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What are the Activities of Daily Living and How do They Impact Senior Care Decisions?

By Paul - July 7, 2014

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One of the things children and young adults often think is their lives will take a fairly straightforward trajectory until one day, they’ll be incapacitated and “old”, unable to care for themselves. This is as far from actuality as possible, as aging and losing the ability to maintain independence is usually a gradual process (with the exception of traumatic events like a stroke or serious injury). Because independence and dependence is measured on a scalar continuum, one of the ways we look at how senior care should be decided and administered is through the ability to carry out activities of daily living, or those essential acts that everyone must do on a daily basis.

What are Activities of Daily Living?

As we mentioned before, activities of daily living, or ADLs, are essential parts of a person’s day that are carried out by everyone. These differ from other activities that can depend on a person’s lifestyle, such as commuting to social activities, levels of bodily strength or ability to read a book without glasses. Those activities vary according to the person and what their day looks like, but ADLs are things that every person, senior or not, undertakes. Currently, there are six ADLs, and they include the following:

  • 1. Bathing: This refers to a person’s ability to clean themselves, either through a shower, bath, or sponge bath, as well as how completely and/or efficiently they can manage it.
  • 2. Dressing: It’s not enough to call buttoning a shirt or pulling on a hat as doing this ADL, as dressing includes getting clothes from a closet or chest of drawers and then being able to put the full outfit on.
  • 3. Toileting: For seniors not using a catheter, toileting means being able to get to the bathroom, get on and off the toilet, use it without creating a mess, and then clean up their genital area appropriately, followed up with washing their hands and exiting the bathroom.
  • 4. Transferring: If seniors can get themselves in and out of bed or a chair without partial or total assistance, then they can complete this ADL successfully.
  • 5. Continence: Being able to fully control your bladder so urination and defecation happen on your schedule means independence for this ADL, as opposed to partial or total incontinence of bowel and bladder.
  • 6. Feeding: The act of preparing food is separate from being able to get it off the plate and into your mouth, as seniors should be able to eat without assistance (whether it’s parenteral feeding or helping lifting a fork to their mouths) to call themselves independent in this area.
  • What Does it Mean to be Independent, or Require Some Degree of Assistance with Living?

    The guidelines that caregivers use are pretty clear when it comes to assessing ADLs and deciding what level of care the senior needs. If the senior can perform all ADLs without assistance at all, then they are said to be independent, and we’ll take a look at what, if any, kind of caregiving is required for that.

    If a senior needs help with just one or two ADLs, such as transferring and feeding because they’ve broken their dominant arm, then they likely need assisted living. It doesn’t matter which one or two of the ADLs they can’t perform independently, just that not all the boxes are checked and they can move forward with the right kind of assistance to ensure independence and dignity of life.

    However, if a senior has trouble performing three or more ADLs by themselves, then they can probably do best in a nursing home where the level of care is high, skilled and constant. Because ADLs comprise such a large and integral part of everyone’s day, being able to complete them is something that needs to be done everyday, regardless of how many hands it takes to help out.

    Levels of Care: What Seniors Need Depending on Their Level of Independence

    One thing we want to clarify is the difference between completely all the ADLs independently and having full independence. For example, being able to feed yourself is an indication of fulfilling that ADL independently, but it doesn’t necessarily mean a senior can shop for groceries and prepare meals by themselves. In this case, a caregiver may be required to help out a little bit to ensure the senior retains as much independence as possible. Other things include being able to dress themselves, but not able to go out in public and shop for clothes, with barriers such as inability to commute or lack of strength/stamina to complete a shopping trip.

    Requiring assisted living (1 or 2 ADLs not completed independently) also varies from senior to senior, especially when it comes to the kind of ADLs the senior can or can’t do. A visiting nurse or caregiver can spend as little as a few hours in the senior’s home, helping with feeding and bathing if the senior is fine with the other ADLs. Or they could be there for a longer stretch of time, such as if the senior has trouble with continence and/or toileting. The latter two activities are ones that happen regularly throughout the day, and can’t really be planned in advance the way bathing, dressing or transferring can.

    Lastly, being dependent on another for half or more of the listed ADLs means a nursing home is likely the most appropriate option. It’s more than a little tough to place your senior’s life in the hands of a team, as it can mean the loss of independence and aging in place. But while that’s a difficult notion to come to grips to, your senior’s health and wellbeing should be at the forefront of any caregiving plan.

    As well, a nursing home can provide the kind of care that almost no single adult can manage — physically, emotionally or psychologically — on their own. It truly takes a team of skilled and experienced people to assist a senior with all the ADLs, and nursing homes are designed for that. There, the staff will have routines and protocols in place to ensure your senior’s ADLs are carried out regularly and safely, as well as the necessary equipment to complement carrying out the ADLs. For example, transferring may not be something the nursing home staff do on their own, but may rely on a mechanical lifter to carry out the task as safely and comfortably as possible. It’s worth talking to your senior and the prospective nursing home to determine just what level of care your senior truly needs.