Activities for daily living
Activities of Daily Living (ADLs) refer to your basic self-care activities that you engage in daily. These activities include bathing, dressing, toileting, grooming, feeding, personal device care (managing dentures, and hearing aids), sexual activity and functional mobility (moving about your living space). These skills are considered essential for taking care of one’s own body and well-being for survival. In most healthcare settings, occupational therapists are the professionals ordered to assess and assist clients with ADL skills.
The “Occupation” in Occupational Therapy refers to any activity that people engage in daily, ADL’s, IADL’s, rest, sleep, play, work, leisure, and daily living are all included under the term “occupation”. Occupational therapists focus on the quality of participation and help others engage in activities meaningful to them.
Types of Activities of Daily Living
ADLs for personal care are activities we need to do for and to ourselves. In many cases, people need help with ADL tasks due to a decline in health or ability. Occupational therapists ensure that ADL skills are performed safely and efficiently to suit every client’s preference per their specific situation.
Let’s look closer at the main ADLs typically discussed in healthcare settings.
Activities of Daily Living (ADLs)
Bathing and showering
Obtain the necessary supplies to bathe/shower, maintain bathing position, wash, rinse, and dry body parts, and transfer into and out of the tub or shower.
Select and retrieve clothing and accessories appropriate for context and conditions (weather, formal vs casual). Dress, undress, and manage fasteners, including on shoes. Manage personal devices such as prosthetic devices or splints.
Obtain necessary supplies, use grooming supplies safely, remove body hair, apply, or remove cosmetics, hair care (wash, dry, brush, comb, and style), care for teeth (flossing and brushing), care for dentures, care, apply, and remove prosthetics and orthotics, care for skin, eyes, ears, and nose.
Retrieve toileting supplies, manage clothing for the toileting activity, transfer onto or off toilet/commode, maintain the position for toileting, clean body after toileting, manage menstrual cycle and necessary supplies for all other toileting needs.
Eating and feeding
Bring food/liquid to mouth (or feeding tube), manage food/liquid in mouth and swallow food/liquid safely.
Instrumental Activities of Daily Living, IADLs, support a daily living routine in the community and require more complex interactions. Common IADL’s addressed in therapy include housekeeping, meal preparation, shopping, medication management and transportation.
Instrumental Activities of Daily Living (IADLs)
Housekeeping and chores
Obtain, maintain, and repair personal and home possessions. Arrange for professional home management assistance such as lawn care, housekeeping, etc.
Meal preparation and clean-up
Plan, prepare, and serve suitable, well-balanced meals and clean-up utensils, space, and food after meals.
Prepare, select, purchase, and transport items.
Manage medications safely and correctly for well-being.
Plan and move around in the community including public transportation.
Factors that impact ADL performance
Adults may experience ADL disability from a decline in skills due to health conditions, environmental changes, or a catastrophic event such as a head injury.
- A physical impairment may arise from the natural aging process including decreased strength, circulation changes, or changes in sensory functions that limit functional ability.
- Cognitive impairment refers to our thinking skills and can jeopardize the overall safety and accuracy of ADL participation.
- Executive function skills may also decline and include our higher-level, more complex thinking that allow us to problem-solve, organize, manage time, divide attention, and inhibit impulses to complete activities collectively throughout a routine.
- Environmental changes that can serve as a barrier include home layout, if an individual has difficulty managing steps, reaching for materials, or passing through a doorway with an assistive device for safe mobility.
- Caregiver support also plays a significant role in assisting individuals during ADL decline. Having caregiver support can help an individual remain in the community rather than moving to a nursing facility when caregiver support is limited.
Assessment of ADL Performance
How do occupational therapists determine an ADL decline is present or if an individual needs intervention?
Often, people will initially seek help from a medical facility for their decline when they learn about occupational therapy and needing an assessment.
Assessments for ADLs help illustrate a bigger picture of how safe a client is for returning home and what level of impact their diagnosis has on their daily routine. Assessments allow therapists to objectively measure independence during ADL and IADL skills to show how much assistance is needed, the level of current impairment, and establish a baseline to show measurable progress.
Three common assessments for ADLs include the Katz Index of Independence in Activities for Daily Living, The Barthel Index, and the Functional Independence Measure.
Other tools used during the evaluation process include observation, self-report questionnaires, and performance-based measures.
Performance-based measures offer reliable information such as the Kettle Test, a performance-based task where the client prepares two hot drinks providing information for cognition, safety awareness, executive function, and motor skills necessary for basic cooking tasks.
Information for measurement tools can be found at the Shirley Ryan Ability Lab.
Another important note is that even though many of these assessments measure impairment and disability, we want to emphasize the strengths of individuals receiving therapy to add robustness to their plan of care and use a strength-based approach to lead an individual to their progress when increasing independence.
Katz Index of Independence in Activities of Daily Living
A performance measurement that clinicians use to assess functional status by measuring client’s level of independence during basic ADLs in a variety of settings.
A paper and pencil assessment that measures the ability of a client with neuromuscular or musculoskeletal disorder to care for themselves.
Functional Independence Measure
A standardized, performance-based tool that measures an individual’s level of disability based on the International Classification of Impairment, Disabilities and Handicaps. Measures the amount of assistance needed for an individual to perform ADL tasks. Generally performed in an inpatient setting with multi-disciplinary team members scoring tasks.
Occupational therapists use a “Top Down” approach, meaning they look at the bigger picture of how an activity is completed and use methods to assess and address components required for an individual to complete the task optimally.
- Task modification will require changing how an individual performs a task, maybe the use of compensatory strategies or changing a sequence to make the task more efficient.
- Environmental modification may be used to include assistive devices or equipment to increase stability such as a grab bar to help with standing.
- If a caregiver is required, caregiver training will teach effective strategies or how to implement therapy recommendations into a daily routine.
- Lastly, community-based programs offer another avenue of support to help individuals experiencing health decline, to continue residing in the community offering engaging programs to support their level of ability.
Activities of Daily Living are necessary for caring for oneself and continued survival. Occupational therapists are experts in participation and occupational performance to address any difficulty someone may be experiencing when trying to care for themselves.
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