Instrumental Activities of Daily Living

This post is all about exploring Instrumental Activities of Daily Living, or IADLs which are addressed in occupational therapy interventions.  What are IADLs?  What are examples of IADLs? What is the difference between ADL (activity of daily living) and IADL? And, how to explain all of the above in layman’s terms for caregivers/parents/teachers…We’ll cover all of that here!

Instrumental activities of daily living

Instrumental Activities of Daily Living

As a “seasoned” therapist, I used the term ADLs (activities of daily living) for all tasks regarding self care. The term IADLs is newer to me.  Perhaps it is because I work with young children, who do not do a lot of instrumental activities of daily living.

However, IADLs are an important part of occupational therapy, especially when considering the goals of the person. One individual receiving OT services may have a goal to work on cooking so they can make meals for their family. Another may have a personal goal to balance a checkbook so they can manage their own finances.

iadl medical abbreviation

IADL is a medical abbreviation for Instrumental Activities of Daily Living. Related, but different than ADLS, which stands for activities of daily living.

These two areas are primary focus of the occupational therapy practitioner, as together, they represent all functional occupations, or the daily tasks that make up an individual’s day.

IADLs are different for every individual and also vary depending on the age of the individual. A middle school student or high school student will have different instrumental activities of daily tasks that make up their day.

This leads to the question….

What are IADLs?

Instrumental activities of daily living are more complex activities or tasks that a person does to maintain independence in the home and community. IADLs are not necessary for fundamental functioning, but allow an individual to live independently in their community.  This includes tasks beyond activities of daily living that involvement with physical and social environment.

The definition of “instrumental” is;  very important in helping or causing something to happen or be done. It is something that is useful or helpful. It is used as an aid.

A simple way to remember what IADLs are, is to use the mnemonic SHAFT.

  • S – shopping
  • H – housekeeping or housework
  • A – accounting or managing money
  • F – food preparation
  • T – telephone/transportation

IADLs, while physical in nature, involve a certain amount of cognitive thinking (executive functioning skills).  This is the reason young children are not able to do these tasks yet, and the elderly population loses this ability first, as their cognitive abilities decline. An interesting statistic is the fact that 50% of persons over the age of 85 need assistance with at least one IADL activity.  

Contributing to the ability to complete more complex daily tasks is mental dexterity which enables quickness of thought in IADLs.

Check out this recent post on the OT Toolbox regarding Occupational Therapy at Home.

Examples of Instrumental Activities of Daily Living

So, what are some examples of IADLs?

Within the “SHAFT” categories, are several activities such as:

  • Managing a budget, including using the ATM, counting and using money, managing bank accounts, writing checks, and remembering bills. 
  • Remembering to go to doctors appointments and taking medications as prescribed.  Medication management includes taking medications as prescribed, learning which medications treat which conditions, learning about possible side effects, and discussing medications with health care providers
  • Planning and preparing meals, including hot and cold items. This could also pose significant safety and health risk if done incorrectly
  • Being able to do housework, sweeping, dusting, vacuuming, washing dishes, cleaning bathrooms.  This can include arranging for help if desired
  • Doing your own shopping – groceries, clothing, or anything else you need.  This includes identifying which stores sell specific goods, making shopping lists, and planning routes for shopping trips. 
  • Using the telephone and computer, including landline, cellphone, internet, and/or medical alert device as a means of communication
  • Managing transportation – driving, hiring cabs, arranging for rides, navigating the community, or taking public transportation
  • Yard work – includes mowing grass, raking leaves, pruning shrubs, and other tasks.
  • Clothing care/Laundry – includes washing, drying, folding and putting away clothing
  • Time management – includes telling time, reading a calendar, following a schedule and making appointments
  • Managing your household in its entirety – including pet care, arranging for help, childcare
  • Any and all extracurricular activities – maintaining a hobby or socializing with friends, family, and peers

A list of Instrumental Activities of Daily Living includes aspects that can apply to pediatrics, including school-based OT as well as life skills addressed in OT sessions:

  • Retrieving things or putting things away which are needed for ADLs
  • Getting objects out of cupboards, drawers, closets, etc.
  • Using a telephone or computer
  • Handling mail
  • Using money
  • Writing checks and balancing a bank account
  • Using vending machines
  • Using equipment
  • Using public transportation
  • Purchasing items from stores
  • Caring for devices like ambulatory aides
  • Laundry tasks
  • Home management tasks
  • Meal preparation
  • Shopping
  • Purchasing food or needed items
  • Following emergency procedures
  • Emergency preparedness such as knowing how to call 911 or what to do in the case of an emergency
  • Home maintenance tasks
  • Leisure activities (hobbies, playing games, etc.)
  • Many other components of daily tasks
  • Serving others through community service- These service ideas are practical ways to help others.

These life skills cards target many aspects of IADLs and are a great tool for practicing daily tasks.

What is the difference between ADL and IADL?

ADLs are the basic things you need to do to survive and be well. IADLs are the things you can do to enhance your personal interactions and/or environment.

ADLs are essential to unassisted survival. If a person can not do these things independently, their ability to live unassisted diminishes greatly.   As the name suggests, these are activities done on a daily basis, needed for basic living or survival.  A mnemonic that can be used to remember these is DEATH:

  • D – dressing: including wearing clothes in an acceptable fashion
  • E – Eating:  feeding self (not including meal prep)
  • A – ambulation: walking, sit to stand, getting in/out of cars/tub/bed/chairs
  • T – toileting: including using the facilities, then wiping/washing self without help
  • H – hygiene: bathing, grooming, brushing teeth

A person who can perform basic self care but not IADLs can live independently with some assistance from family or others in the community.  For example, they can hire a housekeeper, Meals on Wheels, accountant, lawn care professionals, and a transportation service.  This type of person can have help come in daily, or weekly as needed but can do basic self help skills.

In contrast, a person who can not perform basic ADLs is likely to need around the clock care in order to survive.  This would include young children, elderly, and people with disabilities.

IADL assessments

IADL Assessments

Some common evaluation tools for measuring functional performance levels include the following IADL assessments:

  • Lawton Instrumental Activities of Daily Living Scale – The scale addresses ability to use the telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medications, and ability to handle finances.
  • Independent Living Scales – A standardized, performance-based test that requires the patient to complete tasks in 5 IADL areas: memory/orientation, managing money, managing home and transportation, health and safety, and social adjustment. Norms are included for adults ages 65 and older
  • Evaluation of Living Skills 4th Edition – requires the patient to complete tasks in the following areas: self care, safety and health, money management, transportation and telephone, work and leisure. The 4th edition has been revised to include modern pictures and communication devices, i.e. cell phones.
  • Assessment of Motor Process Skills – The assessment evaluates performance during both ADL and IADL skills. The IADL tasks included are meal preparation, home maintenance, and laundry.

A final thought

As you can see from the description of IADL above, you can understand why this has not been a foundation of my work with 2-5 year old children. They are focusing efforts on basic living and self help skills, not laundry, money management, or housekeeping. 

Toddlers and young children do not have the cognitive skills for these higher level tasks.  As children move into late elementary/early middle school, these skills become paramount in shaping their ability to live independently in their community, and should be addressed frequently. 

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

Life Skills task cards

Target many IADLs using our Life Skills Activity cards. Choose one or more cards to work on at a time.  Learners will practice each task ten times, using a hole punch or other marking tool to measure their attempts. Once they have completed the card, learners can display them on a keyring to track their progress.  Cards may need to be completed more than once in order to master a skill, however there are some skills that may be mastered after only ten trials. Get your copy here.

Instrumental activities of daily living

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