Medical, housing and even legal staff use the term Activities of Daily Living (ADL) to refer to the functional capability of the elderly or people with disabilities. ADLs are the things we do as a normal part of our daily lives such as bathing or toileting. Where they become important is when the ability or more likely inability to perform a certain number of ADLs makes a person eligible for benefits such as Medicare or Aid & Attendance or for types of housing such as independent or assisted living. (Although, those are not the entire list of things affected by an ADL evaluation.) Measuring ADLs for individuals with physical limitations involves the actual physical ability to perform the function but to measure the ability for individuals with cognitive limitations may involve the necessity for prompting or cueing that person.
Here is the list of things that people are referring to when they talk about ADLs and what they mean:
- Bathing and showering (washing the body)
A person can have problems bathing for many reasons. They may be unable to perform the function physically or they may have cognitive issues that make bathing an alien and problematic situation. The actual process involves undressing, getting into the shower or bath, washing, drying and re-dressing. For individuals with cognitive issues, bathing can be especially difficult because it may be frightening, dangerous, and can interfere with their idea of modesty especially if they do not recognize the individual assisting them with the function. The first function that many people need assistance with is bathing.
The second function that individuals need assistance with is generally dressing. Dressing refers to the putting on or the removal of clothing including any assistive devices such as braces or artificial limbs or the using of fasteners such as buttons, fasteners and zippers.
- Toilet hygiene (completing the act of urinating/defecating)
Toileting includes the ability to pull down clothing in preparation for elimination including getting on (or later off) the toilet, cleaning of the perineal area and pulling clothing up after completion.
- Functional mobility (moving from one surface to another)
This function includes moving into and out of a bed, chair, or wheelchair and also includes transfer to shower, bath or toilet.
- Eating/feeding (including chewing and swallowing)
This function is not limited to the individual needing to be fed but also includes preparing food including if the food preparation replaces a part of eating such as chopping, pureeing or grinding the food.
- Functional mobility (ambulation)
The ability to move around the rooms within a residence or outside areas of a residence.
Nearly half of all individuals turning 65 on any given year will eventually enter a nursing home due to an inability to perform multiple ADLs.