Activities of Daily Living

What are activities of daily living (ADLs)?

Activities of daily living (ADLs) are important tasks you do on a regular basis to take care of your body and overall well-being. ADLs include things like eating, bathing and using the bathroom — tasks you must do to keep your body functioning. ADLs can also include more complex tasks like managing your money, cooking and doing laundry — things you must do to live independently.

Some people need help doing ADLs for a short time — for example, while recovering from surgery. Others might need help for a long time, even for the rest of their lives. This might happen if you have a chronic condition that affects how well you can move, remember or solve problems.

ADLs may come up in conversation with your healthcare provider or your loved one’s care team. Understandably, this isn’t the easiest topic to talk about. You might worry that you’ll need to rely on others, or that your loved one won’t be able to live on their own anymore. These are common concerns, and healthcare providers will take the time to listen to how you feel and what you prefer. Having this open and honest conversation can help you and your family understand available options to make an informed decision.

To have this conversation, it helps to know exactly what healthcare providers mean by ADLs. In general, ADLs fall into two main groups:

• Basic activities of daily living.
• Instrumental activities of daily living.

Basic activities of daily living (basic ADLs)

Basic activities of daily living are tasks you typically do every day that are essential to your physical survival and well-being. They’re sometimes called physical activities of daily living because they relate to your body’s needs.

Examples of basic activities of daily living

Keep in mind there’s a difference between doing a basic ADL and doing it safely. You might be able to move from one spot to another in your home, but if you feel off balance as you do so, or have near misses where you almost fall, it’s important to tell a healthcare provider.

It’s easy to shrug off such challenges as normal for your age or nothing to worry about. But if you notice it’s harder to do a basic ADL than it used to be, don’t keep it to yourself. Your provider may make suggestions for simple changes, like getting rid of area rugs or installing handrails to help you stay steady in the shower.

Instrumental activities of daily living (IADLs).

Instrumental activities of daily living (IADLs) require more advanced skills than basic ADLs. IADLs support your overall well-being, not just your basic physical needs. You have to think in complex ways and stay organized in order to do IADLs. You also need to be able to navigate your home and spaces outside your home.

Examples of instrumental activities of daily living

IADLs are often the first tasks that people ask for help with when they realize they can’t do them on their own. In other cases, a person may not realize they need help with IADLs until a loved one or healthcare provider points it out. Many people who need help with IADLs can still do basic ADLs just fine.

A person’s needs may also change over time. For example, someone with mild cognitive impairment or early-stage Alzheimer’s disease might have trouble doing some IADLs but need no assistance with basic ADLs. As their condition progresses, they might start to find basic ADLs difficult, too.

This is why assessing ADLs usually isn’t a one-and-done task. Instead, healthcare providers may assess your ability to do basic and/or instrumental tasks on a routine basis. They’ll look for changes that suggest the need for further support.

When do healthcare providers assess ADLs?

When and how often healthcare providers assess your ability to perform ADLs depends on your medical history and current situation. In general, nurses and occupational therapists may assess how well you can perform ADLs when you:

• Are staying in a hospital (hospitalized).
• Return home from a hospital stay.
• Are recovering from surgery, physical injury, traumatic brain injury or stroke.
• Have a neurodegenerative disorder, like Alzheimer’s disease or Parkinson’s disease.
• Have an intellectual disability.
• Have a mental health disorder.

How are ADLs assessed?

Healthcare providers use different methods to evaluate how well a person can perform activities of daily living. For example, they might directly observe you or your loved one performing these tasks. Sometimes, they ask caregivers to share their observations. In some cases, a person having difficulty with ADLs will share their own thoughts (self-report).

Providers might use a combination of these methods to get the best possible sense of how well a person can take care of themselves and what support they might need. Depending on how much support is needed, healthcare providers may recommend:

• Using devices or equipment, like special eating utensils or transfer belts, to help with everyday tasks and movements.
• Making adjustments in the home, like using chairs with armrests to help with sitting and standing.
• Bringing in an informal caregiver or home health aide.
• Considering other living arrangements, like assisted living or a nursing home.

Healthcare providers will recommend the options that can keep you or your loved one as safe as possible.

What is the Katz Index of Independence in Activities of Daily Living?

Also called the Katz ADL scale, this is a checklist that healthcare providers commonly use to determine how well you can do activities of daily living. The Katz ADL scale focuses on basic ADLs but doesn’t include instrumental ADLs.

The Katz ADL scale evaluates how well you can do six basic ADLs. You get one point for each task you can do independently, and zero points for each task you need help with. So, you can get up to six points, and the higher the score, the more you can do on your own. The lower your score, the more help you may need in your daily life.

Here are the six ADLs on the Katz scale and what you need to do to earn a point for each:

• Bathing. Clean your entire body without any help or with help for just one body part (like your back).
• Dressing. Put on all of your clothes and use buttons, snaps and other fasteners on your own (you may need help tying your shoes).
• Toileting. Get on and off the toilet and clean up afterward without assistance.
• Transferring: Move in and out of bed or a chair without another person helping.
• Continence. Completely control when and where you pee or poop.
• Feeding. Transfer food from a plate to your mouth on your own.

Healthcare providers often use the Katz ADL scale along with other checklists or evaluations to get a full picture of what you’re able to do and what kinds of support you might need. For example, your provider might use the Lawton Instrumental Activities of Daily Living Scale to see how well you can do more advanced tasks like making food and taking care of your home.

If you find an ADL checklist online, it’s a good idea to talk to a healthcare provider before trying to use it on your own. Even with the best intentions, it can be easy to misinterpret a checklist or what it’s telling you. When you have any concerns about yourself or a loved one, the best and safest bet is to talk to a provider and let them guide you on what to do next.

A note from Cleveland Clinic

Activities of daily living are so routine and built into your life that you probably don’t think about them much until you or a loved one can’t do them. Then, you might start wondering what kind of support you’ll need and for how long. You may also wonder what all this means for the future.

Questions pop into our minds so easily, but answers aren’t always so easy to find. That’s why it’s important to take your concerns to a healthcare provider. They’ll be ready to work with you to find solutions. If these concerns are causing you to feel sad or overwhelmed, consider speaking with a mental health professional. They can help you sort through how you’re feeling and find positive coping strategies so these life changes are a little easier to manage.