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home | Assessment Tools | Instrumental Activities of Daily Liv . . .

Instrumental Activities of Daily Living (IADLs): First Alert For Senior Caregivers

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Every adult who lives independently has several complex tasks to accomplish on a regular basis. The "experts" have chosen to call these activities "instrumental activities of daily living," or IADLs. A person who is having trouble managing one or more of their personal IADLs is signaling to you that all is not well. If you can begin the planning process at the point when IADLs begin to be a problem, you can probably avoid the need for a crash course in senior care planning during a crisis, when you and your senior will certainly have fewer options.

Most people have at least heard of activities of daily living. These are the basic things that everyone does on a daily basis: maintaining hygiene (bathing, grooming, shaving and mouth care), dressing, eating (the ability to feed oneself), toileting (the ability to use a restroom), transferring (moving from a seated to standing position and getting in and out of bed). When one or more of these activities is impaired, the need for caregiving help is obvious and urgent.

By the time a senior is having difficulty with ADLs, staying at home safely without constant help and supervision is no longer possible. It is definitely NOT a good idea to wait until an older person can't do one of these activities to begin planning for care.

Independent Activities of Daily Living require a higher level of physical and mental ability than do ADLs. Less related to the ability to manage basic personal needs, they involve the more complex activities that we all must do regularly to remain safely independent. A decline in the ability to manage one's IADLs is a sign that a senior is beginning to lose the ability to remain independent.

While there is no single accepted list of IADLs, the following activities are usually included:

  • Preparing meals (planning the meal, gathering ingredients, opening cans, jars and packages, using kitchen equipment safely)

  • Essential housework (doing laundry, washing up, vacuuming, taking out the garbage, etc.)

  • Driving or arranging transportation (either by personal vehicle or public transportation)

  • Shopping (getting to stores and purchasing necessities such as food, clothing and medication)

  • Using the telephone

  • Making and keeping appointments

  • Managing finances (budgeting, paying bills and writing checks)

  • Managing medication (keeping track of medications and taking them as prescribed)

When a senior begins to have difficulty managing one or more of these IADLs, family members often step up to the plate to help out. They may begin by lending a hand with the more physically challenging IADLs, such as shopping and housework. As time goes by, they take on more and more of their elder's IADLs. Often they do not realize how much they have become their senior's lifeline until they are deeply committed.

A word to the wise from several experienced caregivers: When difficulties with IADLs first begin to show up is the time to begin seriously exploring helpful services in the community. If you can introduce help into a senior's household now...help that is not you...you will have consideraby more success in getting your senior to accept necessary help when things become more critical.

A housekeeper who comes every ten days is not a threat to an older person's self esteem. As needs increase, it will be easier to increase this kind of help to weekly or even more often. Services can be expanded from basic housekeeping to include laundry, meal preparation, and even transportation as needs progress.

Persuading your senior with arthritis to experiment with a medication dispensing system that eliminates the need to open multiple small bottles several times a day is easier now, when the humiliating issue of confusion may still be just a speck on the horizon.

Hiring a local handyman to work along side you while you make a senior's house safer will be easier to accomplish while your senior is still mentally flexible enough to understand, accept, and possibly even welcome that what you are doing is designed to increase independence, not restrict it. Later on, confusion and fear of change can make it much harder to make safety improvements in a senior's home.

If you look up one day and discover that you have become the only shopper, the only housekeeper, the only driver, and the only cook, it will almost certaily be too late to get your senior to accept help from anyone else without a real battle. If you start when you first see a decline in a senior's instrumental activities of daily living you will be better prepared to help your elder stay at home, a) with safety and dignity; and, b) without requiring an impossible level of support from you and other family members.

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