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An Introduction to Activities of Daily Living (ADLs)

CPDTime.
6m

Published: 07 December 2021

In your work, you may need to assist clients with activities of daily living (ADLs). These are basic, essential tasks that are part of every person’s daily life, and therefore, it’s important that you understand what ADLs are, as well as their clinical significance.

What are Activities of Daily Living (ADLs)?

The term activities of daily living (ADLs), which was created by Sidney Katz in 1950, refers to the fundamental life skills that someone must be able to perform in order to independently care for themselves (Edemekong et al. 2020; Kindly Care 2019).

Being able to perform ADLs is an indicator of functional status. Someone who struggles with ADLs is likely to experience a poorer quality of life, depend more on other people and mobility devices, and live with a risk of harm if not properly cared for (Edemekong et al. 2020).

ADLs are typically used to measure the functional abilities of older adults, people living with disabilities and those who have undergone surgery (Physiopedia 2017). They may assist in determining whether someone requires extra support, for example, home care or admission to an assisted living facility (Edemekong et al. 2020).

Types of Activities of Daily Living

Basic Activities of Daily Living

Basic ADLs (also known as BADLs) include:

  • Ambulating - the ability to move from one position to another and walk independently (e.g. going from a sitting to standing position, moving from a bed to a chair)
  • Feeding - The ability to independently feed oneself
  • Dressing - The ability to choose and put on appropriate clothes
  • Personal hygiene - The ability to bathe, groom oneself, maintain dental hygiene and perform nail and hair care
  • Continence - The ability to control bladder and bowel function
  • Toileting - The ability to get to and from the toilet, use the toilet appropriately and clean oneself after using the toilet.

(Edemekong et al. 2020; Kindly Care 2019; Physiopedia 2017)

basic activities of daily living man brushing teeth

Instrumental Activities of Daily Living

Instrumental ADLs (IADLs) are more complex tasks that are required in order to live in the community independently. They generally require greater thinking skills, including organisational skills (Edemekong et al. 2020).

IADLs include:

  • Transportation and shopping - The ability to buy groceries and medicines, and organise a means of transportation
  • Managing finances - The ability to pay bills and manage financial assets
  • Meal preparation - The ability to get a meal on the table, including shopping for groceries and storing them in the home
  • Home maintenance - The ability to perform housework and maintain the home (e.g. cleaning, keeping living areas tidy, doing laundry)
  • Managing communication with others - The ability to manage the household’s phone and mail, and ensure the home is welcoming for visitors
  • Managing medications - The ability to get prescriptions filled, keep medicines up-to-date and take them as directed (e.g. taking them on time and at the right dosage)
  • Companionship and mental support
  • Coordinating healthcare
  • Social interaction
  • Community interaction - The ability to participate in services, events, hobbies and spiritual observance
  • Responsibilities for others - The ability to perform tasks such as parenting and carer roles
  • Safety procedures and emergency responses
  • Decision-making.

(Edemekong et al. 2020; Kindly Care 2019; ME/CFS SA 2021)

What Affects the Ability to Perform Activities of Daily Living?

Someone might become unable to perform ADLs due to:

  • Physiological changes associated with ageing
  • Decreased physical capacity caused by musculoskeletal, neurological, circulatory, or sensory conditions
  • Cognitive or mental impairment (e.g. dementia)
  • Social isolation
  • Medication side effects
  • An unsuitable home environment
  • Episodes of acute illness
  • Admission to hospital.

(Edemekong et al. 2020)

Measuring Activities of Daily Living

Measuring a person’s capacity to perform ADLs is a routine assessment that provides insight into whether the individual requires more support in their day-to-day life. Inability to perform ADLs may lead to serious harm, for example, a person who has difficulty mobilising will be at greater risk of falling (Edemekong et al. 2020).

There are a variety of tools that can be used to assess a person’s ADLs. One such tool used in Australia is the Resource Utilisation Groups - Activities of Daily Living (RUG-ADL), which measures four ADLs: bed mobility, toileting, transfer and eating (DoH 2021).

Clients are assessed in these four categories and assigned a score between one and five for each, with a score of one indicating that the client can perform the task independently or with supervision only, and a score of five indicating that the client requires two or more people to physically assist them in order to perform the task (DoH 2021).

Note: Not every category uses every score.

ADL Capacity Score Definition
Bed mobility - The ability to move in bed after the transfer into bed has been completed. Independent or supervision only 1
  • The client can readjust their position in bed and perform their own pressure area relief through spontaneous movement around their bed, or by prompting from a carer
  • No hands-on assistance is required
  • The client may be independent with the use of a device
Limited physical assistance 3
  • The client can readjust their position in bed and perform their own pressure area relief with the assistance of one person
Other than two persons physical assist 4
  • The client requires a hoist or other assistive device to readjust their position and provide pressure area relief
  • Assistance from one person is required
Two or more persons physical assist 5
  • The client requires assistance from two or more people to readjust their position in bed and provide pressure area relief
Toileting - The ability to mobilise to the toilet, adjust clothing before and after toileting, and maintain perineal hygiene without incontinence or soiling clothes.

Note: If the client requires different levels of assistance for urination and defecation, record the lower performance of the two.		 Independent or supervision only 1
  • The client can perform all aforementioned tasks without incontinence or soiling clothing
  • All tasks can be performed independently or with prompting from a carer
  • No hands-on assistance is required
  • The client may be independent with the use of a device
Limited physical assistance 3
  • The client requires hands-on assistance from one person for at least one of the tasks
Other than two persons physical assist 4
  • The client requires one of the following:
    • Catheter
    • Uridome
    • Urinal
    • Colostomy
    • Bedpan
    • Commode chair
    • Enema
    • Suppository
  • The client requires assistance from one person to manage the device
Two or more persons physical assist 5
  • The client requires assistance from at least two people to perform any of the tasks
Transfer - the ability transfer in and out of bed, bed to chair, in and out of shower/tub.

Note: The score should be based on the lowest performance of the day/night.		 Independent or supervision only 1
  • All tasks can be performed independently or with prompting from a carer
  • No hands-on assistance is required
  • The client may be independent with the use of a device
Limited physical assistance 3
  • The client requires hands-on assistance from one person for any transfer during the day/night
Other than two persons physical assist 4
  • The client requires assistance from a device, plus one person for any transfer during the day/night
Two or more persons physical assist 5
  • The client requires assistance from two people for any transfer during the day/night
Eating - The ability to cut food, bring food to the mouth, chew food and swallow.

Note: Does not include meal preparation.		 Independent or supervision only 1
  • Once the meal has been presented, the client can cut, chew and swallow food independently or with supervision
  • No hands-on assistance is required
  • Clients who require parenteral or gastrostomy feeding but administer feed themselves also score 1
Limited assistance 2
  • The client requires hands-on assistance from one person to bring the food to their mouth, and/or
  • The client requires food to be modified (soft or staged diet)
Extensive assistance/total dependence/tube fed 3
  • The client needs to be fed by an assistant, or
  • The client relies on parenteral/gastrostomy feeding and does not administer feed themselves

(Adapted from Williams et al., as cited in DoH 2021)

The four scores will then be added together, resulting in a total of between 4 and 18. The higher the total score, the more support the client requires in order to perform these ADLs.

Assisting With Activities of Daily Living

activities of daily living assisting client

When assisting clients with ADLs, remember that your goals are different to theirs. What might be a work task to you is another person’s daily routine and life. For example, while you might be rushing to transfer a client from their bed to a chair because you know you have other clients to attend to, the client might just want to watch television without being disturbed (ATrain Education 2014).

It’s also important to understand that in Western societies, where independent living is encouraged, being unable to perform ADLs may cause feelings of fear and distress due to the associated loss of autonomy (Edemekong et al. 2020).

When assisting clients with ADLs:

  • Allow the client to express their wishes and respect their autonomy (e.g. accept that a client might not want to do a particular task)
  • Make eye contact
  • Use a calm demeanour and voice
  • Offer choices (e.g. ‘Would you like apple juice or orange juice?’)
  • Be empathetic
  • Give the client enough personal space and avoid crowding them
  • Use non-challenging body language
  • Allow plenty of time to assist the client with the ADL
  • Give the client clear, simple instructions.

(ATrain Education 2014)


References

Test Your Knowledge

Question 1 of 3

You are assessing the ADLs of a client, Paul, using the RUG-ADL tool. Paul can defecate independently but has a urinary catheter in-situ and requires another person to help him use it. What should Paul score for toileting?

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