Understanding Activities of Daily Living (ADLs): Key Skills for Independence

Older adults make up 19% of the Los Angeles population, while 39% of Californians struggle with at least one chronic condition. These growing numbers indicate why understanding Activities of Daily Living, or ADLs, is crucial for healthcare systems to craft personalized care plans toward a functional, productive life.

Activities of daily living (ADLS) refer to the basic skills needed to survive and function in day-to-day life. These are typically related to eating, movement, grooming, and toileting. With age and chronic conditions, the ability to perform ADLs can be deeply impacted.

Linda Whiteside, Clinical Supervisor at the NuView Treatment Center, informs, “Activities of daily living were first introduced by Sidney Katz in the 1950s. In recent times, there has been an upward trend of ADL-related disability among those aged between 60 - 79 and a downward trend among those aged 80 and older.”

The basic activities of daily living are tasks that are crucial for survival and basic functionality, such as:

• Eating: Eating is the ability to feed yourself - like the ability to bring food to the mouth, chew, and swallow food so that it reaches the stomach.
• Movement: It involves maintaining basic movement, mainly the ability to transfer yourself from one place to another. For instance, moving yourself from the bed to the washroom to the drawing room to the dining room, and so on.
• Toileting: It involves the ability to go to the toilet, properly position yourself, and use the devices to keep yourself clean. It also refers to the ability to maintain continence. Moreover, if any other devices like catheters are present, it involves the ability to manage them as well.
• Bathing: It refers to the ability to use water, soap, towels, and other bathing supplies to keep the body clean. You must also be able to move your body in a manner so that every part of the body can be rinsed and cleansed.
• Grooming: It refers to the basic abilities to maintain good personal hygiene, like cleaning teeth, washing hair, and using tweezers or nail clippers, among others.
• Dressing: It is the ability to get the clothes out of the drawer or cupboard and put them on your body. It also involves the ability to use hooks, buttons, zip, and any other material that will be needed.

Instrumental activities of daily living (IADLs) are used to ascertain a person’s ability to live independently, as they are more complicated to perform than ADLs. IADLs involve:

• Caring for Health: The ability to care for your own health, like visiting doctors and taking medicines as prescribed.
• Household Chores: The ability to perform household chores like cleaning, gardening, and so on.
• Cooking: It is the ability to cook your own meals and to do so properly and safely.
• Running Errands: Running basic errands like grocery shopping, purchasing toiletries or clothes, and other basic necessities.
• Managing Finances: Managing your own finances, like using banking services, paying bills, and planning to effectively handle your expenses.
• Managing Communication Devices: This refers to the ability to use post, telephone, e-mail, and other devices for communication.
• Understanding Safety: It involves knowing safety procedures, what the emergency contacts are, and how to contact them during emergencies.
• Managing Transport: It is the ability to manage your own transport, like driving vehicles, using public transport, availing of cabs, and so on.
• Caring for Others: This involves the ability to care for dependents, like children, pets, and others.
• Maintaining Other Activities: This refers to maintaining religious practices, engaging in other hobbies and interests, and maintaining a social life.

ADLs are measured using scales like the Katz Index of Independence, Lawton Instrumental ADL Scale, and Kohlman Evaluation of Living Skills.

• Katz Index of Independence: It is a checklist used to ascertain whether a person can perform ADLs independently. The scores range from 0 to 6, where tasks that are rated 0 require assistance or supervision, while tasks rated as 1 can be performed independently.
• Lawton Instrumental ADL Scale: It ascertains a person’s ability to live independently across 8 daily living skills, with scores ranging from 0 (dependent) to 8 (independent). It also tracks changes in functioning over time to inform care and discharge planning. However, because it is self-reported rather than observed, results may over- or underestimate real abilities.
• Kohlman Evaluation of Living Skills: It combines observed task performance with self-reported information, making it especially useful for those with cognitive decline or dementia. It evaluates 17 skills across five areas: ADLs, cognition, life participation, occupational performance, and communication.

There can be many challenges in performing activities of daily living for the elderly and for those struggling with disabilities or chronic conditions. Some of them are:

• Physical Impairments: Typically linked with decreasing strength, imbalance, pain, and other conditions. Physical impairments can impede people from performing ADLs effectively and promptly.
• Mobility Concerns: Mobility concerns follow physical impairments, and they make it difficult for a person to move from one place to another. For instance, basic movements like getting up from the bed and going to the washroom can begin to feel challenging.
• Cognitive Impairments: Cognitive impairments are often connected with cognitive decline and are more evident among those struggling with dementia or Alzheimer’s disease. People can experience memory troubles as well as eating, cleaning, and other difficulties. This can lead to unhygienic, unhealthy, and highly unsafe conditions.
• Toileting Difficulties: Mobility and incontinence are the main challenges that can lead to problems with toileting. In fact, incontinence can be embarrassing and stigmatizing for many.

Linda Whiteside says, “When a person experiences challenges in performing ADLs, it creates circumstances that are not only unhygienic but can also easily turn into life-threatening conditions. Therefore, immediate care and assistance must be provided to persons finding it difficult and challenging to perform ADLs consistently.”

ADLs in Los Angeles are the basic indicators of a person’s functional status - their ability to survive. The inability to perform ADLs indicates that a person is at a great risk of leading an unsafe, poor quality of life. It also indicates that the person may require care and assistance from other people or devices.

As per the US National Health Interview Survey (2011), it was found that an estimated 20.7% of persons aged 85 or older, 7% of persons aged between 75 - 84, and 3.4% of persons aged between 65 - 74 needed care and assistance when it came to managing their ADLs

Linda Whiteside says, “At NuView’s Los Angeles facility, we use ADLs as a measure to cater to different levels of care and assistance needs, especially among the elderly and those struggling with chronic illnesses or conditions. They also become a measure for us to understand the need for hospitalization, admission into care homes, requiring paid home care services, or other living arrangements.”

Activities of daily living are part of everyday life, so it is easy to take them for granted 0 until they become difficult for you or someone you care for.

However, you do not have to navigate these difficulties on your own. Reach out to NuView to better understand what is happening and explore practical solutions. Our mental health specialists help you process your feelings, build healthy coping strategies, and regain a sense of confidence and control as you move forward.

Please do not hesitate to call us at (323) 307-7997 to learn more about our personalized care and assistance plans!

1. What is the difference between ADLs and IADLs?

ADLs are basic activities required for survival and daily functioning, while IADLs are activities required for independent living.

2. Can ADL difficulties be temporary?

Yes, ADL challenges can be short-term and improve with therapy, rehabilitation, or recovery from illness or injury.

3. Do mental health conditions impact ADLs even without physical limitations?

Yes. Mental health conditions like anxiety, depression, and trauma can significantly reduce motivation, focus, and energy needed for daily tasks, even if there are no physical limitations.

4. When should families intervene if someone is struggling with ADLs?

Early intervention is recommended when safety, hygiene, nutrition, or medication routines consistently decline.

5. Are ADL assessments used to determine the right level of care?

Yes, ADL performance often informs decisions regarding outpatient care, home support, assisted living, or higher levels of treatment.