Instrumental activities of daily living (IADLs) are the everyday tasks that require planning, organization, and cognitive effort to live independently. The most widely used framework, the Lawton-Brody scale developed in 1969, actually lists eight IADLs, not seven. The confusion likely comes from the fact that the original scale assessed men on only five of the eight categories. Here’s what all eight include and why they matter.
The 8 IADLs on the Lawton-Brody Scale
Each IADL represents a category of tasks that goes beyond basic self-care like bathing or eating. They require you to think in complex ways, stay organized, and navigate spaces both inside and outside your home.
- Using the telephone: Looking up numbers, dialing, and handling calls independently.
- Shopping: Planning what you need and completing all shopping without help.
- Preparing food: Planning, cooking, and serving meals that meet nutritional needs.
- Doing household tasks: Maintaining the home independently, with occasional help allowed for physically demanding work like washing windows.
- Doing laundry: Washing, drying, and managing all personal laundry without assistance.
- Traveling beyond walking distance: Using public transportation or driving a car without help.
- Managing medications: Taking the correct doses of prescribed medications at the right times.
- Managing money: Handling finances including budgeting, writing checks, paying rent, and tracking income.
Why Some Lists Say 7 Instead of 8
When Lawton and Brody published their original scale, they scored women on all eight categories but assessed men on only five. Food preparation, housekeeping, and laundry were excluded from men’s assessments, reflecting 1960s assumptions about gender roles. Current practice recommends including all eight domains regardless of gender, but older references and simplified lists sometimes trim the number down, which is likely where the “7 IADLs” framing originates.
How IADLs Differ From Basic ADLs
Basic activities of daily living (ADLs) cover physical survival needs: bathing, dressing, eating, using the toilet, transferring in and out of a chair or bed, and maintaining continence. They’re sometimes called physical ADLs because they center on what your body needs moment to moment.
IADLs sit a level above that. They require more advanced cognitive skills like planning a grocery list, remembering when to take a pill, or keeping track of bills. Many people who struggle with IADLs can still handle basic ADLs without any help. This distinction matters because it tells caregivers and clinicians where someone falls on the spectrum of independence.
What Each IADL Actually Involves
The categories sound simple, but each one bundles together several cognitive and physical steps. Managing money, for instance, isn’t just paying a bill. It means understanding income, creating a budget, writing checks or handling online payments, and keeping records accurate over time. A missed rent payment or an unexplained overdraft can be the first visible sign that this skill is slipping.
Medication management is similarly layered. It’s not just swallowing a pill. It means knowing which medications to take, at what dose, at what time of day, and whether to take them with food. Someone who previously handled a complex medication schedule without trouble but starts missing doses or doubling up is showing a meaningful change in function.
Even telephone use, which may seem outdated, has evolved to include smartphones and video calls. The core skill being assessed is the ability to initiate communication, look up contact information, and carry on a coherent conversation to get needs met.
IADLs as an Early Signal of Cognitive Change
A person with mild cognitive impairment or early-stage Alzheimer’s disease often has trouble with IADLs while still managing basic ADLs like dressing and eating just fine. As the condition progresses, basic ADLs become harder too. This is why healthcare providers pay close attention to IADL performance: it can reveal cognitive changes before they become severe enough to affect physical self-care.
That said, IADL difficulties in mild cognitive impairment tend to be subtle. They become more pronounced only near or at the onset of dementia, which limits their usefulness as very early markers. The changes are real, but they can be easy to miss or explain away (“Mom just forgot to pay that one bill”). A pattern of decline across multiple IADLs is more telling than a single slip.
How IADLs Are Scored
On the Lawton-Brody scale, each of the eight categories is scored based on the person’s highest level of functioning, from fully independent to completely unable to perform the task. The total score gives a snapshot of overall functional ability. A lower score signals greater dependence and a need for more support, whether from family, home health aides, or assisted living.
The assessment is typically done through an interview with the person being evaluated, and sometimes with input from a family member or caregiver who can confirm what’s actually happening at home. It’s a quick, practical tool, not a lengthy exam, and it can be repeated over time to track whether someone is stable, improving, or declining.
Modern Updates to IADL Tracking
Researchers are now exploring ways to monitor IADLs passively using smart-home technology. One system uses wireless tags attached to everyday objects (like a pill bottle or a stove knob) paired with a wearable sensor. When the person interacts with a tagged object, the data is recorded and sent to the cloud. This kind of continuous tracking could catch gradual declines in daily function that a once-a-year office assessment might miss, and it could help caregivers provide support before a crisis happens.
The practical technology people use for IADLs has also shifted. Online banking has replaced checkbooks for many people, and ride-hailing apps have supplemented public transit. The underlying skills being measured, planning, sequencing, problem-solving, and memory, remain the same even as the tools change.