Activities of daily living – assessing the need for lifestyle support

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We rarely give the activities of daily living – like dressing, washing, eating, and walking – much thought. But if a senior in your life begins to struggle with the basics, they may need additional support.

You may have never heard of the “Activities of Daily Living” (ADLs) or “Instrumental Activities of Daily Living” (IADLs). But if you’re a senior, or the child or caregiver of a senior, these are terms worth knowing.

ADLs and IADLs are the everyday tasks that people need to manage their lives. It’s what lets them live at home and be fully independent. If a senior is struggling with any of these tasks, it can be a sign that they need greater support.

ADLs and IADLs explained
ADLs are the basic care tasks that we learn at a young age, says Tanya Baker, Clinical Practice Director for Bayshore HealthCare. “These are physical tasks a person performs everyday to manage their hygiene and health.” She shares that these tasks include:

Personal hygiene and grooming
Dressing
Eating
Toilet hygiene
Bathing
Getting in and out of a chair or bed
Walking inside or outside the home.

IADLs are skills that we often learn as we mature, says Baker. “They involve more complex thinking and organizational skills.” She notes that these activities include:

Bill paying and managing finances
Shopping and meal preparation
Driving or using public transit
Using the telephone and other forms of communication
Housecleaning and home maintenance
Managing medications.

“We rarely give these tasks much thought,” says Baker. “But as you age, these activities can become more difficult to perform. And you rarely think of them until you or someone close to you can’t do them anymore.”

Why ADLs and IADLs matter
Most people want to live in their home for as long as possible. Assessing ADL and IADL abilities can show where supports are needed to allow this independent living to continue.

Baker says that the first signs of trouble for seniors are often the more complex IADL tasks.

“The senior may have little trouble with grooming, dressing and eating, and you think everything is fine. But then you notice a pile of unopened bills on their desk. That’s a signal to look a little deeper.”

Baker says there are many signs that an ADL or IADL assessment might be worthwhile. These include:

Altered eating habits (less of an appetite or unhealthy eating)
Neglect of personal hygiene
A home that’s messier or less clean than usual
Relationship changes
Not wanting to go out anymore
Physical accidents
Cuts and bruises that they don’t notice or mention
Not opening mail
Missed appointments
Purchasing unusual things.

The inability to manage ADLs and IADLs can create health problems – or make existing problems worse.

Poor personal hygiene is one example. If a person is unable to maintain good skin health, the skin can break down. This can potentially allow unwanted organisms to enter the body, resulting in infection.

Poor eating is another danger sign.

“Consider a person who can no longer plan and shop for meals,” says Baker. “They’ll eventually become malnourished. And this can lead to a progressive decline in physical and mental well-being.”

Making an ADLs assessment
Difficulties with ADLs and IADLs can reveal how much help, supervision and hands-on care an older person needs. But is this something you can assess and measure?

Baker says that there are many free online tools that can help families make their own assessment. It’s often a good starting point, as it doesn’t involve a third-party assessor. This can be important if a parent is resistant to getting support. By doing your own assessment, you can have a conversation directly with the parent. This can minimize potential embarrassment and hurt pride.

If the parent is willing, provincial health authorities can provide an in-home assessment. And many private home care agencies – like Bayshore – also provide free in-home assessments. And both public and private agencies can advise on the care and services that may be available to help.

“We use a few different tools at Bayshore to measure a person’s ability to manage ADLs and iADLs,” says Baker. “We can then tailor our care plans to meet client specific needs. The tools also provide an important baseline. Over time, we can measure whether the supports are improving or maintaining a person’s abilities to manage daily tasks.”

ADLs supports available
The potential supports available to help seniors at home are vast, shares Baker. “They range from caregiver help with meals and bathing to visits from nurses, physical therapists and social workers.” In many cases, physical alterations to the home are a starting point, she says. This might involve the removal of tripping hazards, placing needed supplies in reach, or installing handles for support.

“It’s important to remember that putting supports in place is not an all or nothing proposition,” says Baker. In fact, it’s important that seniors continue to do as much as possible on their own.

“We want people to have as much independence as possible,” says Baker. “If they sit all day and let others do the work, they’ll lose the skills they still have.”

It’s all about providing the right amount of support at the right time. Perhaps a person needs help getting into and out of the bath, but they can do the bathing themself. Or they need a medication reminder but can take the medication on their own.

Baker says that one of the best ways of ensuring the right support at the right time is to have conversations early.

“If you have conversations with the senior before they need support, you can involve them in the eventual decision-making. Nothing feels forced or sudden – and you can often ease them into support and care.”

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