Functional assessment is a standardized method used in healthcare to objectively measure an individual’s capacity for self-care and independent living. This measurement provides clinicians with objective data to evaluate a person’s health status and predict potential decline or improvement. The primary categories used are Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These frameworks quantify functional abilities and help professionals determine support needs across various settings like hospitals, clinics, and home care.
Activities of Daily Living (ADLs)
Activities of Daily Living (ADLs) are the fundamental personal care tasks required for self-maintenance and physical survival. These basic needs are often learned in infancy and represent a person’s ability to care for their physical body. The most commonly cited core ADLs are:
- Bathing: Involves the ability to wash one’s body.
- Dressing: Includes selecting appropriate clothes and managing fasteners like buttons and zippers.
- Toileting: Requires the capacity to use the toilet safely, including maintaining hygiene afterward.
- Transferring: Refers to the ability to move from one position to another, such as getting in and out of bed or a chair.
- Continence: The ability to maintain bladder and bowel control.
- Feeding: The capacity to move food from a plate to the mouth independently.
Instrumental Activities of Daily Living (IADLs)
Instrumental Activities of Daily Living (IADLs) are more complex tasks that interact with the environment and community, going beyond basic self-care. These activities support overall well-being and independent living, requiring higher levels of cognitive function, organization, and planning. IADLs are typically learned later in life, often during adolescence, and are not strictly necessary for basic physical survival.
Key IADLs include:
- Managing finances: Paying bills and budgeting.
- Preparing meals: Planning, shopping, and cooking.
- Shopping: Purchasing necessities.
- Using transportation: Driving or utilizing public transit.
- Managing medication: Taking the correct dose at the right time.
- Housekeeping: Maintaining the household.
- Using communication devices: Operating a phone or computer.
The Functional Hierarchy: Progression of Independence Loss
The distinction between ADLs and IADLs is meaningful because they decline in a predictable, hierarchical order, signaling the severity and progression of functional impairment. IADLs generally involve a greater degree of cognitive function, problem-solving, and executive skills, making them more sensitive to early health changes. Consequently, the loss of IADL capacity is typically the first sign of functional decline, often correlating with early cognitive impairment or mild physical limitations.
A person might first struggle with complex tasks like balancing a checkbook or managing multiple medications before losing the ability to dress themselves. The inability to perform ADLs, however, signifies a more severe level of functional impairment, often requiring hands-on personal care. ADLs are more resilient to physical and cognitive decline, and their loss indicates a greater need for direct assistance with life-sustaining tasks. Because IADL impairment precedes ADL impairment, the former is a valuable tool for identifying incipient decline in older adults.
Application in Care Planning and Assessment
Healthcare professionals use standardized assessments, such as the Katz Index for ADLs and the Lawton Scale for IADLs, to objectively measure functional status. The scores derived from these tools serve as a foundation for developing individualized care plans and tracking changes over time. Functional assessment helps identify specific areas where a person needs support, allowing for targeted interventions like occupational therapy or home health services.
These measurements also determine qualification for various benefits and services, including long-term care insurance eligibility and the approval of home health aid hours. Insurers often require a person to demonstrate dependence in a specific number of ADLs to qualify for financial coverage. Also, assessment results guide placement decisions, indicating whether a person can remain safely at home with support, transition to assisted living, or requires the higher level of care provided in a skilled nursing facility.