Activities of Daily Living Explained: Who Needs Help With What

What are ADLs?

Basic activities of daily living (ADLs) are the self-care tasks needed for personal survival and dignity. The commonly used list, from the Katz Index, includes:

1. Bathing (washing the body). 2. Dressing (choosing clothes and putting them on). 3. Toileting (getting to the toilet, using it and cleaning up). 4. Transferring (moving between bed, chair and standing). 5. Continence (control of bladder and bowel). 6. Feeding (getting food from the plate to the mouth).

Some lists add walking or mobility and grooming (hair, teeth, nails).

What are IADLs?

Instrumental activities of daily living (IADLs) are more complex tasks needed to live independently in the community. The Lawton scale lists:

1. Using the telephone. 2. Shopping. 3. Preparing food. 4. Housekeeping. 5. Doing laundry. 6. Using transport (driving, public transport, taxis). 7. Managing medicines. 8. Managing money.

IADLs usually decline before ADLs. A parent who stops managing bills, forgets medicines or stops cooking may be showing the first signs of memory or health problems, long before they need help with washing.

Why they matter

• They show real function, rather than a diagnosis. Two people with the same illness may need very different help.
• They predict needs: difficulty with several ADLs means a high chance of needing regular care, hospital admission or nursing home care.
• They guide equipment: a problem with bathing suggests a shower chair, grab bars or a handheld shower; a problem with dressing suggests dressing aids.
• They guide care plans and costs, and are used by insurers, agencies and care homes to assess eligibility.
• They monitor change. Tracking ADLs over time shows whether a person is improving, stable or declining.

Signs a parent is struggling

Look for subtle signs.

IADLs:

• unopened post, unpaid bills or odd purchases;
• an empty fridge, spoiled food or repeated takeaways;
• missed or doubled medicines; see medicine reminders for a forgetful parent;
• a messy, dusty or smelly house;
• burnt pans, forgotten stoves;
• unwashed clothes, or the same clothes repeatedly;
• getting lost, or avoiding driving or public transport;
• difficulty using the phone.

ADLs:

• body odour, unwashed hair, long nails, dental neglect;
• stained or inappropriate clothing;
• weight loss or poor eating;
• falls, bruises or burns;
• incontinence, wet clothes or odour;
• difficulty getting out of a chair or bed;
• stopping going out;
• reluctance to bathe, which may be fear of falling.

Do not assume it is just laziness; there is usually a reason.

How professionals assess ADLs

• Observation. The professional watches the person do tasks, as an occupational therapist does at a home visit; see occupational therapy home assessment.
• Questionnaires and scales: the Katz Index of ADLs, the Barthel Index, the Lawton IADL scale and others. Each task is scored as independent, needs some help or dependent.
• Interviews with the person and family.
• Geriatric assessment, which also looks at medical conditions, medicines, memory, mood, nutrition and falls; see geriatric assessment explained.
• Cognitive tests to see whether memory and judgement affect tasks.

The results are used to plan care.

Levels of support

A rough guide to levels of help:

Independent. Manages all tasks alone, with or without simple aids.

Needs prompting or supervision. Can do tasks but needs reminders or someone nearby, as in early dementia.

Needs some physical help. Help with one or two tasks, such as bathing or heavy housework.

Needs help with several ADLs. Daily support from a carer, family or an attendant, for dressing, toileting, bathing and meals.

Dependent in most ADLs. Needs round-the-clock care, perhaps in bed, with help for all personal care; see caring for geriatric patients.

Needs may fluctuate, with good days and bad days, and change after illness.

Turning assessment into a plan

1. List each task and rate how your parent manages: independent, with difficulty, needs help or cannot. 2. Find the reasons. Is it pain, strength, balance, vision, memory or fear? A doctor and therapist can help. 3. Treat what is treatable: pain, dizziness, depression, vision and hearing problems, and medicines side effects. 4. Use aids and adaptations for tasks where equipment helps; see daily living aids that keep older adults independent. 5. Change routines: simplify tasks, break them down, allow more time. 6. Arrange help for tasks that remain hard: family, neighbours, an attendant, meals services, laundry and shopping services. 7. Build safety: an alert device, a key safe, regular check-ins; see home safety for seniors living alone. 8. Review regularly, every few months, and after any change.

Families often find it easier to start with IADLs: arranging shopping, bills and medicines first, to keep their parent independent for as long as possible in personal care.

Keeping independence

• Let your parent do what they can, even if slowly.
• Offer help, not take over.
• Break tasks into steps.
• Use cues and routines.
• Keep active: exercise helps maintain ADLs; see exercise at home for seniors.
• Eat well, since weight loss weakens function; see malnutrition in older adults.
• Stay social, since loneliness speeds decline; see loneliness and isolation in older adults.
• Check vision and hearing.
• Review medicines.

Talking about help

Many people resist help because it threatens their identity. Approach the subject gently. Describe what you have noticed, ask how they feel, offer choices and start small. A professional's assessment can make it easier, since it is neutral. See talking to parents about ageing and care.

A worked example

Imagine a seventy-eight-year-old woman who lives alone after her husband's death. She manages her own washing, dressing and meals, but her daughter notices that the post is piling up, the fridge holds only biscuits and the pill box is untouched. By the ADL and IADL lens, her basic self-care is intact but several instrumental activities, namely money, shopping, cooking and medicines, are failing. That pattern suggests low mood, memory change or both, and it points to the right first steps: a visit to the doctor for a memory and depression check, a simple weekly shopping and meal service, a pill organiser with phone reminders, and a regular call. It does not point to a care home. Six months later the family repeats the exercise and finds that she is eating better and taking her medicines, which shows the plan is working. The same exercise a year later, if bathing and dressing begin to slip, may show that more personal support is needed. This is the real value of thinking in terms of daily activities: it turns a vague worry into a short list of specific, fixable things.

Write the list down, date it and revisit it every few months. Share it, with your parent's agreement, with the doctor and any carers, so that everyone works from the same picture.

When to ask a professional

Ask a doctor for a medical review if function is declining, and consider a comprehensive geriatric assessment. An occupational therapist assesses daily tasks and equipment. A physiotherapist assesses mobility. A dietician, speech therapist or social worker may help. Our care advisors can arrange assessments, a care plan and the right level of help.