Activities of Daily Living (ADLs)

and Instrumental Activities of Daily Living (IADLs) Issues and Tools of Measurement ; Determinants of those needing assisted living:

Performance of

• • Instrumental Activities of Daily Living (IADLs)
  • Activities of Daily Living (ADLs)
    
• Cognitive status
  • Orientation, registration, attention and calculation, recall, language, judgment, and reasoning.
    
• Mental and behavioral status
  
• Physical health and medical status

Issues in the performance of ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living):

• Is activity done
  • At the appropriate time?
  • At the appropriate place?
  • In the appropriate manner?
    
• Time required for the activity
  
• Difficulty with the performance of the activity
  
• Changes in function over short periods of time.
  
  

Reasons for difficulties with ADLs and IADLs:

• Physical impairments/problems
  • Reduced Range of Motion (ROM), stiffness, tremors, reduced sensation
  • Pain/discomfort
  • SOB (shortness of breath), weakness, lack of endurance
  • Gait/balance problems
  • Sensory impairments
  • Eating/Chewing problems
    
• Cognitive limitations
  • Memory
  • Reasoning ability
  • Judgment
• Emotional and behavioral factors
  • Fear, uncertainty, lack of confidence
  • Depression
  • Anxiety

Contextual factors in ADL and IADL function:

• Personal preferences/decisions
  • Motivation
  • "Learned dependency"
  • Cultural factors
    
• Family dynamics
  
• Environmental fit
  • Barriers to accessibility
  • Features that increase risks
  • Lack of assistive technology
    

Tools for measuring physical function:

• Katz Index of ADL (Activities of Daily Living)
  • Specifies some components of activity, but they are aggregated
  • Only indicates whether elder receives assistance - not the amount needed
  • Uses hierarchy to determine level of dependence
  • Good for predictive ability, not applicable for determining needed services
    
• Functional Independence Measure (FIM)
  
  • Considers:
    • Time to accomplish activity
    • Need for assistive device
    • Need for cueing/coaxing
    • Approximate amount of activity person can do
  • Does not consider
    • Context - home, hospital, structured environment
    • Resistance - in cognitively impaired

Cognitive assessment tools:

• Mini-Mental State Examination (MMS)
  
  • Advantages:
    • Relatively short
    • Well tested
    • Samples the domain of cognitive function relatively well (except for judgment)
  • Disadvantages:
    • Educational level may have effect
    • Vision or upper extremity disabilities may interfere (drawing and writing)

 

Problems with Measurement Tools:

• Fail to measure interactions among various domains:
  
  • Examine only physical function or amount of assistance needed, not
    • Cognitive factors
    • Social or cultural factor
    • Contextual factors (environmental barriers)
  • Examine only cognitive, mood, or behavior status and do not link to physical function
    

Implications of limitations in tools:

• Good interviewing skills are critical.
  
• Acute observational skills are imperative.
  
• Professional judgment is absolutely necessary.

Source: Dr. Linda Redford, Center on Aging, Kansas University Medical Center, at "Assisted Living Skills Training" sponsored by Nebraska Department of Health and Human Services, January 20, 1999.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.