The activities of daily living (ADLs) are essential and routine chores that individuals can achieve without the need for assistance. The six essential ADLs includes the ability to be able to eat independently, dress, walk or transfer from one place to another, bath, use the bathroom for toileting, and maintain good continence. Independent adults generally can manage these activities of daily living that are instrumental in their ability to successfully live without much burden to their families. Inability to accomplish these essential activities serves as the baseline for caregivers to determine long-term goals for continued long-term care and support plans. In order to optimize care, primary care providers often discuss a patient’s need for assisted living, in-home care, or nursing home placement. 
Caregivers and professionals commonly note that patients' functionality declines. This reality is central to the encouragement that healthcare practices adopt routine screening for sustained ADLs. Clinical examination and diagnosis performed by primary care providers are important in determining an individual’s ability to sustain independent living. For instance, certain comorbidities such as dementia influence a person’s ability to meet personal goals and sustain independent living. Other factors include comorbidities that limit a patient’s ability to sustain independence. This may include cancer, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). These are some clinical diagnoses that could be limiting as the presentation progresses over time and eventually results in worsening prognosis. A medical provider’s role in determining a patient’s functionality is often categorized as mildly, moderately or severely impaired when they take into consideration a patient’s quality of life or ability to perform ADLs. Declined or inability to achieve one or more ADLs should motivate a primary provider to routinely check on and determine a patient’s independence and evaluate the need for physical therapy or placement in an assisted facility.
There are predefined and functional criteria to help primary care providers determine whether a patient can benefit from private long-term care insurance, Medicaid, or Medicare that covers the cost of assistance with ADLs. This results from established social health care findings showing that more than half of the American population ages 65 years old or older are placed in long-term care facilities due to the diminished ability to accomplish their ADLs tasks and activities. The first signs of diminished functionality shows in lack of capacity to accomplish basic self-care activities (feeding, grooming, dressing, bathing, walking, toileting, ability to transfer from bed to a wheelchair or walking).
Aside from being able to perform ADLs, geriatric patients also need to be able to perform necessary activities of daily living, for example, managing their finances, medications, being able to do their shopping, or prepare their meals (Wiener et al. 1990). Placement in a care facility has become common for patients and their families. Though most visits at care facilities are short-term, most patients end up staying longer than a year due to being incapacitated and unable to perform more than two of the six ADLs.
In an effort to index independence and access activities of daily living clinicians incorporates best practice evaluation of the client’s status to plan and intervene appropriately. Aging is a natural process that presents a decline in the functional status of patients at baseline. Central to issues of concern is the increased risk of falls recorded among the aging population. There is an increased mortality rate among individuals who have more than one incidence of falling. The most at-risk group of individuals include those 65 years old and older who tend to have the worse prognosis after experiencing a fall. Independent living is highly encouraged and advocated for in the American society, and the aging individuals greatly fear a loss of autonomy. Social workers, along with primary care providers, work together to define the individual patient’s requirements before placement. Issues that are central to placement in assisted living or nursing home as opposed to independent living at home includes a patient’s ability to cook and clean their homes, shop, use of public transportation or drive. It is often important for a provider to address a patient’s general medical condition when determining his/her level of accomplishing functional capabilities that otherwise ensure independent living and personal care. Primary care providers are encouraged to routinely assess patients’ ease in performing ADLs during office visits.
It is important for providers to be thorough when discussing options patients and their families to determine if they meet pre-defined criteria to either continue living in their homes or go to assisted living or nursing home facilities. For patients diagnosed with cancer, congestive health failure, or chronic obstructive disease, their degree of exacerbations, rehabilitation, or hospitalization influences the ability to continue to live alone at home. A patient’s inability to perform ADLs as well as IADLs constitutes a disability that often requires measurement of functionality which becomes a significant predictor of being admitted into an assisted facility or nursing home depending on variable factors that pertain to the individual patient (United States National Library of Medicine, 2017).
Depending on the level of assistance required, as well as presenting comorbidities, most families work with providers to care for loved ones at home. Families often hire in-home licensed home health providers most commonly certified nurses' aides, licensed practical nurses, or licensed vocational nurses to provide continuous care and support patient’s ADLs. Depending on the severity of the patient, most home health providers help with medication dispensations, shopping and going on walks with patients to support their desire for continued independent living.
According to a study, severe cognitive fluctuations in dementia patients had a significant association with impaired engagement in activities of daily living that negatively affected their quality of life (Sun, M et al., 2017). Cardiovascular Health Study (Jacob, M et al., 2017) investigated a higher incidence of disability based on age, sex, and race and found it to be associated with mobility difficulties in older patients, women and black patients. Also, most families chose to place their loved ones in assisted living or nursing homes instead of letting them live at home or use home health visiting provider due to the exorbitant costs. It, therefore, requires a well-trained geriatric care professional who accumulates the necessary skills in geriatric care to care for patients with diminished ADLs.
All healthcare workers including nurses, nurse practitioners, and clinicians should get in the habit of assessing the functionality of seniors before discharge. Patients who are unable to perform daily living activities may require further rehabilitation or assistance at home. The inability to dress or go to the bathroom can lead to a very poor quality of life. In addition, assessment of functionality should become routine practice in medicine as it can affect people of all ages. An interprofessional team working together will provide the best patient evaluation and discharge with good follow up care. [Level V]
Nurses should regularly access the activities of daily living (ADLs) which are the basic tasks that must be accomplished every day for an individual to thrive. The assessment should include:
Nurses also commonly access Instrumental activities of daily living (IADLs). The evaluates a person’s ability to live independently and thrive. IADLs include:
Appropriately accessing ADLs and IADLs can mean the difference between graceful and independent aging and needing daily assistance. Financially, it is important as they may become eligible for government assistance or qualify them for long term care insurance.
Nurses should evaluate ADLs and IADLs on a frequent basis. When a patient is at risk for a change in ADLs or IADLs, the nurse should report to the interdisciplinary team members so that a new plan of care can be established.
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