Female attendant filling in a form with a senior woman during a home health visit

Female attendant filling in a form with a senior woman during a home health visit

As you explore the many care options that are available for your elderly loved ones, you may come across the terms “Activities of Daily Life” (ADL) and “Instrumental Activities of Daily Living” (IADL) and be confused by what activities fall into each category, or whether or not your senior loved one needs assistance managing one or both areas.

It is quite common for aging adults to need assistance with a variety of activities.  In fact, according to a 2014 Center for Disease Control (CDC) study, 10.6% of adults over 75 have limitations in ADLs, while 18.8% have limitations in IADLs.  But, what exactly are ADLs vs IADLs, what are the differences between the two and how can this knowledge assist you as you search for the appropriate level of help that your loved one needs?  

What are ADLs?

ADLs are activities that we perform daily that are instrumental to our happiness, health and survival.  If we view ADLs from the perspective of a personal care attendant (attendant), these are all hands-on services that require physical assistance.

Some ADL examples include:

  • Bathing – this would also include other daily personal hygiene tasks, such as oral care.
  • Dressing – both getting dressed and choosing appropriate clothing.
  • Eating – the act of consuming food and using cutlery, but not actually preparing meals.
  • Mobility – being able to get in and out of bed, and to move around the house independently.
  • Using the Restroom – this includes the ability to get on and off of a toilet, as well as cleaning oneself.

Why Do ADLs Matter?

ADLs matter because they are essential to survival.  A person needs to eat, drink and have at least some mobility in order to maintain life.  If your aging loved one has difficulty performing one or more of these activities on their own, they will need to have some form of assistance, whether it be in-home health care, daily help from loved ones or, in some cases, a move into assisted living.

What are IADLs?

IADLs are activities that are not instrumental to survival, but are crucial to a person’s well-being and quality of life.  They are also the key to a person’s ability to live on their own long-term.   IADLs can be thought of as hands-off services, as they don’t require the attendant to make physical contact.  

Some IADL examples include:

  • Errands – grocery shopping, trips to the pharmacy and clothes shopping.
  • Healthcare – managing all aspects of healthcare, including making and remembering to go to doctor visits, and taking medications as prescribed.
  • Meal Prep – this includes preparing meals as well as meal planning.
  • Housekeeping – cleaning the home, taking out the trash and doing laundry.
  • Communication – being able to properly use the telephone and computer to communicate.
  • Transportation – being able to drive, take public transportation or hire cabs, in order to get to doctor visits, social functions, etc.
  • Managing Finances – paying bills on time, writing checks and performing basic banking tasks.
  • Extracurricular Activities – socializing, going to church or enjoying hobbies.

Many of these IADL tasks can be handled by local family and friends, or some services might be handled by an outside party, such as an accountant.  

What are the Differences Between ADLs and IADLs?

The biggest difference between ADLs and IADLs is that ADLs are essential for survival.  They are also performed on a daily basis – often multiple times per day.  If someone has difficulty completing one or more of these activities, then the chances they can safely live without assistance are considerably reduced.


DOWNLOAD: Checklist: Does my loved one need help with Daily Activities?

The Importance of IADL Performance

The inability to perform IADL tasks is not always as obvious.  They will not necessarily immediately affect a person’s survival, but they will eventually cause major issues.  Many of these instrumental needs can be met by family members, friends or neighbors for quite some time.  However, it is important to keep in mind that this also indicates that there may be a need for further help – whether that be outside care, in-home care or home modifications.  

Also, after a while, the list of services that your loved one needs help with in order to continue living independently can grow larger than you may be able to handle on your own.  Between cleaning, managing finances, grocery shopping and running errands, family caregivers can find themselves unable to keep up.

Diminished IADL abilities are often one of the first signs of early cognitive impairment so it is important to take them seriously.  These IADL activities are also some of what brings true joy in life, and not being able to adequately manage them can be quite devastating to your loved ones.


How are ADLs and IADLs Assessed?

Knowing the difference between ADLs and IADLs can make all of the difference in correctly assessing your loved one’s care.  Dr. Leslie Kernisan, a geriatric expert and educator, explains that “(family) caregivers have more information about how a senior loved one is doing than the doctor does.”   It’s important for family caregivers to bring up any changes that they notice in ADLs or IADLs to their loved one’s doctors because these may unearth a variety of underlying issues.


Another equally important means of assessing ADLs and IADLs is self-reporting.  This can be especially helpful if cognitive deterioration is minimal.  It can be very difficult to figure out a good way to bring this up to your loved ones.  Dr. Kernisan suggests that a good way is to simply ask them how they feel things are going.  


DOWNLOAD: Checklist: Does my loved one need help with Daily Activities?


There can be issues if the person is either unaware of their own mental and physical limitations, or too embarrassed to bring them up.  Therefore, a full assessment of the situation should take into account a combination of the perceptions of the elderly person, their caregivers and their doctors.

Specific Signs to Look Out For

If your loved one has recently experienced any of the following, it could be an indication that you should have a professional assess their ADLs and IADLs:

  • Driving accidents
  • Physical health problems, such as falls
  • Memory impairment, including forgetfulness or getting lost
  • Consistently late bill payments, or other issues with managing their finances
  • Falling for “scams”

Often with cases of Alzheimer’s and dementia, ADLs will only decline in the later stages of the disease.  The first indications of cognitive impairment will be much more obvious in a person’s ability to independently perform IADLs, so it is important to keep an eye on these signs.

Initial Assessment Steps

Determining the level of impediment in a person’s day-to-day life is the very first step in creating a personalized care plan.  It is important to clearly define the types of ADL and IADL care that an individual may need, as it may also determine whether or not in-home care is possible.  The following tips may help you as you begin to consider an initial assessment:

  • Make your own observations, but also ask around.  Check in with other friends, family and neighbors who may have close contact with your loved one and see what changes they may have noticed.
  • Keep in mind the time of day and the possibility that the elderly person may simply be tired.  For things like memory impairment, it’s best to assess on a spectrum.  
  • Be patient and try and find the time to truly stop and observe.
  • Support your loved ones as best you can as you seek treatment for them.

Benefits of Choosing In-Home Health Care

Probably the biggest benefit for choosing in-home health care is the happiness and comfort of your loved one.  While some elderly people prefer assisted living communities, many are much happier living in their own home, just as they have always known.  Their quality of life will be far greater if they would prefer to live out their life at home, and are able to comfortably do so.

In-home health care allows for patients, caregivers and RNs to design completely customized care plans right from the comfort of your loved one’s own home.  These plans can be continually monitored and adjusted according to changes in ADLs and IADLs.

We know that above all else, you want what is best for your aging loved ones.  But, it can be difficult to know what living situation or level of care will be best.  For more information on ADLs vs IADLs, home health aide or in-home health care in general, give us a call for a free phone consultation.  One of our experienced Family Choice Healthcare team members will be happy to assist you with any questions that you may have.