If you've noticed memory loss or thinking problems in your aging parent, chances are, you're wondering if they're safe enough or if they should be getting more help or maybe even if they need to move. Those are great questions and knowing how they're doing with their activities of daily living ADL's and instrumental activities of daily living IADLs is key to answering those questions. Stay tuned, to learn more about what are ADL's and IADL's and how to use this information to help your parents. Hello, everyone. Welcome to Helping Older Parents with Memory Loss, a video podcast series that gives you strategies and information about assisting aging parents who are experiencing memory or thinking problems. I'm your host, Dr. Leslie Kernisan board certified geriatrician and the founder of Better Health While Aging, and also of the Helping Older Parents online programs. In today's episode, I'm going to talk about something that is really relevant if you're trying to figure out whether your aging parent needs more help or can keep living at home. And that is: how is your parent doing with their ADL's and IADL's? Those terms stand for activities of daily living and instrumental activities of daily living. They are basically fundamental self care activities that we learned to do early in life and in my line of work, and in much of elder care, assessing them is key to figuring out how much help an older person needs and how we can support them so that they can have the best quality of life and wellbeing. ADL's and IADL's are also often relevant to important things like determining what stage of Alzheimer's or related dementia a person is in, diagnosing mild cognitive impairment versus dementia, qualifying for certain elder care programs or for long-term care services such as nursing home care, or getting long-term care insurance to pay for services. Personally, I really like ADL's and IADL's because they are practical and they give me a very pragmatic understanding of where an older person is struggling in life and how we can help them. So let's now help you understand what they are and how you can assess them in your aging parents. In this video, I'll cover: What are ADL's and IADL's, what's the difference between ADL's versus IADL's, how to assess ADL's and IADL's and why you might want to do so. Let's start with activities of daily living or ADL's. ADL's are foundational self-care skills that we usually learn as very young children. They're also sometimes called basic ADL's or B ADL's. They include walking or otherwise getting around the home or outside, the technical term for this by the way is ambulating, also feeding as in being able to get food from a plate into one's mouth, dressing as in selecting appropriate clothes for the weather and the occasion, and being able to put them on, then there's grooming, which means adequately managing your personal appearance, such as managing your hair, doing your makeup or shaving. Next toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself. And then there's bathing, which means washing one's face and body in the bath or shower. There's also one additional ADL, which is sometimes referred to by professionals, including physical therapists. That is transferring, which means being able to move from one body position to another. This includes being able to move oneself from a bed to a chair or into a wheelchair. It can also include the ability to stand up from a bed or chair in order to grasp a walker or another assistive device. This ADL is mostly relevant to people. Who've developed mobility difficulties for some reason. So those are the ADL's, let's now go over IADL's: Instrumental Activities of Daily Living. These are key life skills that we usually learn as teenagers, and that are necessary to live independently. As adults, they require more complex thinking skills and often require organizational skills. They include things like managing finances, such as paying bills and managing financial assets, managing transportation, either via driving or by organizing some other means of transport, shopping, and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothes or other items required for daily life housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one's living space, reasonably clean and tidy, and keeping up with home maintenance, managing communication, such as the telephone and mail, and nowadays also managing email and the computer. And then last but not least, there's managing medications, which covers obtaining medications and taking them as directed now, as you can imagine, not everyone learns to manage all IADL's as young adults, because depending on our life circumstances, sometimes we've never been in a position to learn or have to be responsible for certain IADL's. So when it comes to assessing IADL's, we always want to be mindful of whether someone's abilities reflect a change from what they were able to do earlier in adulthood. So if someone never had to manage finances and now has difficulty when asked to do so independently, we would want to note that this is an IADL that they weren't responsible for earlier in life. Whereas if they used to manage their own finances, and now they're struggling, we would definitely want to note that this is a decline compared to before. Now sometimes people ask me, what is the difference between ADL's and IADL's? It partly comes down to history in terms of history. ADL's were defined first in the late 1950s by a geriatrician named Sydney Katz who wanted to help healthcare providers measure changes in physical function for patients who are being treated after experiencing physically disabling conditions, such as stroke or hip fracture. Dr. Katz and his colleagues were trying to define what it would look like to recover to independence. And he decided that a person's ability to function in these core skills, which in fact, we learn as toddlers, the ADL skills was pretty reflective of how independent you could be as you recovered from a stroke or a hip fracture. However it soon became apparent in using ADL's that being independent requires more than being able to walk, get dressed or otherwise complete your basic ADL's on your own. So about 10 years later, another expert in elder care, a psychologist named M.P. Lawton developed the Instrumental Activities of Daily Living Scale to assess for additional skills that might not show up on the ADL scale, but were still often relevant to living independently or returning to one's home. And many of these ended up being the practical life skills that we usually learn as teenagers: managing money, managing a household, getting groceries, driving, and so forth. So in terms of the difference ADL's are more physical and IADL's are more cognitive that said memory loss or thinking problems can certainly affect an older person's ability to do their ADL's and physical problems can affect IADL's. For instance, you could easily have trouble with grocery shopping. If your arthritis is so painful that you can barely walk for me the way I think of ADL's versus IADL's is first, I do find it helpful to think of ADL's as the early childhood skills and IDLs as the teenager skills second, because IADL's are cognitively more demanding. I think of them as the skills where we're first likely to see people with memory loss or early Alzheimer's struggling. And then third, I think of IADL's as the tasks for which it's much easier for a spouse or family member to fill in and help with compared to ADL's. Once somebody gets to the point where they need help with walking or getting dressed or toileting, that's generally a lot more work for family or paid caregivers to manage. Okay. Let's now talk about how ADL's and IADL's get assessed in geriatrics. And in healthcare, we call this assessing function because we're assessing how well the person can function when it comes to core self care tasks and life skills. How do we do this? Well, it's actually not rocket science. We usually have a list of the ADL's and IADL's, and then we need to find out if the person being assessed can do the tasks. Now it's important for you to know that for each task, we don't usually score it on a yes or no. We actually are usually going to score their ability to do it on some type of scale. That is to say for each task, we're often considering first, how much help does the person need to perform the task as in: no help, some help, a lot of help, or are they fully dependent? And then second, we also often will consider how often they need help. Is it never, sometimes, often, or every time? To gather this information, I recommend doing the following: First, get a worksheet on ADL or IADL assessment. For instance, we have one available for free on Better Health While Aging - I'll link below to my article on ADL's - or you can find one easily by Googling online. Then gather information on your parents' abilities. What is most accurate is if you can observe them directly, or if you can talk to someone who lives with them, or is otherwise likely to know how they are doing on a daily basis. Now you can also ask your parent how they're doing on all these tasks. That said, if your parent is having memory loss or thinking problems, they probably are not going to be an accurate reporter of their abilities. Furthermore, even older adults who are not cognitively impaired are often uncomfortable revealing difficulties to family members or others. So although you can ask your parent, if they're struggling with any of these key life tasks, be mindful that it's often either a touchy subject for older adults, or if your parent has memory loss or signs of Alzheimer's, they will be extremely unlikely to give you accurate information. Now ADL's and IADL's were originally designed to be assessed by healthcare professionals. But personally, I think it's a good idea for families to learn to assess them as well. Why? Well, I believe it provides a handy structured way for you to get a sense of what your aging parent is struggling with. And once you have that information, you can do a lot with that knowledge. For instance, you can help your parent report any trouble with ADL's or IADL's to their doctors, so that their doctors can try to figure out what underlying problems are causing the difficulties. That's important because when an older person develops trouble with ADL's or IADL's, that's usually the sign of a physical or cognitive health problem interfering with their abilities. And so we want to figure out what's causing the problem so that we can try to treat it or otherwise manage it better. You can also use what you learned from your parent's ADL and IADL assessment to anticipate certain safety issues so that your family can come up with a plan. For instance, an older person who is having trouble with finances will often benefit from getting a little bit more help and maybe supervision on that front. And if your parent wants to age in place as many people do, then it's essential to assess ADL's and IADL's because this helps us identify areas in which your parent might need extra support or supervision to remain in their home for as long as possible. Now, how do problems like memory loss, dementia, or Alzheimer's usually affect ADL's and IADL's? That's what I'll be covering in my next video. So if you have a parent with memory loss, please subscribe or otherwise stay tuned. And I hope to see you again soon.