinking, making this one of the first symptoms of the disease to watch for and an important facet in diagnosing dementia. Knowing how your loved one is changing makes it easier to predict someone’s ability to function. All of this information is compiled to form a care plan that manages your loved one’s symptoms while maintaining the highest quality of life possible.
Assessing ADLs and IADLs is also necessary for:
– Applying for financial assistance through Medicaid and other programs
– Moving into assisted living and memory care
This article will cover the basics of ADLs and IADLs in regard to someone with dementia, offer information about different assessments, and information to help apply for financial assistance.
Definition of ADLs and IADLs
Activities of Daily Living are basic tasks related to someone’s health and safety, affecting their ability to live independently. Examples of ADLs are:
– Bathing and showering
– Brushing teeth
– Grooming (completing tasks like cutting nails or combing hair)
– Going to the bathroom (continence/toileting)
– Getting dressed
– Mobility (also called “ambulating,” meaning rising from a chair or bed and walking independently)
– Eating
Instrumental Activities of Daily Living are tasks related to living within a community. The ADLs above are necessary for basic function and independent living. IADLs are tasks someone does to maintain their quality of life. Examples of IADLs are:
– Housekeeping (home maintenance and regular cleaning)
– Managing money (paying bills or balancing a checkbook)
– Managing medications
– Cooking
– Shopping
– Transportation
– Communicating by phone or email
IADLs are activities that can be helped by service companies. For example, meals can be delivered for someone who can’t cook or a money manager can handle a person’s finances. ADLs are different in that they require hands-on care. It is much more difficult to hire someone to help your loved one eat in comparison to having meals delivered.
How Dementia Affects ADLs and IADLs
Dementia’s impact can be measured by a person’s ability to perform activities of daily living and instrumental activities of daily living. The most common symptoms of Alzheimer’s disease and dementia correspond to one’s ability to perform ADLs and IADLs. They are:
The loss of executive functioning in the brain means someone has difficulty planning, organizing, and processing. Getting dressed can seem like a basic task, but if your executive functioning is affected, you might need help understanding putting pants on before underwear.
Memory problems mean someone can simply forget to do things like brush their teeth or hair, take a shower, or put on clothes. In the middle and late stages of dementia, memory problems can cause someone to forget what something like a hairbrush or toothbrush is used for.
Judgment can be impacted by dementia and cause someone to wear the wrong type of clothing for the given weather, ignore nails that are too long, or refuse to eat when they are hungry.
Coordination problems can make tasks that require manual dexterity, like buttoning a shirt, tricky.
Problems with attention can make it hard to complete a task because of being distracted. Getting dressed might be complicated if there are loud noises outside.
Aggressiveness can lead someone to refuse your help with ADLs. Getting help with tasks they have done their whole lives could be perceived as insulting, like getting dressed or bathing.
Vision problems and losing spatial judgment are other signs of dementia that can make everyday tasks like getting on and off a toilet and picking up objects like a toothbrush more difficult.
Apathy can cause someone with dementia to lose interest in everyday tasks like bathing.
When Do People with Dementia Lose ADLs and IADLs?
A decline in the ability to perform instrumental activities of daily living is one of the first signs of early dementia. It can seem part of the normal aging process that your loved one becomes less interested in managing their finances or cooking. This relates back to one of the earliest signs of dementia is a loss of focus. A common scenario is that if one is having a hard time concentrating, it is still possible to eat and go to the bathroom independently, but making bank deposits or cooking a meal can be too complicated.
Activities of daily living are taken for granted because they are normal and commonplace given the fact that these activities have been done every day for the majority of one life causing them not to be lost until the later stages of dementia. There will be noticeable signs when your loved one cannot perform ADLs. When a person begins to look disheveled or dirty, it might mean they’ve lost the ability to clean themselves. More hands-on help is required. The loss of ADLs is one of the main reasons people move into assisted living homes, including facilities with memory care units where staff is specifically trained to help dementia patients. Click here for more information.
| Loss of Ability to Perform ADLs and IADLs by Stage of Dementia | ||
| Stage of Dementia | IADL abilities | ADL abilities |
| Mild Cognitive Impairment (MCI) | Some difficulties with driving, managing money | Unaffected in early stages |
| Early | Needs hands-on assistance with IADLs | Minimal assistance is needed, like gentle reminders to do tasks like bathing or getting dressed |
| Middle | Needs IADLs done by someone else, but can normally still observe with minimal participation | Needs help through prompts and modeling, but patients can still accomplish some tasks independently |
| Late | Needs total assistance with all IADLs | Needs total assistance with ADLs, except that the ability to feed oneself often remains |
Important of Tracking Ability to Perform ADLs and IADLs
Entering Memory Care / Assisted Living
Because Alzheimer’s disease and related dementias are progressive conditions, the ability to perform activities of daily living and instrumental activities of daily living deteriorate over time. The ability to perform ADLs is a benchmark for assessing dementia and a reason why it is crucial for assisted living and memory care facilities to know what help and support your loved one needs before moving in.
When someone moves into a residential care facility, an individualized care plan is formed creating a contract between the residence and patient. Your loved one’s care needs must be documented to ensure they are in a home that can best support them. An assisted living home needs to know prior to moving in what specific ADLs cannot be completed independently. When ADL needs are established in writing, care can be planned and give you peace of mind that your loved one is adequately taken care of.
A smart first step is to note which ADLs and IADLs someone is capable of doing. This creates better care at home, when communicating with doctors or entering into an assisted living home. It is easy to take these notes yourself or use an online tool that simplifies the process. For more, see “How To Assess” below.
Getting Medicaid or LTC Insurance Benefits
When trying to qualify for Medicaid or Long Term Care (LTC) insurance, it is important to get an assessment of your loved one’s ability to perform activities of daily living and instrumental activities of daily living. Insurance case managers will want to know which benefits should be awarded, and this is accomplished by a comprehensive evaluation of ADL and IADL abilities.
State Medicaid offers health insurance to people based on their finances and medical needs. In most states, there are programs for covering personal care. The amount paid is determined by how many ADLs a person needs help with, and to what degree. To find out more information about getting an assessment for Medicaid, contact your local Area Agency on Aging.
An individual’s evaluation of ADLs is not sufficient for insurance companies or assisted living facilities. To get a professional assessment of your loved one’s abilities, start by making an appointment with your primary care doctor. Prior to the appointment, do an assessment with your own notes or via an online assessment for activities of daily living.
How to Assess ADL and IADL Abilities
When your loved one begins showing signs of dementia and after a diagnosis is made, it is a good idea to keep notes on their functional abilities. Start by observing what tasks are difficult. This helps with healthcare, because if a doctor asks about symptoms you can be very detail-oriented. Sometimes the key to telling the difference between Alzheimer’s disease and another form of dementia is knowing which specific tasks are a problem. For example, people with Frontotemporal dementia, are more prone to aggression and apathy than memory loss.
There are many different assessment tools for activities of daily living. The most common is:
– The Katz Index, click here for an online version of the Katz ADL tool
– Klein-Bell
– Cleveland
– Bristol Scales
Caregivers and health professionals can use these assessments to predict future symptoms and develop an effective care plan. An important goal is to record observations, so your loved one abilities are constantly being monitored. Ultimately, this helps manage symptoms and ensure a high quality of life.