Activities of Daily Living
Measuring What They Can Do
I’ve done a lot of research since starting this website, and I did research on a plethora of topics in the past 15 years I have been a primary caregiver. Not a day goes by that I don’t reach some article or watch some video to gain greater understanding on the topics affecting my loved one. You are probably the same—that’s what led you to this blog.
No matter how hard I try to be informed and updated on topics related to my situation, I’m shocked how often I come across something that hasn’t been mentioned to me along the way. That’s how I feel about this topic. I’ve known about the several ADLs for years, but this is the first I’ve found IADLs, which is frustrating to me. Even if knowledge wouldn’t have changed anything I did with Pop or in the past with Mom, I still like to have all of the information I possibly can to make an informed decision. A few previous blogs—anticipatory grief and therapeutic lying—stemmed from the same frustration of finding something I hadn’t heard of before that would help and support my position as Mayor.
So, let’s delve into the daily tasks that are required by every adult, and look at how cognitive decline plays a part in the quantification of dementia from the medical perspective.
ADL’s Explained
ADL stands for Activities of Daily Living, and I’m betting you’ve heard of this before. It is a commonly discussed measure of the cognitive and physical decline of an elderly person, and is used by the medical community to quantify how impacted the older person is by their decline. There are seven ADL’s that the medical community uses to measure the abilities of your loved one. They are:
- Walking – also referred to as “ambulating”, this refers to their ability to get from point A to point B.
- Bathing – refers to their ability to clean their entire face and body in a bath or shower unassisted.
- Dressing – refers to not only their ability to put clothes on and take them off, but also refers to their appearance and ability to self-groom.
- Feeding – means that they can consume a meal completely from a plate using the proper utensils.
- Toileting – requires that they be able to use the toilet fully independently.
- Transferring – is their ability to move from one position to another, for example lying prone to sitting up in bed.
Now that you’ve seen the list the medical community uses, perhaps you are recalling conversations with doctors about these things. One of the ones that is really striking to me is the “Dressing” ADL, because Pop had very specific feelings about that one. He always talked about men of his generation who become widowed and don’t know how to care for themselves because they were so reliant on their wives. He made me promise him that I would require that he get dressed every day, brush his teeth and come to the table for meals. He did, too, until the very last days.
Referring to the first resource below, 68% of adults over age 65 will become cognitively impaired in at least two of the above categories. With one in five reporting difficulty in one or two ADL’s. These are sobering statistics, particularly when you realize that it is the ability to complete ADL’s that keeps older people independent.
When you can’t care for your own safety, you simply can’t live independently. Sobering fact for two-thirds of our senior citizens.
IADL’s Explained
Before doing research for this blog, I had never heard of IADL’s. That is frustrating to me, and actually makes me angry. I have been an extremely active partner in my parent’s health for 15 years, visiting multiple doctors and specialists on an ongoing basis, asking every question I could think of, and requesting advice and suggestions at every visit.
But nobody mentioned that IADL’s could be the most accurate precursor to cognitive decline. Maybe it wouldn’t have changed things, but perhaps I would have been more prepared, and I certainly would have been more informed.
IADL refers to Instrumental Activities of Daily Living. These are more complex activities that require thinking and mental organizational skills to be successful. These absolutely essential skills are often the first clue you will have that your loved one is facing some cognitive decline that will require your assistance.
Let’s look at the six most commonly discussed:
- Finances – taking care of recurring and one-time bills for assets, properties, or any other financial instrument.
- Transportation – refers to operating a vehicle in a safe manner to get from one place to another for specific purposes.
- Running errands – means that you can independently plan and execute multiple stops on the same trip.
- Home maintenance and housekeeping – refers to the ability to do mundane tasks such as dishwashing, as well as taking care of seasonal repairs or anything else necessary to maintain a safe living space.
- Communications – refers to the ability to use current technology to keep in touch with people on a two-way basis, as well as handling incoming and outgoing mail.
- Medication – is the process of obtaining medication, keeping it in an organized fashion, and taking it as directed by a physician.
Now that we have listed the common IADL’s, I can almost feel you going over different scenarios in your head and evaluating your loved one. Research indicates that monitoring the IADL’s is a great way to “catch” the first symptoms of cognitive decline, and will help you start to facilitate assistance with anything that is becoming problematic for your loved one.
I really wish that I had a better understanding of the importance of monitoring IADL’s when my parents started to decline. In retrospect, I saw signs of mild cognitive decline long before I recognized the physical decline in my father. Keeping abreast of your loved one’s abilities is one of the easiest ways, in my opinion, to keep something catastrophic from going on.
The Fine Line Between “Competent” And “Incompetent”
Imagine telling your loved one they are “incompetent”. Yikes. That word is so negatively charged, I can’t even imagine ever telling Pop or Mom that I thought they were incompetent. I don’t care how old I am—I would’ve gotten hit!
Let’s avoid that phrasing altogether, please.
Let’s use the legal determination, which is “capacity”. As a general statement, capacity requires that people are able to understand the situation they are in, the decision in question, and the consequences they face by making a given choice.
Doesn’t that sound much better than “incompetent”? I think so.
So, from a legal perspective, we are talking about whether or not your loved one has the capacity to live independently and handle their own resources and decisions. Capacity, in my experience, is quite the slippery slope, and really what you are evaluating when we are talking about ADL’s and IADL’s. It’s not that Mom doesn’t want to get dressed sometimes—it’s that she can’t manage the buttons on that shirt, or she forgets it’s summer and she doesn’t need two jackets on.
Looking at it from the perspective of “capacity for understanding” versus “incompetence”, the conversation becomes much less emotionally charged and accusatory. You need to carefully consider the language you are using with your loved one’s, to avoid insulting or upsetting them unnecessarily.
My Experiences
Now that we’ve identified the skills the medical community finds important for your loved one to remain independent, we need to evaluate how all of these indicators fit with your loved one. In retrospect, I started handling IADL’s very slowly with my parents. I distinctly remember the first one in 2007, when I bought them their first cell phone, because they needed an emergency contact method after Pop had his first heart incident. From that point on, I started to slowly and methodically take over all of the IADLs for them. They still ran their own errands well into 2015, but I started to oversee the finances and make sure bills and car registrations were being taken care of for them.
That’s how it started for me, and probably how it will start for you. As things declined with Mom, it became quite obvious that she didn’t have the capability to recognize good versus unhealthy choices—I’ve told you how she reacted to every television commercial telling her she needed more health insurance. While even now she remembers to eat, and can be coaxed into drinking water on a regular basis, she lost the ability to prepare her own food due to our safety concerns several years ago.
The worst thing, in my opinion, is how subtle and insidious the loss of IADLs and ADLs can be, slowly robbing your loved one of the independence they enjoyed. That is why you need to be as vigilant as possible, so you can step in with love and respect to help them maintain their dignity while you oversee their physical and mental care.
It ain’t easy being The Mayor.
THANK YOU FOR READING THIS FAR!!!
Wow! You made it! Thank you for reading about activities of daily living!
Hey, since you’re here! You may as well check out therapeutic lying, here, or if you’ve read that, check out more dementia problems, here! Or maybe you want to hear more about Pop, here. Or, check out our other topics here! Either way, I appreciate you!
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Resources
https://www.agingcare.com/articles/instrumental-activities-of-daily-living-defined-427370.htm
https://www.agingcare.com/articles/activities-of-daily-living-why-this-measure-matters-186853.htm