What Does ADLs Stand For, And What Does It Mean For Caregivers?

Scary Mommy interviewed three registered nurses with experience in geriatric care to provide in-depth medical insight for this article on ADLs: Carolyn Garrett, RN, who has worked at several nursing homes and is behind Teach.Work.Mom; Sarah Johnson, RN and the health ambassador for Family Assets; and Ellen Lishansky, RN and director of marketing at Dry Harbor Nursing Home & Rehabilitation Center.

Even though we all know aging is coming — both for ourselves and our family members — it’s never easy to start to see people we care about decline. As you may have learned in your early 20s (or maybe 30s) when you embarked on your life as an adult, doing the bare minimum to keep yourself alive, fed, safe, clothed, and housed not only takes a lot of money but involves quite a bit of effort as well.

Eventually, we get used to these everyday tasks, and they become routine. Technology changes, but we do our best to adapt. But at a certain point, we may not be able to keep up with everything required to care for ourselves and run our version of a household. That’s why it’s important to consider the activities of daily living (ADLs) a person needs to enjoy a decent quality of life.

But what, exactly, are ADLs, and why are they so important? Scary Mommy spoke with three registered nurses with experience in elder care to find out.

What is the medical meaning of activities of daily living (ADLs)?

ADLs stand for “activities of daily living.” It refers to the things we do and the skills we need every day to keep taking care of ourselves. In a medical context, a person’s ability (or inability) to perform is an important measure of ability/disability resulting from myriad disorders and conditions.

What are some examples of activities of daily living (ADLs)?

There are two different categories of ADLs: basic ADLs and instrumental ADLs. Basic ADLs — also referred to as “physical ADLs” — are the skills required to manage one’s basic physical needs.

Basic ADLs

These fall into six categories:

• Ambulating: The extent of an individual’s ability to move, change positions, and walk independently.
• Feeding: The ability to feed oneself.
• Dressing: The ability to select appropriate clothes and to put the clothes on.
• Personal hygiene: The ability to bathe and groom oneself, as well as maintaining dental hygiene, nail care, and hair care.
• Continence: The ability to control bladder and bowel function.
• Toileting: The ability to get to and from the toilet, using it appropriately, and cleaning oneself.

Instrumental ADLs

Instrumental ADLs, on the other hand, require more complex thinking and organizational skills. They also fall within six categories:

• Transportation and shopping: The ability to get groceries, attend events, and get oneself from one place to another on their own — whether it’s driving or by organizing other means of transport.
• Managing finances: The ability to pay bills and manage financial assets.
• Shopping and meal preparation: Everything required to get a meal on the table, plus shopping for clothing and other supplies.
• House cleaning and home maintenance: Cleaning kitchens after eating, maintaining living areas reasonably clean and tidy, and keeping up with general home maintenance.
• Managing communication with others: The ability to use the telephone and mail (anything internet-based may be a big ask for certain generations).
• Managing medications: Ability to obtain medications and take them as directed.

Why are ADLs important?

While the loss of ability to perform necessary daily functions is enough of a concern, there is other information that this type of decline can provide for compassionate caregivers — including crucial clues about their loved one’s health.

“The functional status that is necessary to perform these activities are what the average adult may take for granted; however, the inability to perform ADLs can lead to poor hygiene, malnutrition, risk of infection, pressure ulcers, muscle contractions, etc.,” says Carolyn Garrett, RN, who has worked at several nursing homes and is behind Teach.Work.Mom, a resource to help moms achieve better work-life balance.

And according to Sarah Johnson, a geriatric RN and the health ambassador for Family Assets, an eldercare and senior living resource, ADLs are not only important because they both address a person’s basic biological needs and establish routines for seniors. “Routines are crucial for older adults living in care homes and assisted living because they provide a sense of safety and stability, while also making it easier to handle memory and cognitive decline,” she explains.

Finally, it’s important for caregivers to make aging adults recognize where they are still capable of taking an active role in their lives, Ellen Lishansky, an RN and director of marketing at Dry Harbor Nursing Home & Rehabilitation Center, explains.

“Providing choices so they can make simple decisions — even if they have some dementia — to allow them to partake in establishing their preferences in customary routine and schedule can make them feel that they are still in some way, having active meaningful lives,” she says. “Every individual still needs to feel they are important despite loss in physical and/or mental capabilities. It is up to the caregivers to recognize each individual’s strength and build upon it and help to maintain the individual’s self-esteem.”

What is the ADL assessment?

To help determine whether the older adults in your life can live independently or need assistance, take an ADL assessment. It’s normal for certain functions to decline as people age, and a great way to gauge this is by using an ADL assessment. It’s used to measure an older adult’s ability to live alone and manage their day-to-day. They usually look like questionnaires and require one to rank or score certain functions based on the senior’s abilities such as bathing, dressing, or feeding. Check out The Lawton IADL example below.

What is an ADL disability?

It’s important for seniors to be able to do regular activities to help them throughout their daily lives. However, if you find this person struggles to do day-to-day tasks independently, they may have certain limitations. More than 46 percent of seniors, 60 years and over, have disabilities. A few common signs include not being able to get in and out of the shower by themselves or needing help getting dressed.