What to Know About ADLs and IADLs – Occupational Therapy

Definition

ADL stands for activities of daily living. ADLs are the essential activities that humans need to do every day.

The American Occupational Therapy Association (AOTA) publishes a Framework that is regularly updated. This framework defines and describes what ADLs are. The activities that comprise ADLs have changed over time. For example, rest and sleep were once an ADL, but is now considered its own category due to their importance.

ADLs are defined as “activities oriented toward taking care of one’s own body and completed on a routine basis”.

Categories

The categories of ADLs in the current version of the AOTA Framework (version 4, 2020) include:

  • Showering and bathing
  • Toileting and toilet hygiene
  • Dressing/undressing
  • Eating and swallowing
  • Feeding
  • Mobility
  • Personal hygiene and grooming
  • Sexual activity

Importance for Patients

If you stay at a hospital, you may hear the term ADLs discussed by staff. ADLs are important because doctors and therapists (including occupational therapists) evaluate each patient’s level of independence with ADLs. Most people are likely to be independent with ADLs, but may need assistance or a caregiver temporarily during a hospital stay.

Although you may know how to do basic things such as using the toilet, having new back surgery, for example, may change how this is all done if you have restrictions from the doctor such as no bending. Barriers to ADLs may not always physical. Patients may have cognitive impairments such as a concussion (acute or chronic) that may affect areas such as memory or problem-solving.

Occupational therapy practitioners work directly with patients to practice and relearn their ADLs, either the way they did it before, with some assistive equipment such as a dressing stick, or another compensatory technique. Occupational therapy practitioners work with the patient on the goals that are important to them.

Doctors may even ask patients or family members how they are doing with their ADLs. If patients need a lot of help, they may not be ready to discharge back home and may benefit from a rehab facility or a skilled nursing facility.

When the team asks about ADLs, they are primarily concerned with much help the patient needs with these activities. This is called the patient’s level of assistance. While it is not necessary that a patient be independent with all of their ADLs, it does factor into the discharge plan. By demonstrating to nurses, therapists, and doctors your independence with ADLs, it can help factor into an earlier discharge date if you are hoping to leave early.

IADLs

Another term is you should be familiar with is IADLs. The I stands for instrumental. IADLs are not considered as important as ADLs and are less important of a factor in the discharge plan. Activities such as meal preparation, bill paying, pet care, or shopping are examples of IADLs. Because some individuals may not participate in IADLs prior to their hospital admission or they may have hired help with IADLs, ADLs are more of a priority overall.

Although occupational therapists are primarily the ones who will work with you on ADLs, other staff may as well such as nurses and physical therapists. It’s not like nurses won’t take you to the restroom if you ask or physical therapists will only do exercises with you. Nurses may assist with urinatation and bowel care, e.g, reducing constipation. Physical therapists may work on mobility and moving around in the bathroom. Occupational therapists work directly with the activity, e.g., taking off pants, pericare, etc.

To learn more about occupational therapy and how it may help you during your hospital stay, subscribe to our free newsletter.

References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process
(4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001

Rogers, J. C., & Holm, M. B. (1994). Assessment of self-care. In B. R. Bonder & M. B. Wagner (Eds.), Functional performance in older adults
(pp. 181–202). Philadelphia: F. A. Davis.

 

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.