We often take it for granted, but this whole “being alive” business is hard work. Sure, by the time we reach our 20s, many of us can at least go about our day without risking mortal peril, but we didn’t start that way, and many of us won’t end that way either.

As we grow older, things that were once automatic and habitual often become significant challenges. Working, completing chores, even getting around and caring for ourselves. The sudden dip in our ability to be independent can be…alarming to say the least.

When we or someone we love reaches this stage, any hope of comfort and emotional peace depends on finding a balance between ability and need.

For professionals and care providers of these veterans of human existence, the concepts of IADLs and ADLs serve as the foundation of such efforts. 

What Are ADLs and IADLs?

ADLs and IADLs are categories of activities required for individuals to handle things on their own. The terms are very similar, so the difference may not be immediately clear. Below are some concise definitions, and a few examples.

Activities of Daily Living (ADLs)

ADLs represent the most fundamental tasks required for a person to make it from day to day.

Examples of ADLs include:

  • Eating—moving food from “ready-to-eat” to our stomach, such as biting an apple, grabbing pretzels from a bag, or picking up potatoes with a fork.
  • Mobility—relocating around the house/apartment/room/etc. as needed through the day; visiting the bathroom, grabbing food from the kitchen, climbing into bed, and so forth.
  • Bathing, hygiene, and “trips to the Loo”—using the bathroom, showering, oral hygiene, and hair care all fall under this category.

All of us had to be trained in ADLs as we grew old enough to do them ourselves, and all of us have seasons when one or more of them may prove difficult. 

Anyone who’s been responsible for a toddler knows that things like bathroom trips are neither simple nor easy by default. And anyone who has had to recover from surgery knows that things like getting dressed, eating food, or even moving can be problematic. 

So while ADLs are treated as minimum thresholds for a person’s ability to care for themselves, they are by no means taken for granted.

Instrumental Acts of Daily Living (IADLs)

IADLs are the activities required for the ongoing maintenance of life and pursuit of healthy outcomes. They’re more complex, more involved, require more exertion and skill, and often present higher levels of risk than ADLs. They are also tied to ADLs, or are precursors for them. 

A few examples of IADLs include:

  • Preparing food—before food can be eaten, it usually has to be cooked or prepped in some way, and the mess that food prep creates also has to be addressed.
  • Completing chores—e.g. you need clean clothes before you can dress yourself, and you need clean dishes before you can prepare food or eat.
  • Macro-mobility—getting around the house is one thing; getting around town is another, and you’ll have to do the latter for things like shopping and clinic visits.
  • “Adulting”—managing finances, setting appointments, taking medications on schedule, addressing maintenance concerns for things in the home or vehicle, etc.

Key Distinctions Between ADLs and IADLs

We’ve made the comparison a few times already, and it’s not meant as an insult: there are a lot of concerns regarding accessibility and independence for adults that’s reflected in the normal development stages of childhood. And no matter the age of the person in question, the issue ultimately boils down to two questions:

  1. Can they be responsible for their own safety and well-being, or do they need external support?
  2. If they need help to ensure their own safety, how often should they be checked on?

These can be difficult topics to discuss, because no one likes feeling as if they’re being treated like a child. And most concerned parties are not looking to infantilize their loved ones through overzealous supervision. But if safety is a concern, sometimes the only reasonable and beneficial solution is to find an acceptable compromise.

ADLs: Can They Be Left Alone at Home?

There are some support needs that mandate near constant overwatch. A three-year-old and an elderly family member with memory struggles may have different reasons for walking out the front door of the house, and the safety risks may be slightly different. But the danger is real in either case, and the steps required to help keep them safe look very similar.

If an individual doesn’t currently have the tools and skills to ensure their own safety day-to-day, this is most likely reflected in struggles with ADLs. As a result, the extent to which they can be left on their own, and for how long, is directly correlated with their capacity to perform ADLs.

At one end of the spectrum, the individual may be bedridden, and need constant care and supervision the same way a patient in the ICU would. At the other end, someone who can reliably complete any necessary ADL, but who struggles with IADLs, can often be somewhat independent with regular check-ins and a few accommodations.

IADLs: Can They Live on Their Own?

Once ADLs have been accounted for, determining support needs comes down to how they handle IADLs. 

  • If they can feed themselves, can they also cook and clean up for themself?
  • If they can handle dressing themselves, can they also do their own laundry?
  • If they’re mobile enough to move about their own home, can they safely and reliably get to appointments, grocery stores, and other locations that require some kind of transportation?

In extreme cases, some individuals may be able to handle a lot on their own, but may require handing over full control of things like finances, medical decisions, and similarly important responsibilities. 

ADLs and IADLs: Discussing and Planning for Long-Term Care

If you or someone you care about struggles with ADLs or IADLs, please remember that these are difficult but essential conversations. The goal isn’t to make someone feel like a child, but to acknowledge the very real struggles they face, and the legitimate risks those struggles present to them.

Discussions regarding support needs, independence, and personal limitations should be handled with respect, kindness, and understanding. But the discussions need to happen. It’s the only way to ensure that at-risk individuals get the help they need, while still maximizing their autonomy.

No one wants to be told they can’t be trusted to look after themselves, but there are some tragedies that can only be avoided if we plan ahead and account for them.

Confronting Problems Head-On

Uncomfortable or not, these chats will be a lot more productive if everyone can be upfront with each other. Be honest about limitations, frustrations, fears, and above all, care. Don’t be surprised if there are sensitive emotions, and don’t hesitate to clarify intentions. 

Anticipating Changes

Our abilities and limitations today may not be the same as they’ll be in five, ten, or twenty years. Things change, and even the direction of that change is yet to be determined. What’s effortless for a person today may present significant challenges in a few short years. Or, major hurdles for someone now might simply be hurdles they have yet to clear. 

Leave room in the preparations to adjust to these shifts. If support needs increase, have plans for how they can be met. If more independence and autonomy is possible, encourage those as goals to shoot for. 

Sourcing Support

This might be the most intimidating aspect of any of these discussions, but they’re important: if you’re helping a loved one find the resources to meet their support needs, you may be able to provide some or all of it, or you might not.

  • Some support needs are high-demand, require special training, or create significant logistical concerns.
  • Financial factors may play a role, from either direction.
  • Support needs may be manageable individually, but may become insurmountable when taken together.
  • Changes in situation, support needs, or other factors may turn the circumstance from livable to unsustainable.

No one can really provide definitive answers for you and your loved ones, here. The options available to you, what’s realistic and what’s acceptable, and how comfortable any arrangement is…all of these will be unique to you.

Whether you’re checking in on a grandparent who lives alone, sharing space with an older family member in your own home, or facilitating long-term care for a loved one whose needs exceed what you can provide personally, the objective is the same: help them to live life with as much comfort and fulfillment as is possible. 

Taking care of someone is one of the clearest expressions that you do care for them. It may not always be simple or easy, but it may be the best way to help them, and the best way to tell them how much they mean to us.

Ensure a safe, happy home for your loved ones using the resources provided on our site. With the right information and careful consideration, you can make the best choice for your loved one’s care and well-being.