Introduction
The activities of daily living (ADLs) is a term used to collectively describe
fundamental skills required to independently care for oneself, such as eating,
bathing, and mobility. The term activities of daily living was first coined by
Sidney Katz in 1950.[1][2]
ADL is used as an indicator of a person's functional status. The inability to
perform ADLs results in the dependence of other individuals and/or mechanical
devices. The inability to accomplish essential activities of daily living may lead
to unsafe conditions and poor quality of life. Measurement of an individual's ADL
is important as these are predictors of admission to nursing homes, need for
alternative living arrangements, hospitalization, and use of paid home care. The
outcome of a treatment program can also be assessed by reviewing a patient's ADLs.
[3][4][5][6]
Nurses are often the first to note when patients' functionality declines during
hospitalization; therefore, routine screening of ADLs is imperative, and nursing
assessment of ADLs is performed on all hospitalized patients. Hospitalization for
an acute or chronic illness may influence a person's ability to meet personal goals
and sustain independent living. Chronic illnesses progress over time, resulting in
a physical decline that may lead to a loss of ability to perform ADLs.
In 2011, the United States National Health Interview Survey determined that 20.7%
of adults aged 85 or older, 7% of those aged 75 to 84, and 3.4% of those aged 65 to
74 needed help with ADLs.[7][8]
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Function
Types of ADL
The activities of daily living are classified into basic ADLs and Instrumental
Activities of Daily Living (IADLs). Basic ADLs (BADL) or physical ADLs are those
skills required to manage one’s basic physical needs, including personal hygiene or
grooming, dressing, toileting, transferring or ambulating, and eating. The
Instrumental Activities of Daily Living (IADLs) include more complex activities
related to the ability to live independently in the community. This would include
activities such as managing finances and medications, food preparation,
housekeeping, and laundry.
Basic ADLs
The basic ADLs include the following categories:
Ambulating: The extent of an individual’s ability to move from one position to
another and walk independently.
Feeding: The ability of a person to feed oneself.
Dressing: The ability to select appropriate clothes and to put the clothes on.
Personal hygiene: The ability to bathe and groom oneself and maintain dental
hygiene, nail, and hair care.
Continence: The ability to control bladder and bowel function
Toileting: The ability to get to and from the toilet, use it appropriately, and
clean oneself.
Learning how each basic ADL affects an individual to care for themselves can help
determine whether a patient would need daily assistance. It can also help the
elderly or disabled people to determine their eligibility got state and federal
assistance programs.
Instrumental ADLs
The instrumental ADLs are those that require more complex thinking skills,
including organizational skills.
Transportation and shopping: Ability to procure groceries, attend events, and
manage transportation, either via driving or by organizing other means of
transport.
Managing finances: This includes the ability to pay bills and manage financial
assets.
Shopping and meal preparation, ie, everything required to get a meal on the table.
It also covers shopping for clothing and other items required for daily life.
Housecleaning and home maintenance. Cleaning kitchens after eating, maintaining
living areas reasonably clean and tidy, and keeping up with home maintenance.
Managing communication with others: The ability to manage telephone and mail.
Managing medications: Ability to obtain medications and take them as directed.
The IADL differs from ADL as people often begin asking for outside assistance when
these tasks become difficult to manage independently.[9]
Causes for limitations in ADLs
Decline or impairment in physical function arises from many conditions. Aging is a
natural process that may present a decline in the functional status of patients and
is a common cause of subsequent loss of ADLs.[10] Musculoskeletal, neurological,
circulatory, or sensory conditions can lead to decreased physical function, leading
to impairment in ADLs. A cognitive or mental decline can also lead to impaired
ADLs.[11] Severe cognitive fluctuations in dementia patients have a significant
association with impaired engagement in activities of daily living that negatively
affect the quality of life. Social isolation can lead to impairment in instrumental
activities of daily living. Other factors, such as side effects of medications,
social isolation, or the patient's home environment, can influence the ability to
perform ADLs.[12][13]
Hospitalization and acute illnesses have also been associated with a decline in
ADLs. Sands et al. reported that loss of ADL functioning over 1 year is
independently associated with acute hospital admission for acute illness and
cognitive impairment among frail older adults. Similarly, Cinvinsky et al.
performed a prospective observational study that evaluated the changes in ADL
function occurring before and after hospital admission. They found that many
hospitalized older people are discharged with ADL function that is worse than their
baseline function.
