Activities of Daily Living

What Are They and Why They Are Important to the Dementia Caregiver

Why Activities of Daily Living Need to Be Evaluated

It is important for the dementia caregiver to know what kind of symptoms the dementia patient is experiencing. One way to do this is to evaluate Activities of Daily Living (ADL’s.)

Knowing how well your loved one is able to take care of themselves will help you in a variety of ways. It can help to know what to expect as the dementia progresses. One day our Mom was able to pick out a set of clothes and put them on. A few weeks later she would put her bra on over her blouse. This, of course, was an obvious decline in her abilities, but there are many ADL’s that with even a subtle change can mean the difference between safety and danger.

Paying attention to where the dementia patient is in their level of functioning can help the dementia caregiver to get adaptive devices for the patient. There are many tools available that can help someone with cognitive impairment to continue to have some of their independence.

It may also be necessary to adapt some of the activities of the dementia patient. If they no longer have the ability to balance their checkbook it would be helpful for the dementia caregiver to take over this task.

As the dementia patient starts to lose some of their muscle tone it may be possible to help them with occupational, physical, speech or other therapies. Evaluating ADL’s can help to make these kinds of arrangements.

Having an understanding of Activities of Daily Living can help in the dementia caregiver’s discussion with the patient’s physicians. It is helpful to know what to look for in the dementia patient’s daily functioning so that you know what to tell the Dr. when you visit. Drs. may not always ask about ADL’s so be sure to mention anything that concerns you.

An evaluation of ADL’s can also help in making insurance decisions. Many healthcare policies will only cover Medical Care (care that is necessary to treat or aid in the recovery of an illness or injury.) But a dementia patient may require what is referred to as Custodial Care—care that helps the patient to function in everyday life.

Knowing the kinds of and amounts of care that your loved one needs (or may need in the future) can help you to get the right kinds of coverage and to best use the benefits of various policies the patient may carry.

Knowing how well your care recipient can accomplish Activities of Daily Living is an important factor in deciding what kind of long term care may be appropriate for them. Knowing their level of functioning can make decisions like when or if to place them in a nursing home or if it is practical to continue with home care easier to make. Insurance will sometimes cover the cost of nursing home care for a patient who is unable to perform two or more of the basic ADL’s.

What are Activities of Daily Living?

ADL’s fall into the following categories:

Basic (self-care needed for independent living)

• Ability to eat and drink
• Ability to dress oneself (including choosing own clothing)
• Ability to care for personal hygiene (including bathing, toileting, etc.)
• Ability to be mobile (walking, getting into and out of a chair, moving from wheelchair to bed, etc.)

Instrumental (skills not needed for basic functioning, but for effective living in a community)

• Being oriented to place and time
• The ability to dispense medication
• The ability to use the telephone
• The ability to correctly use speech and understand conversation
• The ability to complete household chores (including grocery and clothes shopping)
• The ability to prepare food
• The ability to handle money (including making change, balancing checkbook, etc.)
• The ability to participate in social activities and/or hobbies
• The ability to drive a vehicle or take public transportation

How to Evaluate ADL’s

As dementia progresses the dementia patient will require increasing levels of care. Knowing how their symptoms are progressing can help you to decide when to make changes like taking away their driver’s license or moving them into your home or when to place them in a nursing facility.

For your own personal use, ask if your loved one can perform the Basic Activities of Daily Living without instructions, with instructions, can’t do them even when given instructions, or cannot do them at all.

Try to let this be completely objective without involving your emotions. If possible, have a friend or family member who isn’t involved in your loved one’s every day care do this evaluation. It can be easy to deny the truth when you are so close to the situation. No one wants to admit that their parent or spouse needs an increased level of care, but it is important for the dementia patient’s safety and well-being to honestly evaluate ADL’s and to make informed decisions based on that evaluation.

For insurance purposes Activities of Daily Living will be evaluated by a professional. It was sad to watch a home health care nurse ask our Mom questions that we knew she couldn’t answer. We knew that she had declined and needed a higher level of care than we had been giving her, but hearing that from a professional was hard to take.

Making Decisions Based on ADL Evaluation

If your loved one can no longer complete the Basic Activities of Daily Living on their own without instruction (including remembering to do them in the first place) then it may be time to move them into your home or into an assisted living facility.

It may help to write out a plan of what your criteria will be for deciding to do things like take away their driver’s license or take over their finances or move them into your home. Knowing ahead of time what the signs will mean helps to remove the emotions so that you can make the necessary, but difficult decisions.

If your loved one is in the early stages of dementia it may be possible to discuss these possibilities with them and get their input as to what would be practical as the symptoms progress. If they are able to understand what ADL’s are and how their ability to perform them will affect their safety and ability to function on their own then they can contribute their opinions and their reassurance that you will, someday, need to make difficult decisions.