Independence is a precious commodity that only increases in value as you age. When you’re no longer able to complete routine tasks and activities, such as shopping for food, preparing meals or handling medications, it can be especially jarring and put you at risk for an accident, injury or illness.
And as you get older, these so-called activities of daily living can become harder. If you or a loved one starts to have trouble performing these tasks, it may be time to consider moving to a senior living community. However, that’s not the only option. Some resources and services allow you or a loved one to age in place at home. What avenue you pursue is an individual choice, but one of the key considerations is the ability to manage activities of daily living.
[Read: 11 Signs Your Aging Parent Needs Senior Care]
What Are Activities of Daily Living?
Activities of daily living, or ADLs, are everyday tasks that people perform to care for themselves and maintain their independence.
Shannel Kassis Elhelou, a neuropsychologist at Pacific Neuroscience Institute’s Brain Wellness & Lifestyle Program at Providence Saint John’s Health Center in Santa Monica, California, says it can help to think of ADLs as “basic self-care” activities.
Another way to view ADLs is as the “activities that are truly needed on a day-to-day basis,” says Dr. Esiquio Casillas, Los Angeles-based chief medical officer for AltaMed Health Services Program of All-Inclusive Care for the Elderly. “Without being able to complete these independently, someone will have an immediate decline from one day to the next.” Some examples of ADLs include:
— Feeding
— Continence, or the ability to control bladder and bowel function
— Walking independently
— Toileting, meaning the ability to get to and from the bathroom and use the toilet without assistance
— Grooming, such as bathing, showering, brushing teeth and styling hair
— Dressing
Knowing how to perform ADLs and readily using them in your day-to-day life can help you take care of yourself, whether you live alone or in a community with others. In order to confidently live at home, however, you’ll want to master skills beyond ADLs.
“When assessing whether someone can continue living independently, it’s really important to evaluate not only activities of daily living, but also instrumental activities of daily living,” Elhelou says.
[Read: What Is Life Like in Assisted Living?]
Instrumental Activities of Daily Living
IADLs are closely related to ADLs but are a touch more complex.
“They’re similar but different,” Elhelou clarifies. “Think of more complex things like managing your finances, managing your medications, housekeeping (and) keeping a safe home where you’re not putting things on the floor that you could trip over.”
Being able to perform IADL tasks may not be mandatory in every environment, such as if you have support from a nurse or home health aide, but they can be “necessary for managing a household and engaging in a community,” Elhelou adds. Some IADL skills include:
— Using the telephone
— Shopping
— Preparing food
— Housekeeping
— Doing laundry
— Using transportation
— Handling medications
— Handling finances
Using the telephone
Being able to communicate with others can help a person maintain relationships and increase their sense of safety, especially if they live alone. Communicating through phone calls, texting and emailing are all important and useful skills for people to practice and incorporate into their daily or weekly habits.
Knowing who to call in an emergency, such as having an emergency contact on file or remembering to dial 911, is another essential part of communication.
Red flags include someone appearing to have trouble using their phone, failing to answer calls or not hearing or recognizing a ringing telephone.
[READ: How to Talk to Your Parents’ Doctors: Tips for Successful Communication]
Shopping
Being able to shop for yourself is another core component of independent living. This doesn’t just pertain to buying holiday gifts or going on a shopping spree, but purchasing weekly or monthly necessities like groceries, toiletries and weather-appropriate clothing.
If a loved one is declining in this IADL, you might notice that they’ve suddenly or significantly increased shopping-related expenses, says Dr. Michael Wasserman, an Auckland, New Zealand-based geriatrician with the California Association of Long-Term Care Medicine. Conversely, you might notice that they keep an empty refrigerator, suggesting they may not be shopping at all.
“Signs of a problem might be that Mom goes to the store for milk and comes home with chicken, or Dad always ate healthy and has started buying junk food,” Wasserman says.
Preparing food
Maintaining a nutritious diet is vital for everyone. And if you live alone, how well you eat depends on how capable you are of preparing healthful, tasty meals for yourself.
Your meal-prep routine doesn’t have to be Michelin-star — or Instagram-influencer-quality for you to be successful at this IADL, but they do need to nourish your body in a way that supports your health and activity levels. Preparing food can be as simple as heating microwavable meals or making a sandwich, or as elaborate as making hand-pinched dumplings from scratch.
Red flags include burning food or leaving the stove on, missing meals and experiencing weight loss or significant changes in diet or eating habits.
Housekeeping
Whether you live in a house or apartment, you’ll need to take care of your space to live alone safely at home.
Housekeeping can include picking up after yourself so that you don’t trip on loose items, emptying the trash can before it overflows or remembering to turn off appliances before you head out the door. It can also include calling maintenance personnel to address hazards such as plumbing issues, infrastructure damage or bug infestations that pose a threat to your health.
Hoarding, leaving food out, creating messy or cluttered rooms and letting garbage pile up are signs to watch for.
Doing laundry
Wearing clean clothes has a positive impact on your health. If you live alone, you’ll want to ensure that you regularly do your laundry or take your items somewhere to get them cleaned.
Using transportation
Whether you use public transportation, drive safely or have someone who can take you places, reliable transportation is an essential part of being able to function independently.
“Transportation means different things to everyone,” Wasserman says. “Some people rely on their car to go everywhere. Others may exclusively use the bus or train, and they walk everywhere.”
For people who drive themselves places, frequently getting into car accidents, getting lost or receiving parking tickets are red flags, he adds.
Handling medications
If your doctor has prescribed medication, neglecting or forgetting to take it as directed can be harmful. When living alone, managing medications is an important IADL that includes remembering to take them, taking them at the correct dosage and refilling prescriptions on time.
Mishandling medications can trigger falls and fall-related injuries, memory and cognitive issues, weight loss or other problems that can result in an emergency room visit or hospitalization.
Handling finances
Financial health is a key component of living alone. Particularly if you have loans or household bills to pay, staying on top of your payments, writing and depositing checks and balancing checkbooks are IADLs you can’t afford to ignore, literally.
Handling finances can also include staying vigilant of fraud, such as fraudulent phone calls or text messages asking for your money.
How to Assess Signs of Declining IADLs
No one is perfect, and forgetting to perform a routine task every once in a while doesn’t necessarily mean your IADLs are in decline. On the other hand, commonly neglecting IADLs can be a red flag that you or a loved one is struggling with day-to-day tasks and a sign to start thinking about whether or not it’s safe to live alone.
If you are unsure if your loved one can safely perform IADLs — and whether or not you should start a conversation about their living environment — Elhelou says that it can be important to check their overall health first. If your loved one is experiencing unexplained deterioration in their health and wellness, that is cause for concern.
Casillas adds that declines in IADLs can be tricky to spot and may not “manifest into a crisis” for many weeks or months. Because of the health and safety implications, however, you should not ignore potential signs.
If you are unsure whether declining IADLs could negatively impact your loved one’s health, ask yourself:
— Is your loved one neglecting their basic needs?
— Are they experiencing unexplained weight loss?
— Does your loved one appear often dehydrated?
— Is your loved one showing signs of poor hygiene that are uncharacteristic of them?
— Does your loved one appear to be in an unsafe living condition?
— Are they being frequently forgetful, such as forgetting to get medications or missing bill payments?
— Does your loved one express confusion about daily routines?
— Do they fall often?
— Are they getting into other types of accidents, such as car accidents?
— Is your loved one experiencing incontinence and not making it to the bathroom in time?
— Is your loved one leaving appliances on when they leave their home?
— Are they frequently ending up in the hospital?
— Is their health condition worsening due to unmanaged care?
While asking yourself these questions can help guide future conversations with your loved one and, ultimately, their future decisions, you’ll want to consult a trusted doctor for any medical diagnoses and official recommendations.
It’s essential to have a good relationship with your geriatrician or other health provider who can identify possible causes for forgetfulness or other functional decline, such as an adverse drug reaction, malnutrition or a vitamin deficiency.
As a neuropsychologist, Elhelou performs cognitive testing that helps inform people about their brain health and guide decisions, such as whether they should continue living alone. While her tests provide guidance, Elhelou says she does not make these decisions for patients or their families.
For individuals seeking additional guidance, there are also social workers and case managers who can visit you to assess your lifestyle and the safety of your home, she adds. More hands-on assessments of a person’s ADL and IADL skills can be conducted by an occupational therapist or physical therapist, who can not only help pinpoint areas of decline but also assist your loved one in working on skills to improve overall function and prevent further damage.
Therapies for Declining IADLs
Physical or occupational therapy can support ADL and IADL function and fight against decline.
“Many times targeted physical and occupational therapy can improve a person’s functional status to regain some ADLs and IADLs that they lost due to chronic conditions or acute health declines,” Casillas says.
Kaela Goldberg, a registered and licensed occupational therapist at The Riverside Premier Rehabilitation and Healing Center in New York City, helps patients tackle deficits, like impaired strength or coordination, that may be impacting ADL and IADL performance.
Goldberg also guides patients through exercises that break down IADL and ADL tasks into smaller, more manageable steps. She does this with toothbrushing, for example, where she may start with having the patient collect their materials. Then she has them stand in front of the sink, turn on the faucet, open the lid of the toothpaste, squeeze out the toothpaste and so on. The goal of these exercises is to improve a patient’s “functional independence” and prevent further ADL and IADL decline, Goldberg says.
However, she notes that whether a patient can regain lost function is highly individualized.
“Ideally, once a patient initiates OT services, further decline will be prevented. But depending on the original cause of the decline, it may not be possible to have a complete return to (their previous level of function),” Goldberg says.
Additionally, some people with declining ADL or IADLs may be in need of more help than a PT or OT can offer. Concerningly, deteriorating IADLs are closely related to symptoms of dementia.
Elhelou adds that the big difference between a dementia diagnosis representing a mild and major neurocognitive disorder, which has a more severe decline and life impact, is a person’s ability to complete IADLs.
Senior Living Options
When someone is unable to perform IADLs or ADLs, this can signal that they need extra support. In some cases, extra support can mean switching living environments. At other times, it may mean taking smaller steps to support your independent lifestyle, such as hiring a driver to take you to and from the grocery store, or a home health aide or in-home caregiver.
If you or your loved one is unsafe to live at home due to deteriorating IADLs or ADLs, there are various senior living options you can consider. Some include:
— At-home care services from companies such as Visiting Angels and Comfort Keepers offer a range of support, including meal preparation, light housekeeping and assistance with bathing and grooming. You can also hire organizations or individuals for support and services, such as housework, transportation, lawn care, pet sitting or dog walking, to help you or a family member stay safely at home.
— An independent living community is a viable option that enables ongoing independence while also providing dining and meal services, opportunities for socialization and physical activity and other amenities. Some even have areas where residents can work or receive health care services.
— Assisted living, memory care or skilled nursing facilities may be appropriate when someone’s deficits put themselves or others at risk for illness, accident, injury, further decline or financial problems.
— A continuing care retirement community provides access to multiple levels of care on a single campus.
Tips for Talking With Your Loved One
If it’s time for your loved one to consider moving, you should talk to them openly, honestly and empathetically about their options.
In initial conversations, Casillas stresses the importance of asking your loved one about their health goals, including “how much risk they are willing to take based on their ADL limitations in order to maintain their independence.”
“Balancing a person’s autonomy and the risk they are comfortable with is critical to provide them with the best environment as they age and their functional status declines,” Casillas continues.
He adds that too often, people fail to inquire about their loved ones’ preferences and instead act on their assumptions.
Additionally, consider using these conversations to highlight steps your loved one can take and things they can do in the future, rather than reminding them of the skills they lack or have lost.
“It may sound trite, but it’s the truth: If you act from a place of caring and concern, and focus on what you or your loved one can do instead of the deficits, it helps,” Wasserman says. “Avoiding these issues is not a good idea. If the conversation is hard or scary, reach out to your physician or other trusted professional.”
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Why Activities of Daily Living Are Important for Living Independently originally appeared on usnews.com
Update 07/16/25: This story was previously published at an earlier date and has been updated with new information.
