Living your best life can be downright difficult when you need help to complete basic daily activities. Everybody needs a little help with activities of daily living (ADLs) at some point in their lives, whether young, old, or somewhere in between.
What are ADLs, really? Knowing what basic ADLs are and what they involve can give you a better understanding of what you need to do to maintain independence and quality of life even as circumstances change. So let's get started exploring what everyone should know about these key life tasks.
What are ADLs - Activities of Daily Living?
Activities of daily living are the most fundamental and functional tasks of everyday life. Sometimes called physical ADLs, they are basic self-care tasks completed from the time you get out of bed to when you retire for the night.
Some even call them BADLs - Basic Activities of Daily Living - because they're just that essential. They're skills initially learned during childhood.
ADLs are typically routine and can be done independently by most young and healthy individuals. Most people do these activities without really thinking about them because they are so accustomed to completing them day in and day out.
It's only when ADLs become difficult or impossible that most people stop to think about how critical these routine skills are.
Why Are ADLs Important?
Performing ADLs is necessary for an independent lifestyle and critical for quality of life. Difficulty with one or more ADLs can adversely affect safety and well-being.
The inability to perform basic skills such as dressing and using the bathroom can seriously impact everyday life. Struggling with mobility can increase the risk of falls and overall decline. Similarly, difficulty with independent eating can result in dehydration, inadequate nutrition, and physical weakness.
Since activities of daily living indicate a person's functional abilities, they are used as a measure for decision-making. The level of assistance or care needed by a senior often correlates with their ability to perform ADLs.
A person's ability to perform ADLs can indicate the likelihood of needing assistance and alternate living arrangements. It can also help predict the need for hospital or nursing home admission and home care services.
Benefits of ADLs
The main benefit of ADLs is independence with everyday tasks. No one wants to rely on others for their basic daily needs. Maintaining independence with activities of daily living provides a sense of confidence that can lead to improved well-being, increased social engagement, and overall quality of life.
Additionally, having the ability to do these tasks without assistance decreases reliance on others. It can also provide peace of mind to family members and friends who worry about seniors' safety and independence.
People who are independent with ADLs generally have greater social engagement as it allows individuals to participate in activities that require a certain level of functional ability. This engagement helps reduce loneliness and isolation, a significant health and wellness concern for seniors.
Let's take a deeper dive into each of these important ADLs.
The Six Activities of Daily Living
Eating is essential for our survival as humans as it's necessary to maintain our physical and mental health. Eating a balanced diet helps ensure that we get the nutrients, vitamins, and minerals our bodies need to stay healthy.
Regular feeding helps regulate our energy levels, focus better, and maintain a healthy weight. Furthermore, it can help improve our moods by providing us with the energy needed to do activities we enjoy.
In particular, here eating refers to the physical act, not the preparation of the food.
Many health issues can make it challenging to eat. Some people have difficulty chewing, others struggle to use utensils to bring the food to their mouth, and others may find it difficult to stabilize a plate or cup.
For most people, getting dressed is a part of their daily routine, unless you're like a former client of mine who lived at a nudist camp. But even most of the residents wore some piece of clothing, even if it was only a hat!
Getting dressed requires going into a closet, reaching for a piece of clothing, opening a drawer, and pulling out an item. What if the clothing rail is too high? What if the drawer is too heavy or the knob too small to grip well?
The next part of the process is putting the clothes on your body. A lot of joint range of motion is required to pull a shirt over your head or maneuver your legs into pants. Then there are the buttons, zippers, buckles, and ties to make sure the clothing is closed up and will stay on.
Anyone with an injury or pain can attest to how difficult getting clothes on and off can be, even though it's a daily skill we take for granted.
3. Personal Hygiene
Personal hygiene is another essential skill for looking and feeling your best. Good hygiene habits can help you prevent illnesses, maintain a pleasant appearance, and boost self-confidence.
This collection of activities includes dental hygiene, hair care, and bathing. Each of these skills has several components.
Dental hygiene includes brushing and flossing teeth manually or with an electronic toothbrush or water-pick flossing device.
Hair and Nail Care
Hair care includes shaving, washing, and styling hair. Although not a daily task, trimming nails is also included in personal hygiene.
Bathing is the most complex of the personal hygiene tasks. The process involves entering and exiting the bathtub or shower and adequately washing the entire body from head to toe including washing hair.
Difficulty with bathing is associated with a greater likelihood of requiring admission to a care facility compared to other ADLs.
Although these grooming and bathing skills may seem simple, many physical and cognitive processes are required to complete them effectively.
4. Functional Mobility
Mobility is another essential skill set for living independently. Being able to safely move from one place to another both indoors and outside, whether getting out of bed, going from your bed to the bathroom, moving around the kitchen, or in and out of the front door is vitally important.
Helping clients improve their functional mobility is a primary goal as a physical therapist. Mobility involves numerous critical activities such as bed mobility, transfers, and ambulation (a fancy term for walking). If someone does not walk, they need to be skilled at using a wheelchair for their functional mobility needs.
Bed mobility refers to a person's ability to move around in bed. This includes the ability to turn over, change position, and push themselves up when needed. Bed mobility also encompasses the ability to get in and out of bed.
Transfers involve a person moving or being moved from one spot to another. Examples of transfers include:
Helping someone move from their bed to a wheelchair
Getting in and out of a car
Transferring into and out of a shower
Ambulation is a more technical term that describes the act of walking or moving from one place to another. Someone may have assistance to ambulate, such as by another person, with a walker, or with a cane.
Usually the most challenging mobility, stairclimbing is a necessary activity when there are steps to enter the home and reach the bathroom and bedroom. Stairs are often problematic requiring a stair alternative such as a ramp, chair lift, or elevator.
Wheelchair mobility is the ability to use a wheelchair to complete everyday activities. It involves more than moving around in a wheelchair, including turning, stopping, and transferring; it also includes a range of skills necessary for safely operating a wheelchair.
Toileting is an integral part of self-care and maintaining good health. It's also a fundamental skill many take for granted until we need additional help.
This, too, is a set of activities, including getting to and from the toilet, managing and adjusting clothing, and then being able to clean up afterward. It's a variety of skills that can be pretty challenging to individuals following surgery and those with disabilities and age-related limitations.
Managing continence is the ability to control bladder and bowel functions. It includes recognizing when you need to use the restroom to avoid accidents.
Note: Certain organizations combine toileting and continence as one category, resulting in a total of five ADLs.
What Factors Contribute to a Decrease in the Ability to Perform ADLs?
As it turns out, many factors, some obvious and some not so obvious, can cause difficulty completing activities of daily living or ADLs.
Age-related ADL impairment is common and can result from many different issues that cause functional decline. For example, strength, stamina, flexibility, coordination, and balance gradually reduce with age. Other factors, such as decreased vision, hearing, and sensation, make ADLs more challenging.
Illness and Injury
Illnesses, whether acute or chronic, can affect someone's ability to complete ADLs independently. Acute illness often leads to a more sudden decline, whereas chronic diseases often result in a gradual decline in physical ability, potentially impacting a person's ability to perform ADLs.
Likewise, injuries can also significantly impact independence with ADLs and often occur abruptly.
Medical conditions affecting the nervous system, joints, muscles, blood circulation, or sensory function can cause decreased physical ability, resulting in challenges with activities of daily living. These issues may cause a fast decline of ADL ability.
In contrast, progressive conditions often cause a gradual reduction in a person's ability. Examples of diseases that get worse over time are osteoarthritis, COPD, scleroderma and Parkinson's disease.
Cognitive ability plays a critical role in our daily lives, encompassing skills such as memory, problem-solving, data analysis, decision-making, and planning.
Therefore, a decline in cognitive function or mental impairment may result in difficulty performing some or all activities of daily living. This can be caused by many different conditions, such as dementia, Parkinson's disease, MS, and traumatic brain injury, and may have a gradual or sudden effect on one's ability to perform ADLs.
Medication Side Effects
Medication side effects can significantly impair an individual's ability to complete activities of daily living. For example, some medications can cause drowsiness, confusion, muscle weakness, impaired balance, or difficulty with coordination. Each of these side effects can make some ADLs challenging or even impossible.
Social isolation can negatively impact an individual's ability to complete ADLs. It can lead to a decrease in overall physical health due to a lack of engagement in activities, including activities of daily living. When problems arise with ADLs, socially isolated people are less likely to seek and receive the help they need.
The home environment can significantly impact a person's ability to complete activities of daily living. The physical layout of the home and the absence of accessible home features can hinder a person's ability to complete ADLs.
Being in the hospital can dramatically impact a person's ability to complete ADLs. In many cases, hospitalized individuals spend excessive time in bed, resulting in functional decline and decreased ability to perform activities of daily living.
Activities of Daily Living Assessments
Healthcare professionals, especially physical and occupational therapists, use various assessment tools to evaluate a person's ability to perform ADLs and functional skills. Essentially, they want to know how much assistance is needed to complete these every day tasks.
Periodic evaluations can detect any possible issues during the performance of activities of daily living. Examples of common ADL assessments used by health professionals include the Barthel ADL Index and Katz Index of ADLs.
Healthcare providers may then suggest interventions to help individuals maintain independence with ADLs. These strategies may include assistive devices, home modifications, or physical or occupational therapy sessions.
Additionally, functional assessment of activities of daily living is used to determine the need for placement in a care facility such as assisted living, skilled care, or nursing home facilities. These evaluations play a role in determining eligibility for state and federal assistance programs for older adults and disabled individuals, as well as benefits for disability insurance and long-term care insurance policies.
What Assistance is Available to Help With ADLs?
Various options are available for receiving help with completing activities of daily living.
Individuals who have difficulty carrying out activities of daily living tasks may benefit from skilled rehabilitation services such as physical or occupational therapy. The therapists design a treatment plan to address specific difficulties someone is having. Therapy may include interventions such as education, exercises, and adaptive tools.
In-Home Care and Assistance
In-home assistance is available through private sources such as family caregivers or a paid agency that supplies staff to provide physical and emotional support with bathing, dressing, grooming, and toilet hygiene, among other activities.
Assistive Devices and Aids
Assistive devices such as walkers, canes, scooters, and wheelchairs help individuals complete ADLs with greater ease, independence, and safety. Other aids such as reachers, grab bars, and shower chairs can also provide support to make daily activities easier.
Technology, including smart technology, has become increasingly integrated into our daily lives and can be particularly useful in helping people with activities of daily living.
Smart home devices such as voice-activated assistants, smart thermostats, and automated lighting systems can help people with mobility or cognitive impairments to control their environment more easily.
Wearable technology can help people monitor their physical activity and manage their health. Emergency response systems can provide individuals and their caregivers peace of mind.
Home modifications can significantly improve the ability of individuals to perform activities of daily living. There are many modifications to choose from with many more becoming available with the demands of the growing Baby Boomer population.
Examples of common home modifications include adding grab bars in the bathroom, installing ramps or stairlifts, and widening doorways to accommodate mobility devices. These solutions are practical and cost-effective for most situations.
By making these modifications, individuals can maintain their independence and perform tasks that may have previously been difficult or impossible. Home modifications can also reduce the risk of falls and injuries, which is especially important for older adults.
Final Thoughts on Activities of Daily Living
It's common to be asked about your ability to perform activities of daily living during medical visits, whether or not you're aware that it's part of an ADL assessment. ADLs are essential for our well-being, from getting dressed in the morning to brushing our teeth before bed.
Many factors can affect ADLs, including physical and mental health issues, making identifying problems and quickly finding solutions necessary.
Yet few people are aware of the importance of ADLs until issues arise and their functional independence, self-care, and quality of life, are impacted. ADL dysfunction is prevalent among older adults, which sadly often results in their inability to continue living independently at home and necessitates moving to a retirement facility.
By focusing on ADLs, individuals can take proactive steps to maintain their independence, improve their overall well-being, and receive the necessary support to thrive, especially during retirement.
What are Basic Activities of Daily Living (BADLs)?
Basic Activities of Daily Living, or BADLs, are another term that refers to ADLs. Also called physical ADLs, basic ADLs are activities required to manage fundamental physical needs.
Why are ADLs important for aging in place?
To live at home safely and independently during retirement, a concept called aging in place, older adults must be able to perform basic, self-care activities of daily living. However, as individuals age, they may experience physical or cognitive decline, making it challenging to perform ADLs.
Assistance from family members and caregivers, as well as adaptive devices and home modifications, may be necessary to ensure that older adults can continue living safely and comfortably in their homes.
What are IADLs?
IADLs, or Instrumental Activities of Daily Living, are tasks related to every day but more complex skills needed for independent living. These activities are more involved than ADLs (Activities of Daily Living) and are skills generally learned in the teenage years or as a young adult.
IADLs require higher levels of cognitive functioning, decision-making, and organizational skills.Examples of IADLs include money management, transportation, meal preparation, medication management, communication, housekeeping, laundry, and shopping for groceries.