Most of us take activities of daily living (ADLs) and instrumental activities of daily living (IADLs) for granted. ADLs include fundamental skills typically needed to manage our basic physical needs. They include grooming and personal hygiene, dressing, toileting, transferring and ambulation, and eating. IADLs, on the other hand, are a little more complex and involve functions such as paying bills, preparing food, communicating, housework and scheduling and keeping appointments. We perform tasks like these on a daily basis without much difficulty whatsoever. What if our cognitive abilities were to decline or we become forgetful due to some diseases like Alzheimer’s or Parkinson’s? Poor cognitive functioning is associated with a decline in ability to perform ADLs and IADLs.
Some Facts
Over 50% of Americans 65 years of age and older move into senior care communities due to diminished ability to accomplish activities of daily living. The first signs of declining functionality are a lack of capacity to accomplish basic self-care activities like dressing, bathing, eating and grooming. Besides ADLs, individuals need to be able to perform necessary instrumental activities of daily living such as managing finances and medications. A decline in these daily self-care skills may be due to a number of conditions including neurological, circulatory, musculoskeletal or sensory conditions.
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Causes of Decline in ADLs and IADLs
A decline in cognitive abilities is also associated with impaired ADLs and IADLs and may be due to Alzheimer’s disease and other dementia-related disorders. Social isolation may also lead to impairment in both ADLs and IADLs. Other causes include side effects of medications, depression, anxiety, falls, fear of incontinence, and fear of losing one’s independence. Activities of daily living are needed to manage one’s basic physical needs. It becomes progressively more difficult to maintain quality of life as ADLs and IADLs decline. Independence eventually becomes dependence on others to live day to day.
IADL performance is sensitive to early cognitive decline due to a number of neurodegenerative conditions including Alzheimer’s, Parkinson’s Huntington’s and other forms of dementia. Early dementia and mild cognitive decline may lead to diminished performance in IADLs. On the other hand, physical functioning is more often associated with a decline in ADLs. Basic declines in ADLs are not usually seen until later stages of dementia. The ability to engage in one’s personal care is a significant part of functional independence. ADL dependence is associated with poor quality of life, increased health costs, increased risk of being admitted to a care center and mortality.
The Importance of Cognitive Functioning
The ability to perform either ADLs or IADLs is dependent upon sensory and motor functioning as well as cognitive abilities. There is, for instance, an important distinction between whether an individual can complete a task like preparing a meal or grooming one’s self, or whether he or she realizes that a task needs to be completed in the first place. Assessing cognitive functioning is an important step in determining the level of impairment and independence or dependence involved in ADLs and IADLs. Assessment also helps to guide daily care needs. Identifying barriers to performance and how to overcome them is important.
ADLs and IADLs are comprised of different kinds of skills that require sequencing of action, conceptual knowledge and manipulation needed to achieve the intended goals. Individuals diagnosed with some type of neurodegenerative disorder, for instance, vary widely in ADL performance relative to their Mini Mental Status Exam (MMSE), which is used to measure cognitive abilities. One’s ability to complete ADLs appears to be preserved among individuals with mild to moderate cognitive impairment. As cognitive impairment worsens, the relationship between cognitive functioning and level of ADL independence become more consistent. Severe dementia is associated with poor ADL functioning.
Last Words
We rarely consciously “think” about what we are doing while eating, brushing our teeth or taking a shower. No one says to him- or herself, “Ok, I am walking into the shower now and then I will pick up a washcloth and a bar of soap”. We just do it. As we age, we risk the development of cognitive impairment due to some disease or illness, including Alzheimer’s and Parkinson’s. As cognitive impairment increases our ability to perform ADLs and IADLs decreases. It reminds me of one of my favorite sayings – “It’s not what you do, but how long you can do it”. How true when it comes to ADLs and IADLs.
(NOTE: Interested in Nursing CEUs? Checkout my Nursing CEUs on CEU Academy and try a FREE CEU today!)