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Activities of Daily Living: As Seniors Become Unable to Perform Basic Self-Care, Families are Faced with Tough Decisions

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(Editor’s note: November is National Family Caregivers Month, set aside as a time to recognize and honor family caregivers across the country.  This week on the AgingOptions Blog, we’re featuring two articles on the subject of caregiving, including one from US News that we first brought you a few months ago. With holiday season approaching, you may be visiting with aging loved ones for the first time in many months. This will give you an important opportunity to assess how they’re doing – and to ascertain whether they may need more hands-on care, either from you or from trusted outside caregivers. We hope this article provides important food for thought.)  

ADLs and IADLs – What’s the Difference?

Many readers of the AgingOptions Blog will recognize the initials “ADL.” But what about IADL?

As most of us know, in the caregiving context ADL means “activities of daily living.” These are the activities ( typically falling into six categories) that are considered basic to our ability to live independently. (We’ve listed the six common ADLs below.) But there’s another group of essential activities, referred to as “instrumental activities of daily living,” or IADL, that are described by one source as “more complex” than basic functions on the ADL list. Being able to perform these IADLs helps improve a senior’s quality of life dramatically.

In this recent article from US Newsreporter Joanne Kaldy describes the importance of instrumental activities of daily living. We think this is a helpful article because it gives adult children a better means of evaluating how well an aging parent is doing as they continue living independently. Mom or Dad might be managing the ADL functions just fine, but if they’re struggling with activities on the IADL list, it might be time to at least consider one of several housing alternatives.

Independence Must Be Balanced Against Safety

“Independence is a precious commodity we particularly value as we age; but when you’re no longer able to do things like shop for food, prepare meals or handle medications, it can put you at risk for an accident, injury or illness,” Kaldy writes in her US News article. If you or an older loved one is beginning to struggle with such tasks, it may be time to discuss options for senior living or in-home services for aging in place.

As Kaldy explains, “Activities of daily living, or ADL, are the life tasks that people need to be able to perform to live safely at home and be independent. How someone can handle any or all of these basic self-care skills helps determine what level of care or support they might need.”

The most frequent list of ADLs includes these six:

  • Ambulating: moving safely from one position to another and walking independently;
  • Feeding: feeding oneself safely;
  • Dressing: selecting appropriate clothes and putting them on;
  • Personal hygiene: bathing and grooming, including dental hygiene, nail, and hair care;
  • Continence: controlling bladder and bowel function;
  • Toileting: getting to and from the bathroom and using facilities appropriately.

Instrumental Activities of Daily Living

But beyond the ADL basics, there are a few more complex tasks—called IADLs, or instrumental activities of daily living—which are just as important for maintaining independence. In her US News article, Kaldy lists the following:

  • Using the Telephone
  • Shopping
  • Preparing food
  • Housekeeping
  • Doing laundry
  • Using transportation
  • Handling medications
  • Handling finances.

In preparing this article, we did a search for Instrumental Activities of Daily Living. The website AssistedLiving.org uses the acronym SHAFT – shopping, housekeeping, accounting, food, and telephone/transportation – as a tool to remember activities on the IADL list.

Breaking Down the IADL List

Kaldy provides the following details about each IADL and some red flags to look out for. She also quotes Dr. Michael Wasserman, a long-term care expert from California. We have slightly abridged the details of her list, but we encourage you to check out the original article for the list in full.

  • Using the Telephone: Being able to place a call and answer the phone. On a mobile phone it may also mean finding a contact and checking messages or texts. Kaldy writes, “Red flags in this area are when someone seems to have trouble using their phone, fails to answer calls or doesn’t recognize when the phone is ringing.”
  • Shopping: The ability to shop for groceries, toiletries, and other essentials. “Signs of a problem might be that mom goes to the store for milk and comes home with chicken, or dad always ate healthy and has started buying junk food,” Wasserman told Kaldy. “Other issues to watch for include suddenly or significantly increased shopping and related expenses or an empty refrigerator that suggests mom’s not shopping at all.”
  • Preparing Food: Kaldy explains, “This doesn’t necessarily mean the ability to prepare elaborate meals. It can be as simple as heating microwavable meals or making a sandwich. Red flags include burning food or leaving the stove on, missing meals, weight loss or significant changes in diet or eating habits.”
  • Housekeeping: “While not everyone has the same standards of cleanliness and order,” Kaldy writes, “housekeeping is important to maintain independence. Hoarding, leaving food out, cluttered rooms and letting garbage pile up are the types of signs to watch for.”
  • Doing Laundry: Not doing laundry or wearing dirty clothes are warning signs that something might be amiss. Wasserman asks, “Did they forget how to use the washer? Are they unable to climb up or down stairs to get to the laundry room? Are they depressed and have lost interest in basic hygiene? The answers can tell you what might be the cause of the issue and how to address it.”
  • Using Transportation: There are many ways that you can measure someone’s ability to use transportation, because transportation means something different to everyone. The red flags aren’t often straightforward. Wasserman said, “Car accidents, getting lost or getting parking tickets are red flags…but it’s also important to assess if someone can navigate using other modes of transportation as well, such as buses or car services.” Because losing the ability to drive can be an emotional blow to someone’s independence, experts recommend having a physician involved in those difficult discussions. 
  • Handling Medications: One of the most common reasons someone has to move into a senior living facility, handling medications isn’t just about taking medications correctly, but also about filling prescriptions in a timely manner. Not handling medications correctly can have real physical and cognitive effects, so if you find yourself or a loved one taking medications incorrectly on more than one occasion, it may be time to reassess the living situation.
  • Handling Finances: “Assessing this can be challenging. People often don’t like talking about money,” says Wasserman. But it’s vital that someone can balance their checkbook, make deposits, pay bills, avoid scams and online cybercrime, and generally manage their money if they want to live independently. Sometimes a bank teller or someone at the grocery store can tell if something is amiss.

IADL Declines Don’t Always Mean Nursing Home or Assisted Living

If you’re starting to worry about one or more IADLs on the list, don’t panic just yet. Sometimes a new routine or a change in accessibility can solve the problem. Wasserman suggests that “it may be as simple as having a shopping list every time you go to the store. There also are several food delivery services that can bring in groceries or full meals.”

For those with difficulty handling medications, there are several solutions. Some pharmacies will package medications in such a way that promotes following instructions correctly, and Kaldy adds that “there are high-tech devices such as smart pillboxes that not only remind you to take your medications, but also track when you take them and report to a practitioner or family member if you don’t.”

In-home services are also a strong option to keep you or your loved one at home for longer. “Companies such as Visiting Angels and Comfort Keepers offer a variety of services from helping with meals and light housekeeping to assisting with bathing and grooming,” Kaldy writes. “You also can hire organizations or individuals to help with housework, transportation, lawn care and pet sitting or dog walking.”

Kaldy adds, “An independent living community is a viable option that enables ongoing independence but also provides dining and meal services, opportunities for socialization and physical activity and other amenities. Some even have space where residents can work and/or receive some health care services.”

But it’s worth noting that if your loved one’s safety is at stake in any way, a higher level of care may be the most appropriate option, either at home or in a care facility.  At AgingOptions, we encourage you to contact a trusted firm to evaluate your loved one and help you determine their best solutions. Contact us and we’ll gladly provide a referral.

Assessing ADL and IADL Skills

Dr. Jawwad Hussain, an Illinois geriatrician, emphasizes the importance of identifying and assessing ADL and IADL early. “When functional declines start, they can cascade and cause additional problems and worsening health,” he cautions. “When identified and addressed early, some functional decline can be reversed with physical or occupational therapy or other interventions.”

Having a good relationship with your medical team is vital to help you get to the bottom of your forgetfulness or other functional decline, as it could be related to a drug reaction, improper nutrition, or vitamin deficiency instead of something more nefarious. There’s also the possibility that you may need to consider admission to a long-term care facility on a temporary basis. “Just because you go into a facility doesn’t mean you’ll always be there,” Hussain explains. “You can work with your physician and other team members to set goals that may enable you to return home or at least to a more home-like setting.”

As uncomfortable as it can be to assess you or your loved ones’ capabilities and have these tough talks, we like Wasserman’s concluding statement. He said, “It may sound trite, but it’s the truth: If you act from a place of caring and concern and focus on what you or your loved one can do instead of the deficits, it helps. Avoiding these issues is not a good idea. If the conversation is hard or scary, reach out to your physician or other trusted professional.”

(originally reported at https://health.usnews.com)

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