You may or may not be familiar with the term Instrumental Activities of Daily Living (IADLs), or you heard the expression in passing. Most home health, hospitals, and rehab facilities use IADLs as an umbrella term to describe specific functions that impact independent living.
Jump ahead to these sections:
- What Are Instrumental Activities of Daily Living (IADL) for Aging Adults?
- What’s the Difference Between Instrumental Activities of Daily Living and Activities of Daily Living?
- List of Instrumental Activities of Daily Living for Aging Adults
- How Are IADLs Used in Choosing Care for an Aging Adult?
Think about all of the various tasks you do each day to get ready for work or engage in activities. Imagine being unable to perform any one or several of these, and you get an idea of the significant impact they have on safety and quality of life for an aging adult.
An understanding of IADLs will help you and your family choose the best care for your particular needs. Conditions that affect the ability to perform IADLs range from dementia to neurological disorders to physical impairments. Difficulty with tasks could be permanent or temporary, depending on the condition that is causing impairment.
Suppose you or your loved one has a permanent disorder that affects carrying out several IADLs. In that case, you will need to consider home care and accessibility options to maximize independence and safety.
What Are Instrumental Activities of Daily Living (IADL) for Aging Adults?
IADLs are those tasks that require both physical and cognitive ability. By that, we mean the strength, endurance, and flexibility to carry out activities and the mental capacity to live independently in the community. Generally speaking, IADLs are considered more complex and, in many cases, can impact the ability of an older adult to live alone.
What’s the Difference Between Instrumental Activities of Daily Living and Activities of Daily Living?
Activities of daily living (ADLs) do overlap with IADLs. Generally speaking, the main difference is this: it is possible to require assistance with ADLs but be completely independent concerning IADLs. For example, a person could fall and break a hip and require bathing, dressing, toileting, eating, and mobility assistance.
That said, they are fully capable of managing IADLs and with proper recovery, will eventually be able to do their ADLs independently as well. Conversely, it is also possible for someone to have difficulty managing some IADLs but be virtually utterly independent with regard to ADLs. A person could have mild cognitive impairment and struggle with finances but still be able to dress, bathe, walk and toilet themselves.
List of Instrumental Activities of Daily Living for Aging Adults
The list of IADLs is not definitive but rather a range of activities that may overlap with ADLs. As mentioned, instrumental activities of daily living do require some level of what is called “executive function.” Not all experts agree on the definition of executive function, but generally speaking, these are the skills needed.
- Attention: Attention is closely tied to memory. If you are unable to attend to something, you will likely not remember it. Think about a time you were reading something, and your mind wandered. You get to the bottom of the page and have no idea what you just read!
- Organizing: Organizing entails sequencing the appropriate steps to complete a task.
- Managing emotions: Managing emotions is necessary to daily functioning. Anger and frustration are normal, but we can keep those in check if they interfere with our normal activities.
- Keeping track: The skill of keeping track allows you to finish one task before beginning another one. You don’t repeat tasks if you are aware they are complete.
Executive function requires a good working memory, flexible thinking, and self control. When our executive process works normally, we aren’t even aware of it, but for someone with impairment, activities become more and more challenging over time. Now that you have a better understanding of the skills involved in IADLs, we will examine the types of daily activities that can be affected.
As the family member of someone who is starting to exhibit impairment in IADLs, difficulty managing finances might be one of the first problems you notice.
Examples include not paying bills on time or losing track of financial obligations. Of particular concern is vulnerability to exploitation or scams. Your loved one may give money away to unscrupulous individuals or lack the judgment to evaluate illegitimate requests.
Managing healthcare requires attention to detail, organizing, memory, and scheduling. If your loved one is missing appointments or mismanaging medications, they could be having difficulty with this IADL.
Occasional lapses are normal, but when there is a pattern of disorganization around healthcare appointments or adherence to medical requirements, there could be a problem.
Shopping, planning, and preparing meals
Meal planning is vital to health. Sometimes families find out the hard way that their loved one cannot organize shopping for food and then prepare it. The first sign of a problem could be weight loss, an empty fridge, and no food in the cabinets. The other potential safety hazard is leaving the stove on unattended.
Transportation and driving
Driving is one of those areas that most families have to deal with sooner or later. There may not be any more challenging activity to relinquish than driving. The ability to drive safely involves a high level of executive function. Reading and understanding traffic signs, adhering to speed limits, not getting lost, and avoiding accidents are all required to drive safely.
People with dementia often can’t remember how to get home or have numerous fender benders. Even for someone who can’t drive due to physical impairments, they have the ability to arrange other transportation. Someone who has problems with IADLs will be unable to arrange for alternative transportation such as using public transportation or calling a cab.
Managing a household is a huge responsibility. If your loved one lives at home, they need to keep up with maintenance, yard care, and house cleaning. If they have a pet, they have to provide proper care by feeding, cleaning, and taking them to the vet.
Communication for older adults these days can be challenging due to an increasing reliance on technology. If your loved one struggles to use a smartphone or video conferencing platform, that doesn’t necessarily mean they are having problems with IADLs. However, if they aren’t able to use a landline, there could be an issue.
Consider the ability to communicate in the context of your loved one’s past habits. If suddenly they can’t manage a simple phone call, something could be wrong.
Hobbies and socialization
Everyone has activities that bring them joy and satisfaction. For some, it might be hobbies like reading, games, or crafts. The ability to interact socially with others is crucial to combating social isolation and loneliness. One person may have multiple hobbies, where another has just a few.
Some people are extroverts, and others are introverts. So how do you evaluate your loved one’s abilities? View impairment in these IADL skills in light of any significant changes to habits.
For example, your loved one has always enjoyed socializing with others but begins to struggle with following conversations or starts to avoid people. Or, they were a terrific card player and begin to lose track of the game and how to play it.
How Are IADLs Used in Choosing Care for an Aging Adult?
Choosing the most appropriate care for an aging adult can be one of the hardest responsibilities you have as a family member. You want them to be safe and encourage and honor their desire to be as independent as possible. In healthcare settings such as hospitals and rehab centers, therapy staff can evaluate IADLs and make recommendations for care.
However, if your loved one is at home, you may have some tough decisions to make. Your three main choices for care are time-limited home health, private pay in-home caregiving, or family caregiving.
If in-home care is not sufficient to support someone, assisted living or memory care might be the best choice. A diagnosis of dementia usually means a progression of the disease process and a continued erosion of IADLs. We have some guidelines to help you decide on choosing care.
Consider viewing safety in terms of all of the IADLs that your loved one is having problems with. If they are unable to drive safely or cook, those activities require support. In the home, caregivers can provide transportation, shop, and prepare meals. If you choose assisted living, typical amenities include transportation, all meals, housekeeping, and laundry. Families choose assisted living because it eliminates many of the IADL concerns.
If your loved one is not managing their healthcare, a geriatric care manager can help coordinate medical appointments and communicate with family. Wandering is a significant safety concern and might involve some home modifications or ongoing supervision.
Entire estates have been wasted due to exploitation or mismanagement of finances. As a family member, your first obligation is to prevent this from continuing.
Speak with an attorney about obtaining financial and healthcare power of attorney so you can take over finances. It is much easier to do this early on before cognitive impairment becomes a danger. As a last resort, you can consider guardianship to help protect a loved one.
Household management becomes too difficult
If your loved one can no longer manage the household, you can hire someone to do almost anything. But that can also be time-consuming and expensive to manage. At some point, it might be easier to consider assisted living where these responsibilities are alleviated.
Quality of life
Sometimes we get so wrapped up in the day-to-day details of IADLs we forget about the quality of life. For someone who was independent their entire life, the erosion of abilities is demoralizing and depressing. If you think about your loved ones in terms of where they are but maximize their skills and enhance their potential, you can improve their quality of life.
The activities your loved one once enjoyed may no longer be possible, but there could be other ways to engage them. At some point, the coordination of care at home to address IADLs may be so complicated it is time to consider supportive senior living.
Looking at Instrumental Activities of Daily Living as Signs
Now that you have a better understanding of what IADLs are, you can be more aware of when those skills start to decline. One mistake families make is assuming that when a loved one starts to need more help it is a normal part of aging.
Before things get worse, take your loved one to the doctor for an evaluation to rule out a reversible cause. Meanwhile, focus on safety and improving the quality of life for anyone who struggles with IADLs.