What is an ADL?

ADL means 'activity of daily living'. These are the 'life skills' we have acquired that allow us to perform daily tasks. This can include tasks such as getting out of bed, going to the bathroom, fixing a meal, driving a car, etc. We often take these abilities for granted until we no longer are able to do them as easily as we once did. Sometimes as we age, these ADL tasks become obstacles to our independence and safety, and alternative solutions need to be found. The Occupational Therapist will provide education, training and adaptive equipment to help in all aspects of ADL performance.

ADL tasks require sufficient 'physical abilities'; which can sometimes be affected by the aging process. We need to have sufficient strength and endurance to accomplish the task at hand, as well as adequate range of motion in all of the joints required for the task. For instance, someone who has an arthritic hip may find that it is no longer possible to bend over far enough to tie shoes, reach down to pick items up off the floor, etc. Or someone with a recent myocardial infarction (heart attack) may lack the stamina to climb stairs, cut the grass, etc. These are just a few of the many examples in which seniors may need to change how they perform everyday ADL tasks, that once seemed so easy to do.

Besides our physical abilities, ADL tasks require appropriate 'cognitive abilities' in order to function independently in our environment. As we age, it is not uncommon to see some mental decline; and although we may still have the physical ability to perform ADLs, there may be some cognitive deficits that make it more difficult to execute these tasks completely and safely. (Just because we may be forgetful on occasion, that is not necessarily an indication of dementia.) But for someone who has dementia, there may be issues with remembering recent events, decreased problem solving abilities, impaired judgement, poor insight, difficult with abstract thinking and processing of information, poor safety awareness, etc. For example, the individual with dementia may not be taking their medication daily due due to forgetfulness.

An electric stove is safer than gas when a resident is forgetful or unsafe. With either type of stove, a timer should always be used when cooking. If unable to remember, a large index card should be placed next to the controls as a reminder to use a timer. And a reminder to not wear long sleeve clothing, when cooking with a gas stove, should also be posted.

Besides having adequate physical and cognitive abilities, we also rely upon our 'sensory-perceptual' abilities in order to function and interact with the environment; and our vision is the most important of these components. Impaired vision can make it difficult to perform everyday self-care tasks such as taking medications, using the telephone, safely walking, driving a car, and various other tasks.

Taking several medications each day is often an area of concern for someone who has cognitive or visual deficits.

Although impaired vision can be an obstacle, there are those who are able to adapt and live fairly independently at home. For instance, someone with macular degeneration could use a camera magnification system designed for people with low vision. It is a low-profile camera mounted on a stand that connects to a standard TV or computer monitor. It is able to greatly magnify images and allow the person to read prescriptions and regular sized newspaper print. The image can even be reversed as a white text on black background is often easier to read for those with significant vision loss.

A tub bar clamp was the solution for a client who had difficulty rising up from sitting in the tub, and who was unsteady with her transfers in and out of the tub.

Many of the obstacles encountered in a home environment can be addressed by consulting with an Occupational Therapist familiar with home adaptations, modifications and alternative solutions. There are often no quick or easy answers, but when the client/family are determined to remain at home, then the Occupational Therapist can be a good resource to call upon.

Case Study: A widow returns home from a recent hospitalization, which was due to a hip fracture from a fall while trying to get out of bed. During a home evaluation the OT determines that the bed is too high for the resident and it will need to be lowered, and that a bed rail should be attached to the bed frame in order to prevent further problems. Due to increased confusion, the OT and the client's family agree that a caregiver should be used a few hours each day to help with self-care tasks, meals and dispensing medications. The client and caregiver are provided specific instructions in order to help the person live at home versus going to a nursing home.

ADL Tasks:

1. Grooming

2. Oral Hygiene

3. Bathing / Showering

4. Toileting & Hygiene

5. Personal Device Care

6. Dressing

7. Meal Preparation / Eating

8. Medication Routine

9. Health Maintenance

10. Money Management

11. Socialization

12. Functional Mobility

13. Community Mobility

14. Emergency Response

15. Leisure Activities