What is IADL? Why is it important?
IADL stands for Instrumental Activities of Daily Living. At its simplest, it’s a category of activities. For a person to remain safe and independent in old age, they need to be able to carry out these important activities.
Most of us will one day need to consider these questions: Can my parent or grandparent still live at home alone safely? How much help do they really need? Will they need to live with me to be safe?
The answers to these questions are not always immediately clear. Things like family dynamics, budget, and proximity to the parent or grandparent all make tackling these questions even harder. So let’s start with what we know: in the United States, most aging parents and grandparents usually wish to live on their own for as long as possible. They rarely want to give up independence, even if it’s in their best interests to do so. This has been well documented. Further, children of aged parents also want them to remain independent as long as possible.
So how do we decide if it’s safe for them to do so? As family members we need to know if they can perform some basic IADL (activities). Here’s a list of eight activities based on The Lawton Instrumental Activities of Daily Living (IADL) Scale
- Managing finances: Paying bills, keeping track of income, budgets.
- House cleaning: Keeping their home and environment clean.
- Laundry: Can clean own clothing.
- Medication management: If they take medicine, taking the correct medicine at the correct dose and time.
- Shopping: Selecting and paying for household items.
- Food preparation: Selecting food and cooking adequate, healthy meals at home.
- Ability to use telephone: Looking up and dialing phone numbers, answering calls.
- Transportation: This is traveling outside the home by public transportation or own vehicle.
IADL vs ADL
You will notice that the above list does not include some very important things, like being able to bathe oneself, feed oneself, or just moving safely through the home. That is because these kinds of personal care activities are under a different category. That category is ADL (Activities of Daily Living). For reference, you may see The Katz Index of Independence in Activities of Daily Living (ADL). These activities are usually learned very early on in childhood. If an aged loved one is not able to perform these activities, it usually means they need immediate help and may not be able to live at home alone safely. IADL refers primarily to the aspect of living independently, which is why we are focusing on it in this article.
IADLs are more complicated tasks than ADLs. Because of this, if an aging loved one is beginning to have cognitive difficulties, it will likely become evident in IADL performance. And if these activities cannot be carried out effectively the eventual consequences can be very serious. For example, if an aging loved one cannot remember when to take their medicine they may forget to take it, or even take too much. If they continue to forget, then there can be health complications depending on the medication involved.
Paying attention to IADLs can be viewed as preventative maintenance on the part of the family member or caregiver. Much like a car, you can do nothing and take it to the repair shop when the engine breaks down. Or you can get regular inspections done, change the oil, making necessary minor repairs when the need arises, etc. When IADL activities are being carried out regularly and safely, it will enable them to be independent and safe at home longer, and will give their family members peace of mind. The key is to know their circumstances and their ability to carry out the IADLs.
Of course we cannot avoid or plan for every problem related to aging. Accidents happen, diseases like Alzheimer’s can become evident, and general health can fail due to old age. Those things are not in our control. But ensuring our loved one can eat nutritious food, travel to doctor appointments safely, and have a clean home is within our ability to organize. And by ensuring there is a plan or method in place to take care of these ahead of time will keep the “engine running” a lot longer than if nothing is done.
How Much Help is Needed?
In the context of IADL performance, it might not be as much as you think. For instance, I used to believe that when my grandmother could no longer drive safely, we would need to move in to her home to take care of her. For some reason I had set up that milestone in my mind as the figurative “tipping point”. The intent was good, but it was based on a wrong assumption. Not being able to drive doesn’t mean a total lack of independence.
Now that I understand her needs better and what transportation alternatives are available, I realize this is a very manageable aspect of her daily life. For example, she has a few close friends who can take her to the store or an appointment. There’s also public transportation available to her, as well as hired services like Uber. After making these adjustments, she now maintains a great deal of freedom, even though she reminds me daily how much she wishes she could drive! The biggest benefit for me is that I don’t have to worry about her breaking down on the side of the road or getting lost. Or worse yet, have a car accident because of slowed reaction time.
In fact, the more I learned about her needs and researched ways to care for them, I came to realize that there was much I could do to assist her from outside the home, even remotely. But we had to figure it out for ourselves. Plenty of websites state that IADL include things like transportation or cooking healthy meals. But the websites don’t give many practical solutions to that problem. Furthermore, what’s the hack for helping grandma open and understand her mail? How can we protect her from fraudulent phone calls, or even legitimate but unwanted sales calls? How do we track how much water she is drinking? How do we help her take her medication properly? What about eating nutritious food? The list goes on. And so has our research.
Many websites tell you what care is needed in terms of IADLs, but few sites give you ideas on how to actually make those adjustments in a practical way.
The Purpose of This Site
I look forward to sharing what I’ve figured out with you. These suggestions and tips are based on our personal experience (not to mention our mistakes), as well as suggestions from others. Not all suggestions will be appropriate for every family situation. But perhaps they will at the least give you some helpful ideas on where to start. Again, the motive is to help our loved ones safely retain their independence and dignity. True, not everyone should live at home alone. But as concerned family members, it’s our hope that they can do so safely and for as long as possible if that is their wish.