An Introduction to Activities of Daily Living (ADLs)
Published: 28 April 2024
Published: 28 April 2024
In your work, you may need to assist clients with activities of daily living (ADLs). These are basic, essential tasks that are part of every person’s daily life, and therefore, it’s important that you understand what ADLs are, as well as their clinical significance.
The term activities of daily living (ADLs), which was created by Sidney Katz in 1950, refers to the fundamental life skills that someone must be able to perform in order to independently care for themselves.
Being able to perform ADLs is an indicator of functional status. Someone who struggles with ADLs is likely to experience a poorer quality of life, depend more on other people and mobility devices, and live with a risk of harm if not properly cared for (Edemekong et al. 2023).
ADLs are typically used to measure the functional abilities of older adults, people living with disability, and those who have undergone surgery (Physiopedia 2021). They may assist in determining whether someone requires extra support, for example, home care or admission to an assisted living facility (Edemekong et al. 2023).
Basic ADLs (also known as BADLs) include:
(Edemekong et al. 2023; Physiopedia 2021)
Instrumental ADLs (IADLs) are more complex tasks that are required in order to live in the community independently. They generally require greater thinking skills, including organisational skills (Edemekong et al. 2023).
IADLs include:
(Edemekong et al. 2023; ME/CFS SA 2021)
Standard 3: Care and Services - Outcome 3.1: Assessment and Planning under the strengthened Aged Care Quality Standards (Action 3.1.5) requires older people’s care and services plans to be reviewed when there is a change or deterioration in their ability to perform activities of daily living (ACQSC 2024).
Furthermore, Outcome 3.2: Delivery of care and services (Action 3.2.5) requires aged care workers to be supported to recognise these changes (ACQSC 2024).
Someone might become unable to perform ADLs due to:
(Edemekong et al. 2023)
Measuring a person’s capacity to perform ADLs is a routine assessment that provides insight into whether the individual requires more support in their day-to-day life. The inability to perform ADLs may lead to serious harm, for example, a person who has difficulty mobilising will be at greater risk of falling (Edemekong et al. 2023).
There are a variety of tools that can be used to assess a person’s ADLs. One such tool used in Australia is the Resource Utilisation Groups - Activities of Daily Living (RUG-ADL), which measures four ADLs: bed mobility, toileting, transfer and eating (DoH 2021).
Clients are assessed in these four categories and assigned a score between 1 and 5 for each, with a score of 1 indicating that the client can perform the task independently or with supervision only, and a score of 5 indicating that the client requires two or more people to physically assist them in order to perform the task (DoH 2021).
Note: Not every category uses every score.
ADL | Capacity | Score | Definition |
---|---|---|---|
Bed mobility - The ability to move in bed after the transfer into bed has been completed. |
Independent or supervision only | 1 |
|
Limited physical assistance | 3 |
|
|
Other than two persons physical assist | 4 |
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Two or more persons physical assist | 5 |
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|
Toileting - The ability to mobilise to the toilet, adjust clothing before and after toileting, and maintain perineal hygiene without incontinence or soiling clothes. Note: If the client requires different levels of assistance for urination and defecation, record the lower performance of the two. |
Independent or supervision only | 1 |
|
Limited physical assistance | 3 |
|
|
Other than two persons physical assist | 4 |
|
|
Two or more persons physical assist | 5 |
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|
Transfer - the ability to transfer in and out of bed, bed to chair, in and out of shower/tub. Note: The score should be based on the lowest performance of the day/night. |
Independent or supervision only | 1 |
|
Limited physical assistance | 3 |
|
|
Other than two persons physical assist | 4 |
|
|
Two or more persons physical assist | 5 |
|
|
Eating - The ability to cut food, bring food to the mouth, chew food and swallow. Note: Does not include meal preparation. |
Independent or supervision only | 1 |
|
Limited assistance | 2 |
|
|
Extensive assistance/total dependence/tube fed | 3 |
|
(Adapted from Williams et al., as cited in DoH 2021)
The four scores will then be added together, resulting in a total of between 4 and 18. The higher the total score, the more support the client requires in order to perform these ADLs.
When assisting clients with ADLs, remember that your goals are different to theirs. What might be a work task to you is another person’s daily routine and life. For example, while you might be rushing to transfer a client from their bed to a chair because you know you have other clients to attend to, the client might just want to watch television without being disturbed (ATrain Education 2017).
It’s also important to understand that in Western societies, where independent living is encouraged, being unable to perform ADLs may cause feelings of fear and distress due to the associated loss of autonomy (Edemekong et al. 2023).
When assisting clients with ADLs:
(ATrain Education 2017)
Question 1 of 3
You are assessing the ADLs of a client, Paul, using the RUG-ADL tool. Paul can defecate independently but has a urinary catheter in-situ and requires another person to help him use it. What should Paul score for toileting?