Activities of Daily Living (ADLs)


Article Author:
Peter Edemekong


Article Editor:
Shoshana Levy


Editors In Chief:
Susan Johnson
Alexandra Caley


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes


Updated:
5/13/2019 10:58:40 AM

Introduction

The activities of daily living (ADLs) are essential and routine chores that individuals can achieve without the need for assistance. The six essential ADLs includes the ability to be able to eat independently, dress, walk or transfer from one place to another, bath, use the bathroom for toileting, and maintain good continence. Independent adults generally can manage these activities of daily living that are instrumental in their ability to successfully live without much burden to their families. Inability to accomplish these essential activities serves as the baseline for caregivers to determine long-term goals for continued long-term care and support plans. In order to optimize care, primary care providers often discuss a patient’s need for assisted living, in-home care, or nursing home placement.  [1][2][3]

Caregivers and professionals commonly note that patients' functionality declines. This reality is central to the encouragement that healthcare practices adopt routine screening for sustained ADLs. Clinical examination and diagnosis performed by primary care providers are important in determining an individual’s ability to sustain independent living. For instance, certain comorbidities such as dementia influence a person’s ability to meet personal goals and sustain independent living. Other factors include comorbidities that limit a patient’s ability to sustain independence. This may include cancer, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). These are some clinical diagnoses that could be limiting as the presentation progresses over time and eventually results in worsening prognosis. A medical provider’s role in determining a patient’s functionality is often categorized as mildly, moderately or severely impaired when they take into consideration a patient’s quality of life or ability to perform ADLs. Declined or inability to achieve one or more ADLs should motivate a primary provider to routinely check on and determine a patient’s independence and evaluate the need for physical therapy or placement in an assisted facility.[4][5][6]

Function

There are predefined and functional criteria to help primary care providers determine whether a patient can benefit from private long-term care insurance, Medicaid, or Medicare that covers the cost of assistance with ADLs. This results from established social health care findings showing that more than half of the American population ages 65 years old or older are placed in long-term care facilities due to the diminished ability to accomplish their ADLs tasks and activities. The first signs of diminished functionality shows in lack of capacity to accomplish basic self-care activities (feeding, grooming, dressing, bathing, walking, toileting, ability to transfer from bed to a wheelchair or walking).

Aside from being able to perform ADLs, geriatric patients also need to be able to perform necessary activities of daily living, for example, managing their finances, medications, being able to do their shopping, or prepare their meals (Wiener et al. 1990). Placement in a care facility has become common for patients and their families. Though most visits at care facilities are short-term, most patients end up staying longer than a year due to being incapacitated and unable to perform more than two of the six ADLs.[7]

Issues of Concern

In an effort to index independence and access activities of daily living clinicians incorporates best practice evaluation of the client’s status to plan and intervene appropriately. Aging is a natural process that presents a decline in the functional status of patients at baseline. Central to issues of concern is the increased risk of falls recorded among the aging population. There is an increased mortality rate among individuals who have more than one incidence of falling. The most at-risk group of individuals include those 65 years old and older who tend to have the worse prognosis after experiencing a fall. Independent living is highly encouraged and advocated for in the American society, and the aging individuals greatly fear a loss of autonomy. Social workers, along with primary care providers, work together to define the individual patient’s requirements before placement. Issues that are central to placement in assisted living or nursing home as opposed to independent living at home includes a patient’s ability to cook and clean their homes, shop, use of public transportation or drive. It is often important for a provider to address a patient’s general medical condition when determining his/her level of accomplishing functional capabilities that otherwise ensure independent living and personal care. Primary care providers are encouraged to routinely assess patients’ ease in performing ADLs during office visits.

Clinical Significance

It is important for providers to be thorough when discussing options patients and their families to determine if they meet pre-defined criteria to either continue living in their homes or go to assisted living or nursing home facilities. For patients diagnosed with cancer, congestive health failure, or chronic obstructive disease, their degree of exacerbations, rehabilitation, or hospitalization influences the ability to continue to live alone at home. A patient’s inability to perform ADLs as well as IADLs constitutes a disability that often requires measurement of functionality which becomes a significant predictor of being admitted into an assisted facility or nursing home depending on variable factors that pertain to the individual patient (United States National Library of Medicine, 2017).

Depending on the level of assistance required, as well as presenting comorbidities, most families work with providers to care for loved ones at home. Families often hire in-home licensed home health providers most commonly certified nurses' aides, licensed practical nurses, or licensed vocational nurses to provide continuous care and support patient’s ADLs. Depending on the severity of the patient, most home health providers help with medication dispensations, shopping and going on walks with patients to support their desire for continued independent living.

Other Issues

According to a study, severe cognitive fluctuations in dementia patients had a significant association with impaired engagement in activities of daily living that negatively affected their quality of life (Sun, M et al., 2017). Cardiovascular Health Study (Jacob, M et al., 2017) investigated a higher incidence of disability based on age, sex, and race and found it to be associated with mobility difficulties in older patients, women and black patients. Also, most families chose to place their loved ones in assisted living or nursing homes instead of letting them live at home or use home health visiting provider due to the exorbitant costs. It, therefore, requires a well-trained geriatric care professional who accumulates the necessary skills in geriatric care to care for patients with diminished ADLs.

Enhancing Healthcare Team Outcomes

All healthcare workers including nurses, nurse practitioners, and clinicians should get in the habit of assessing the functionality of seniors before discharge. Patients who are unable to perform daily living activities may require further rehabilitation or assistance at home. The inability to dress or go to the bathroom can lead to a very poor quality of life. In addition, assessment of functionality should become routine practice in medicine as it can affect people of all ages. An interprofessional team working together will provide the best patient evaluation and discharge with good follow up care. [Level V]

Nursing Actions and Interventions

Nurses should regularly access the activities of daily living (ADLs) which are the basic tasks that must be accomplished every day for an individual to thrive. The assessment should include:

  • Personal hygiene - bathing, grooming, oral, hair, and nail care
  • Continence management - ability to properly use the bathroom
  • Dressing - ability to select and wear proper clothes
  • Feeding - ability to feed themselves or needs assistance
  • Ambulating - ability to change from one position to the other and walk independently

Nurses also commonly access Instrumental activities of daily living (IADLs). The evaluates a person’s ability to live independently and thrive. IADLs include:

  • Companionship and mental support - reflects on the help needed to keep a person in a positive frame of mind
  • Transportation and shopping - can they go around or procure their meals
  • Planning and preparing meals - shopping and storing groceries
  • Managing household - cleaning, removing trash and clutter, doing laundry, and folding clothes
  • Managing medications - getting prescriptions filled, keeping medications up to date, taking medications on time, and in the right dosages
  • Communicating with others - answering the phone 
  • Managing finances - maintaining bank balances and checkbooks and paying bills

Appropriately accessing ADLs and IADLs can mean the difference between graceful and independent aging and needing daily assistance. Financially, it is important as they may become eligible for government assistance or qualify them for long term care insurance.

Nursing Monitoring

Nurses should evaluate ADLs and IADLs on a frequent basis. When a patient is at risk for a change in ADLs or IADLs, the nurse should report to the interdisciplinary team members so that a new plan of care can be established.


  • Image 5801 Not availableImage 5801 Not available
    Contributed by the US National Library of Medicine (NIH, 2017)
Attributed To: Contributed by the US National Library of Medicine (NIH, 2017)

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Activities of Daily Living (ADLs) - Questions

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Which of the following physiological functions is not considered a part of daily living activities?



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What is the best way to assess the respiratory status of a patient performing their activities of daily living?



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A physical therapist is evaluating activities of daily living for a patient after coronary artery bypass grafting. What is most important during evaluation and treatment?



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A 35-year-old male patient is seen by a physical therapist after a total knee arthroplasty. What is the most appropriate intervention?



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A patient has had total hip arthroplasty and is only allowed toe touch weight bearing. Which of the following ADL techniques is appropriate?



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An OT plans to use a functional skills training approach to teach a patient with severe cognitive deficits how to brush her teeth. Select the appropriate method.



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A patient has had total hip arthroplasty and is demonstrating ADLs for her OT prior to discharge. The patient puts on her shoes using a long handled shoe horn while bending 90 degrees at the hips. What should the therapist do?



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A 17-year-old male with juvenile idiopathic arthritis has reduced range of motion at his elbows and shoulders making shaving difficult. What is the best adaptation?



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A young patient has neurological deficits and does not learn new skills or retain skills learned during occupational therapy (OT). What would be the best solution to improve function with activities of daily living (ADLs)?



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What is the best adaptive device to assist with oral hygiene activities for a patient with C7-C8 quadriplegia?



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Which assessment tool is best for assessing patients with dementia for the performance of activities of daily living?



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A patient with a below the knee amputation is in therapy for activities of daily living. Which of the following is most important?



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A patient is returning home after a stroke and a home evaluation reveals that the patient cannot reach the toilet tissue without problems with balance. What is the best option?



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Which of the following would not inhibit negative motor responses for a patient with excess tone preventing activities of daily living participation?



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A patient with dementia is having problems with activities of daily living. What is the intervention least likely to improve independence?



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A patient is involved in a motor vehicle accident and has a cast on the left arm and a full leg cast. Which of the following activities of daily living will the patient be able to do independently?



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When teaching activities of daily living to a patient with a transfemoral amputation, what is the most important goal?



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Which of the following activities of daily living would be most difficult for a patient with ankylosing spondylitis?



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Which test would be best to test patient balance during ADLs?



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Which of the following assesses the degree of assistance required for bathing, dressing, toileting, transfer, continence, and feeding?



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Which of the following activities of daily living assessment question is most relevant and important during a follow-up visit with the primary care provider?



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Activities of daily living include all of the following actions to promote personal well-being and comfort except which one?



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Activities of Daily Living (ADLs) - References

References

Walter CS,Hengge CR,Lindauer BE,Schaefer SY, Declines in motor transfer following upper extremity task-specific training in older adults. Experimental gerontology. 2018 Dec 15;     [PubMed]
Parmar MC,Saikia N, Chronic morbidity and reported disability among older persons from the India Human Development Survey. BMC geriatrics. 2018 Dec 7;     [PubMed]
Turnbull GS,Scott CEH,MacDonald DJ,Breusch SJ, Return to activity following revision total hip arthroplasty. Archives of orthopaedic and trauma surgery. 2018 Dec 7;     [PubMed]
Kinosian B,Wieland D,Gu X,Stallard E,Phibbs CS,Intrator O, Validation of the JEN frailty index in the National Long-Term Care Survey community population: identifying functionally impaired older adults from claims data. BMC health services research. 2018 Nov 29;     [PubMed]
Wang R,Zhang T,Langhammer B, Activities of daily living and life satisfaction of persons with stroke after rehabilitation in China: a longitudinal descriptive study. Topics in stroke rehabilitation. 2018 Nov 26;     [PubMed]
Wu J,Feng Y,Sun P, Sensor Fusion for Recognition of Activities of Daily Living. Sensors (Basel, Switzerland). 2018 Nov 19;     [PubMed]
Abrahamson K,Hass Z,Arling G, Shall I Stay or Shall I Go? The Choice to Remain in the Nursing Home Among Residents With High Potential for Discharge. Journal of applied gerontology : the official journal of the Southern Gerontological Society. 2018 Oct 26;     [PubMed]

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