What are the Activities of Daily Living (ADLs)?
Activities of Daily Living, or ADLs, are the functional skills individuals perform regularly to maintain personal care and engage in society. These tasks encompass basic and instrumental activities, from personal hygiene to managing finances.
Everyone will have different daily life activities depending on their lifestyle and priorities. Still, some basic activities of daily living are universally accepted as essential and can be used to assess functional status.
The six crucial activities of daily living are (Edemekong et al., 2023):
In addition to these six essential ADLs, Lawton-Brody's instrumental activities of daily life (LB-IADLs) give a more complex measure of cognitive and physical functioning. The eight instrumental activities of daily living are:
- Using the telephone
- Food preparation
- Mode of Transportation
- Medication Management
- Personal finances
These daily activities can be helpful in assessing your patient's functional capacity against a standardized measure. This allows for gathering more objective data on your patient's functional status.
Recognizing the nuances of ADLs is crucial for healthcare professionals, particularly occupational therapists, as it forms the basis for assessing an individual's functional capacity and tailoring interventions to meet specific needs.
Why are ADLs important?
ADLs are pivotal in assessing an individual's overall physical and mental function and ability to live independently. The ability to perform these activities contributes significantly to one's identity, self-esteem, and independence. For older adults and those with disabilities, the ability to independently perform ADLs often correlates with the capacity to live autonomously.
While the ability to live independently can be a very subjective experience, ADLs are crucial for practitioners to objectively assess their client's ability to manage the essential activities of daily living. Rather than relying on a patient's self-report of their functioning, ADLs give a more structured and standardized measure, which can be invaluable for occupational therapists, geriatricians, or other providers
Additionally, results of a physical examination or laboratory test do not necessarily correlate to functional mobility or patient function. So activities of daily living are important to assess function practically.
Specific areas of cognition and ADLs
ADLs measure not just physical function but also assess cognitive impairments and cognitive function in terms of practical activities of daily living.
Many areas of cognition can be simultaneously measured alongside these ADLs. If an individual independently manages their medication regime or can handle their finances, they demonstrate aspects of everyday cognition like memory and computation.
Occupation therapists may prefer to measure areas of cognition in conjunction with ADLs, as they give a holistic understanding of an individual's capabilities and limitations. This comprehensive approach enables practitioners to tailor interventions that maximize functional independence and directly address the impact on their patient's quality of life.
Getting ADL assessments
ADL assessments, generally conducted by occupational therapists, are a kind of functional assessment designed to gauge an individual's functional ability to perform tasks necessary for daily living. This multifaceted process involves direct observation, interviews, and collaboration with caregivers or family members.
ADLs may be conducted through patient interviews but may also be assessed through observing the patient in their home environment or through questioning family members or caregivers.
Practitioners who may conduct an ADL assessment include:
- Occupational therapists
- Physical therapists
- Nurses and nurse practitioners.
If conducted in the patient's home, the practitioner will observe how individuals perform specific ADLs, noting any difficulties or limitations. Interviews can also provide insight into ADLs but are more likely to be subjective or susceptible to recall bias.
How does this ADL Assessment Scale work?
This ADL Assessment Scale is a simple, checklist-style tool to keep track of your ADL Assessment. Just follow these simple steps to evaluate your client's functional status.
Step 1. Add in patient details
The first step is to add your patient's details, including their name, date of birth, and ID.
Step 2. Essential ADLs
First is the six essential activities of daily living. These are adapted from Sidney Katz's activities of daily living (Katz, 1983). Each of the six essential activities can be scored either 0 for dependent or 1 for independent.
- Bathing- This activity can be scored 1 point if your patient can bathe themselves thoroughly or only needs help to bathe a single part of their body. It should be scored 0 points if they need assistance to bathe more than one part of the body or help to get in and out of the bathtub or shower.
- Dressing- Independence in this activity includes retrieving their clothing and putting on clothes and outer garments, including fastenings. Dressing can still be scored 1 point if your patient needs help with shoelaces, but should be scored 0 if they need assistance to dress beyond this.
- Toileting- If your patient can independently go to the toilet, including undressing, personal hygiene, sitting down, and getting up, they score 1 point. If they need help with any of these tasks or use a bedpan, they score 0.
- Transferring- A score of 1 can be given if your patient can move in and out of their bed or chair unassisted or with a mechanical transfer aid. 0 points should be given if they require help.
- Continence- 0 points if partially or incontinent, 1 point if they control urination and defecation.
- Feeding- if your patients can feed themselves without help, they can score 1 point. If not- they score 0 points.
Once the six essential ADLs are assessed, score your patient out of six points.
Step 3. Instrumental ADLs
This assessment also includes eight additional activities of daily living. These are:
- Ability to use the phone
- Food preparation
- Mode of ranstportation
- Managing medications
- Handling finances
Similarly to the six essential ADLs, your patient can score 1 point if they can complete the above tasks independently and 0 if they require help with a major aspect or all of the activity.
Once all of these have been scored as 0 or 1, tally up the score out of 8.
Step 4. Interpret the scores and add additional notes
The last step is to interpret your patient's scores in either or both ADL tests. We have also included space for you to add notes or comments on your patient's functional status.
The two parts of this ADL assessment are scored out of 6 and 8, respectively. While the functional status of your client is likely complex and can't be summed up in a single number, these scores give a standardized functional independence measure of your patient's functional ability.
The lower your patient's score, the more dependent they are on others for their activities of daily living.
Depending on your patient's score on their ADL assessment, the following steps may differ.
Suppose your patient is struggling with some of the more basic activities of daily living. In that case, they may need to undergo a complete assessment for assisted living arrangements, nursing home admission, or identification of family caregivers.
Additionally, if your patient has scored low in the essential activities of daily living, they may need further investigation into any underlying disease causing the low score. This might include referral to an occupational therapist, geriatrician, specialist physician, or physiotherapist.
Research and evidence
Ongoing research in occupational therapy contributes to refining ADL assessment tools and interventions. This section explores current research findings, emphasizing evidence-based practices that enhance the effectiveness of ADL assessments and interventions across diverse populations.
Sidney Katz was one of the earliest researchers to develop a set of standardized ADLs in the 1950s and 60s (Katz et al., 1963). This method gave a letter grade from A to G, depending on the functional status of the patient.
One of the other critical pioneers of functional activities of daily living was Lawton, who developed instrumental activities associated with higher cognitive function and level of independence (Katz et al., 1983).
Integrating research findings into clinical practice ensures that occupational therapists stay abreast of the latest developments in the field. Evidence-based approaches enhance the quality of care and contribute to the continuous improvement of ADL assessment scales and therapeutic interventions.
Why use Carepatron as your occupational therapy software?
Carepatron is a leading occupational therapy software designed to streamline ADL assessments and interventions. This section provides an overview of Carepatron's features and benefits, including its user-friendly interface, customization options, and robust data management capabilities.
Data security and compliance
Rest assured, your patients' records will be secure with Carepatron's bank-level digital encryption and adherence to HIPAA-certified data security standards. By choosing Carepatron, you can achieve compliance with privacy regulations while enjoying easy access to necessary documents whenever and wherever you need them with our desktop and mobile platforms.
Telehealth services and appointment reminders
Streamline your workflow by automating your appointment reminders with Carepatron's built-in software. Manage telehealth appointments and bookings through Carepatron's HIPAA-compliant telehealth app. Enhance efficiency during telehealth sessions with Carepatron's AI-powered medical dictation software for streamlined clinical note capture.
Template library and community of professionals
Explore a wide range of templates, including this ADL assessment scale and templates for writing clinical notes, in Carepatron's dedicated resource library. Best of all, by joining Carepatron, you become part of a global community of healthcare professionals committed to excellence in healthcare.
Cahn-Weiner, D. A., Boyle, P. A., & Malloy, P. F. (2002). Tests of Executive Function Predict Instrumental Activities of Daily Living in Community-Dwelling Older Individuals. Applied Neuropsychology, 9(3), 187–191. https://doi.org/10.1207/S15324826AN0903_8
Edemekong PF, Bomgaars DL, Sukumaran S, et al. (2023) Activities of Daily Living. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
Katz, S. (1963). Studies of Illness in the Aged: The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA, 185(12), 914. https://doi.org/10.1001/jama.1963.03060120024016
Katz, S. (1983). Assessing Self-maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living.