Activities of Daily Living (ADL): Definition, Assessment & Examples

Instructor: Shara Spilker

Shara has taught nursing in both AD and BSN programs and holds a master's degree in nursing.

We are born into this world helpless to meet our basic needs, such as food, shelter, and hygiene, but as adults, we must be able to meet our own needs. Learn more about the skills and knowledge considered essential to living life independently.

From Helplessness to Independence: Development of Activities of Daily Living

As infants, most of us learn to roll over, sit, and start feeding ourselves. As toddlers, after our first wobbly steps, we quickly learn to run. We begin toilet training and learn how to dress ourselves. We start communicating in earnest, frequently asking 'Why?' During our early school years, we learn to take more responsibility for our personal hygiene, start learning about money, make simple no-cook snacks, start helping the family by tackling simple chores around the house, and learn to use the phone. As teenagers, we take those skills to the next level: learning how to manage our money, driving, taking public transportation, shopping, cooking, taking medicine, and doing some basic home and car maintenance. By the time we leave for college, most of us can pretty much take care of ourselves.

These life skills are collectively called activities of daily living or ADLs. We define ADLs as the common, everyday self-care skills we all need to live safely and independently.

As a newborn grows into a toddler, child, then adult, it will attain activities ofe daily living.
Newborn baby

Types of ADLs

There are two major sets of ADLs that we acquire over our lifetime. The more basic group is BADLs, or basic activities of daily living, such as dressing, personal hygiene, using the toilet, cooking, and eating. These are the skills learned when you are a toddler and adolescent.

Young children learn BADLs, like brushing their teeth.
Child brushing his teeth

The next set of ADLs is the IADLs or instrumental activities of daily living. IADLs are defined as the more complex set of skills that allow you to live independently; you can think of those as the skills you learned in high school. They include paying your bills, shopping, cooking healthy meals, and correctly taking the medication prescribed by your doctor.

Young adults learn IADLs, like balancing their bank accounts.
Balancing a bank account

Reasons for Assessments

Due to birth defects, accidents, disease, or simply aging, people may lose these self-care skills to varying degrees. In older populations, changes in behavior may indicate loss of ADLs. Perhaps bills are going unpaid, the house is not as tidy as usual, medications are not taken, or the refrigerator contains only a few foods and they may be obviously past their prime. Maybe the individual is getting lost in familiar places or having car accidents, his clothes appear dirty, or there is some unpleasant body odor. People who are losing their BADLs may have difficulty walking or experience frequent falls.

When these concerns are brought to the attention of a physician, the health care team will do a functional assessment to document the areas of concern. This assessment helps them identify possible root problems, like dementia, an acute physical condition, or the worsening of a chronic disease, and determine what diagnostic studies are needed to figure out why the person is having these problems, especially if they are new problems. The functional assessment also helps clarify for the family the specific kinds of help their loved one needs in order to live as independently as possible.

Functional assessments clarify patient needs.
Grandma with a walker

Physicians, nurses, and medical social workers use the functional assessment to assess their patients' needs in outpatient settings, but a functional assessment of BADLs and IADLs can also be used by hospitals to determine if a patient is ready for discharge and able to care for himself after hospitalization for surgery or other treatments. Care agencies, rehabilitation, and care facilities use functional assessments to determine appropriate placement for patients. A functional assessment can also influence insurance coverage. For example, if the individual has long term care insurance, most companies require impairment in three or more BADLs before they will provide benefits, helping with the costs of care.

Types of Assessments

Though severe losses of IADL skills and low level loss of BADL skills are usually easily identified, even experienced health care providers are not always able to easily identify low or moderate levels of impairment of some ADLs during an office visit so we use standardized assessment tools that are suitable for different types of clinical settings and for use by a wide variety of health care professionals. Some tools can also identify and track improvement or deterioration in these skill levels over time, which is particularly helpful for rehab patients, patients with chronic illnesses, and the elderly.

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