IADLs, or instrumental activities of daily living, are the complex everyday tasks that allow a person to live independently. They include things like managing finances, preparing meals, shopping, doing laundry, using a phone, taking medications, handling transportation, and keeping up a household. Unlike basic self-care tasks such as bathing or dressing, IADLs require higher-level thinking: planning, organizing, problem-solving, and memory.
The Eight Classic IADL Domains
The most widely used framework for measuring IADLs comes from the Lawton-Brody Instrumental Activities of Daily Living Scale, developed in the late 1960s and still in clinical use today. It covers eight specific areas:
- Using a telephone (or, increasingly, a smartphone)
- Shopping for groceries and other necessities
- Preparing food and cooking meals
- Housekeeping and maintaining a clean living space
- Doing laundry
- Managing transportation, whether driving or arranging rides
- Managing medications, including taking the right dose at the right time
- Handling finances, such as paying bills and managing a bank account
The scale can be completed in 10 to 15 minutes and is typically filled out by the person being assessed or by a caregiver who knows them well. Each domain is scored based on the person’s current level of independence, and a lower total score signals greater difficulty managing daily life.
How IADLs Differ From ADLs
You’ll often see IADLs discussed alongside ADLs (activities of daily living), and the distinction matters. ADLs are the basic physical self-care tasks: eating, bathing, dressing, toileting, and moving from a bed to a chair. These are more fundamental, and most people lose the ability to perform them only after IADLs have already become difficult.
IADLs sit one level higher on the complexity scale. Paying a bill requires reading fine print, understanding due dates, and navigating an online portal or writing a check. Grocery shopping involves making a list, traveling to the store, identifying products, and handling money. These tasks layer cognitive skills on top of physical ones, which is why IADL performance tends to decline earlier and more noticeably when something is going wrong with memory, vision, or executive function. Research in occupational therapy has consistently found that maintaining good IADL performance is more challenging than maintaining ADL performance, and the gap widens with age.
Why IADL Performance Matters for Brain Health
One of the most important things about IADLs is what they reveal about cognitive health. Because these tasks demand planning, sequencing, and memory, a subtle decline in IADL ability often shows up before a formal dementia diagnosis. A large population-based study found that older adults with IADL limitations had a 55% higher risk of developing dementia compared to those without limitations, even after adjusting for other health factors. When IADL difficulties appeared alongside mild cognitive impairment (MCI), the risk of dementia nearly tripled.
The relationship works in both directions. Cognitive decline leads to worse IADL performance, but struggling with IADLs also appears to accelerate further cognitive decline. This creates a cycle that clinicians watch for closely. Difficulty managing medications, forgetting to pay bills, or struggling with meal preparation can all serve as early warning signs, sometimes years before memory loss becomes obvious to family members.
This is why geriatricians and neuropsychologists routinely assess IADL function during cognitive evaluations. The Functional Assessment Staging Tool (FAST), used in dementia care, maps specific IADL losses to disease progression. At stage 4, for instance, a person typically starts having trouble with complex tasks like planning a dinner, managing personal finances, or forgetting to pay bills. By stage 5, they need help choosing appropriate clothing. Tracking these milestones helps families and care teams anticipate what support will be needed next.
Modern IADLs Include Technology
The original Lawton-Brody scale was designed in an era of landline phones and paper checkbooks. Daily life now requires a different set of skills. Sending a text message, checking a website, managing an online bank account, making purchases with a credit card, and remembering passwords are all technology-based IADLs that weren’t part of the original framework.
Researchers have begun developing updated assessments that capture these digital tasks. In one recent study, items like texting, emailing, visiting websites, and managing online financial accounts applied to over 80% of older adult respondents, including many with Alzheimer’s disease and related dementias. Smartphones, in particular, were used frequently even by people with cognitive impairment. Including these technology-related tasks in IADL assessments improves their accuracy without reducing their ability to detect meaningful functional decline.
How IADL Difficulties Are Addressed
When someone starts struggling with IADLs, the goal is usually to preserve as much independence as possible for as long as possible. Occupational therapists are the primary professionals who work on this, using a combination of strategies tailored to the specific tasks causing trouble.
Common approaches include simplifying routines, modifying the home environment, introducing adaptive equipment, and coaching both the person and their caregiver on compensatory strategies. For medication management, this might mean involving a care partner, reorganizing the medication regimen into a simpler system, and addressing practical barriers to taking pills on time. For handwriting difficulties (common in conditions like Parkinson’s disease), therapists use hand exercises, writing practice, and visual cues like colored target zones to improve legibility. Task-specific training, where you practice the exact activity that’s become difficult, is a core strategy.
Physical activity also plays a role. Social forms of exercise, such as dance classes, have been linked to increased participation in IADLs and other daily activities. The connection makes sense: staying physically active supports the strength, balance, and endurance that underlie tasks like shopping, cooking, and housekeeping.
IADLs and Care Decisions
IADL limitations often drive the biggest decisions families face about aging and care. If someone struggles with one or two IADLs, they can often remain in their own home with targeted support, whether from family, a home health aide, or a senior retirement community that offers light assistance. When difficulties span multiple IADLs and begin to overlap with ADL impairments, assisted living or a higher level of care typically becomes appropriate.
Insurance coverage for IADL help is limited. Medicare does not pay for custodial or personal care (like bathing or dressing) when it’s the only care someone needs, and it does not cover homemaker services like shopping or cleaning unless they’re part of a broader skilled care plan. Home health aide assistance with tasks like grooming, bathing, or feeding is only covered when the person is simultaneously receiving skilled nursing care, physical therapy, speech-language pathology, or occupational therapy. Medicare Advantage plans may offer additional benefits, so checking with a specific plan is worthwhile. Long-term care insurance and Medicaid (for those who qualify) are the more common funding sources for ongoing IADL support.
Gender and Scoring Considerations
The original Lawton-Brody scale assigned certain items, specifically food preparation, housekeeping, and laundry, only to women, reflecting 1960s gender norms. Most current versions of the scale have moved away from this and allow all respondents to answer every item. Some adapted versions include an “irrelevant” option for any task a person has never performed, regardless of gender. In practice, though, the total score is typically used without gender-specific adjustments, which means clinicians need to interpret results carefully when someone has limited experience with certain tasks for reasons unrelated to functional decline.