What Are IADLs or the Instrumental Activities of Daily Living?

IADLs or the Instrumental Activities of Daily Living are more complex than the Activities of Daily Living (ADLs) needed for basic unassisted living and go a long way in improving the quality of life for elders.

Needing help with some areas of life when aging is relatively common- according to research, approximately 18% of adults over the age of 75 require assistance with one or more IADLs, while nearly 11% require ADL assistance. The majority of elders get along fine without ADL assistance, however, about half of all admissions into long-term care are due only to the inability to complete ADL’s without assistance. Examples of ADLs include:

  • Bathing and showering
  • Choosing appropriate clothes and getting dressed
  • Using the bathroom without assistance 
  • Walk, and get in and out of furniture and baths
  • Eat meals independently, not including cooking the meals but simply using cutlery

A simple way to refer to IADLs is by remembering the mnemonic SHAFT – Shopping, Housekeeping (or housework), Accounting (or managing money), Food preparation and Telephone/Transportation. IADLs are different from ADLs in that the basic essential functions of survival are not threatened. You’ll be able to live by yourself but you may find yourself unable to manage tasks such as:

  • Managing your budget, including using the ATM, writing checks, and remembering your bills- you might find yourself coming up short for necessities like food
  • Remembering to go to doctors appointments, and taking your medications as prescribed
  • Planning and preparing meals, which could also pose significant safety and health risk
  • Being able to do housework and prepare your meals.
  • Doing your own shopping – be it groceries, clothing, or anything else you need.
  • Using the telephone and computer as a means of communication 
  • Managing transportation – be it driving, or hiring cabs or taking public transportation
  • Managing your household in its entirety – including pet care if you have any pets
  • Any and all extracurricular activities – be it maintaining a hobby or socializing with friends, family, and peers.

Usually, when a person is unable to perform their IADLs or ADLs at home, they must seek outside help to make sure they stay healthy. This can mean hiring an in-home caregiver or a paid relative to move into your home, or moving into an assisted living community.

What is the Difference Between ADLs and IADLs?

A frequently asked question is the difference between the Activities of Daily Living vs. Instrumental Activities of Daily Living. ADLs are essential to unassisted survival. A mnemonic that can be used to typically define ADLs is DEATH: Dressing (the ability to wear clothes in an acceptable fashion), Eating (feeding self so as to be in perfect health), Ambulation (walking, sitting and then standing up, getting in and out of vehicles), Toilet (ability to use the facilities and & wipe/wash self without help) and Hygiene (bathing to maintain proper hygiene). If a person fails to perform one or more of these activities, then his or her ability to live independently and without care has diminished considerably. This person may need long-term assisted living immediately.

Are IADLs Essential for Living Unassisted?

Think of it this way – while things like being able to bathe, walk, go to the bathroom, eat, and take adequate rest are the activities “essential” for the survival of a person, IADLs are activities that are not necessary for survival but do aid a person in living life to the fullest. The very definition of Instrumental Activities of Daily Living is that these are the things that help an individual flourish as a person in the community, and be completely self-reliant in his or her care and health.

A person struggling IADLs does not necessarily translate into needing assisted living; rather, he or she may need some help to perform these tasks every now and then. So, it’s time for friends, family, and paid care to pitch in as and when needed. It can also be taken as an indication to get a full check-up done, so that any and all medical needs can be taken care of.

The inability of an individual to perform IADLs can indicate one or many potential issues going on, as well as serve as warnings for worse problems. Some causes of the memory slippage that tends to be the first step in the progression of IADL loss include:

  • Mental fog caused by medication side effects, interactions, or overuse
  • Simply not getting enough sleep can cause or worsen memory problems
  • The beginning of dementia often involves memory loss, and can have many causes 
  • Medical issues such as nutritional deficiency, or worsening pre-existing conditions

IADLs need to be taken as an indicator; if a person is repeatedly failing to do them, it’s an indication to get help. Living with IADL dependence doesn’t have to be difficult- from using assistive technology, home modifications, or bringing in outside care, to considering life in a retirement community, there are numerous ways to promote your independence while living with IADL dependence.

How to Talk to Someone About Their IADL Dependence and Care Options

Frankly, it can be extremely difficult to walk up to someone – especially your own parents – and tell them that they haven’t been managing their lives properly be it financially, socially, or even personally. They may view it as an unwelcome intrusion into their way of living or their independence. When it comes to senior care, it’s difficult for the parent to accept this role reversal – for the children to become the caregivers and the parents to become the dependents. However, the process of caring for your aging parents comes with its own set of unique benefits, such as increased time to learn about your relatives and form a stronger bond. 

The good news is, you wouldn’t be the first person in this position. According to the AARP, across the US approximately 42% of caregivers are children caring for their aging parents or grandparents, and 12% of caregivers are spouses who are aging as well. The good news is, there are many resources for family caregivers, including support groups for caregivers and their dependents, as well as other areas of aging like dementia care.

It might be in the best interest of your loved one to let them discuss their IADL dependency with their healthcare team. Professionals will be able to help by providing information backed by the most recent science and research regarding the specific issues facing them, give medical and other advice and prescribe medication as necessary, as well as provide referrals to outside professionals, support groups, and social services programs that can help pay for aging care. What seniors may feel uncomfortable or even embarrassed about discussing with the children, they can freely talk about with their medical caregivers and between the trio – the individual needing help, the family and the medical professional – a solution can be worked out to the best benefit of the person in question.

Assisted Living Facilities

Many people make the decision to move to an assisted living facility (ALF), or community, once they become unable to perform their own ADLs and IADLs, as not everyone is able to modify their home to accommodate aging. In an ALF, independence is ensured for older adults who are in the process of losing one or more lifelong abilities, such as in the case of ADL dependence. Whether this is through memory loss, degenerative disease, or simply breaking down due to the process of time, the facility staff is trained to help people help themselves for as long as possible, in whatever ways they choose. Residents are able to live in their own spaces, make their own decisions, come and go as they please, and have the lifestyle they choose, regardless of ongoing health conditions.

One of the great features of choosing a retirement community is that you are able to seek out the perfect place to retire, based on your unique interests and preferences. Some communities are set up like apartment buildings, with each resident having their own studio or one- or two-bedroom apartment, either alone or with a roommate. Other places are set up cottage-style, with a campus full of cozy houses, each housing several residents, and connected with garden paths. Depending on your level of care needed, there are nursing homes that are set up more like hospital rooms, for those who need 24-hour nursing and intensive healthcare services.

Benefits of Choosing an Assisted Living Community

Many people are resistant to the idea of moving into a retirement community, due to the stigma that ALFs are for the very old and infirm who are ready for the final retirement. The number of people that choose to retire in a community is actually very low, with only 3.1% of adults aged 65-85 doing so instead of aging in place. However, after age 85, that percentage climbs to over 9%. 

When people do opt for moving into an ALF, it is most commonly because they are unable to perform their ADLs on their own, and would rather retire comfortably surrounded by professional help that can step in when needed for things such as preparing meals, and getting out of the bath, so they can live independently as possible, as well as safely.  Assisted living communities are staffed by a well-trained team of medical professionals to help dispense medication, assess any injuries that occur throughout one’s daily life, and help keep an eye on residents’ ongoing health conditions. 

The licensed medical team is only the tip of the iceberg when it comes to the staff and programming offered to residents at assisted living facilities. In addition to caring for all your health needs, there is usually a gourmet chef and full wait staff for serving meals, an activity director with a team of assistants and volunteers, and a maintenance crew to ensure all housekeeping chores are tended to. 

Cleanliness and safety are vital, but are not the most important aspect of a comfortable life. Retirement communities spend a lot of energy focusing on ways to make their residents the most comfortable and encourage them to live the lives that are as fulfilling as possible, honoring their lifelong interests and habits. Aging can be a difficult process and it is crucial to have an appropriate team in place to help you ease into older ages easily. 

Assisted living communities are designed to care for your body as well as your spirit, and every home has its own unique philosophy to encourage its residents to live their best lives as they grow older.  Visit these pages to read our helpful guide on different retirement options, or to find an assisted living community near you

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