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  • Writer's pictureCindy Davis

Speak the Language of Senior Care to Access Essential Support



Older gentleman looking at screen in confusion

In the aging journey, you’ll often witness the subtle shifts in your ability to manage daily life. These changes, ranging from struggles with household tasks to challenges in personal care, may signal a need for additional support. Yet, articulating these needs to medical professionals or insurance companies can be daunting, especially when unfamiliar with the specific language they use to evaluate capabilities and where aid is required. This is where understanding the concepts of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) becomes invaluable to those without a medical background.


Davis family caring for dad

Caring for my father opened my eyes to the power of ADLs and IADLs in a way I never anticipated. After a hospital stay, as we navigated his return home, a nurse from the home health care agency inquired about his struggles with ADLs—a concept unfamiliar to me at the time. Similarly, his long-term care insurance needed to know his ADL competencies to determine benefit eligibility; key for the insurance company to decide when he could stop paying premiums. Initially, I felt lost, not fully grasping the significance of my responses or how they would shape his care and support.


It wasn't until much later, fueled by a desire to understand and advocate better for my father, that I delved into the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. The discovery was revolutionary: these weren't just clinical assessments; they were a map to understanding my father's needs and the subtle shifts in his capabilities. Armed with this knowledge, I could see the direct line between his chronic conditions and their impact on his daily life. This insight transformed our conversations with his medical team, allowing us to focus on what mattered most for his care and independence.

 

This personal exploration of ADLs and IADLs highlighted their undeniable value—not only as tools for monitoring and assessment but as clues for figuring out where and how we could help. It's a realization I'm eager to share, hoping to provide others with helpful tool you can use to work with your medical team and insurance providers to get the assistance you want and need to achieve the independence and quality of life you desire.  An understanding of the activities of daily living transformed my approach to my father's care.

6 ADLs and 8 IADLs: A Cornerstone of Care Evaluation

This first post in our three-part series summarizes how seniors and their loved ones can leverage ADLs and IADLs to effectively communicate needs, track progress, and explore supportive living options. Let’s start with general definitions of the ADLs and IADLs:

 

  • Activities of Daily Living (ADLs) are the six core tasks required for basic personal care and mobility, including bathing, dressing, feeding, transferring, toileting, and continence. These activities are fundamental for your autonomy and are often the first areas where decline is noticed.

  • Instrumental Activities of Daily Living (IADLs) involve eight more complex skills necessary for independent living, such as using the phone, shopping, preparing meals, housekeeping, laundry, managing medications, handling finances, and arranging transportation. These endeavors require cognitive functioning, organizational skills, and the ability to interact with the external world.

 

Understanding and monitoring these 14 activities can provide a clear picture of your capabilities and areas where additional support is needed, guiding families in making informed decisions about care and living arrangements that are suitable for your current condition.


Graphic with icons for each of the 14 activities of daily living

The Challenge of Communicating Support Needs

For many, the realization that assistance is needed often comes before understanding how to articulate what’s necessary. The language of care, particularly around Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), is crucial yet not widely known outside professional circles. These terms, grounded in decades of research and development, form a cornerstone to assess elder care needs and eligibility for support services.

Graphic showing the increased ADL Assistance Required with age

The prevalence of challenges with ADLs and IADLs among the elderly is a significant concern, as highlighted by various studies and reports. According to Medicare data, more than a third of the Medicare population requires assistance with at least one IADL or one ADL. This need for support escalates with age; the Centers for Disease Control and Prevention (CDC) reports that seniors over 75 are notably more likely to need assistance with ADLs (10.6%) and IADLs (18.8%). The situation is even more pronounced among adults 85 or older, with 20.7% needing help with essential tasks such as eating, bathing, dressing, or walking. These statistics, drawn from the 2016 National Health Interview Survey conducted by the CDC’s National Center for Health Statistics, underline the growing need for comprehensive support and intervention strategies to aid the aging population in maintaining their independence and quality of life.


A tool to measure ADLs was first conceptualized through the Katz Index of Independence in ADLs in the 1960s by Dr. Sidney Katz and his team, providing a simple yet powerful measure of an individual's ability to perform fundamental self-care tasks. Meanwhile, the Lawton-Brody IADL Scale, developed shortly after, focuses on more complex activities essential for independent living, such as managing finances and household tasks. These scales, born out of meticulous research and validation, are now universally recognized by the healthcare and insurance industries as important benchmarks for determining the level of care an individual requires.


By familiarizing yourself with the Katz ADL Index and the Lawton-Brody IADL Scale, families and caregivers can more effectively communicate the specific needs. This knowledge not only empowers families to advocate for appropriate care and resources but also ensures that discussions with medical professionals and insurance providers are productive and focused. Understanding and utilizing the ADL and IADL terms transforms the quest for assistance from a game of guesswork into a strategic approach to securing necessary resources.

The Power of ADL and IADL Knowledge to Select Supportive Living Options

Armed with an understanding of ADLs and IADLs, you and your loved ones and caregivers can:


  • Establish Baselines and Track Progress: Documenting how you perform ADLs and IADLs over time helps identify areas of decline or improvement, facilitating early intervention and support adjustments.

  • Identify Specific Needs: Pinpointing which ADLs or IADLs pose challenges enables you to seek targeted assistance, from home modifications to professional healthcare services.

  • Explore Appropriate Living Arrangements: Knowledge of ADL and IADL performance can guide the selection of supportive living environments that match the level of care required, ranging from home health care to long-term care facilities.

  • Communicate Effectively with Professionals: Using ADL and IADL terminology allows you to more effectively convey your needs to healthcare providers and insurers, streamlining access to resources and benefits.

Embracing the Language of Care

This series is more than just a guide; helps you decipher the language of senior care. By understanding and utilizing the concepts of ADLs and IADLs, you can navigate the healthcare system with confidence, ensuring you receive the care and support you deserve. Stay tuned for the next two posts - 6 ADLs Explained to Get the Senior Care You Need and 8 IADLs to Assess Senior Autonomy and Care Needs – which will delve deeper, offering detailed examples.


Let this series extend your view, much like a periscope, offering a clearer perspective on current challenges and available solutions to help achieve your current best quality of life. With these tools in hand, you have a compass to chart your course through the aging process on your terms.

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