Tools
Instrumental Activity of Daily Living
Definition/Introduction
Instrumental activities of daily living (IADL) are those activities that allow an individual to live independently in a community. Although not necessary for functional living, the ability to perform IADLs can significantly improve the quality of life. The major domains of IADLs include cooking, cleaning, transportation, laundry, and managing finances. Occupational therapists commonly assess IADLs in the setting of rehab to determine the level of an individual’s need for assistance and cognitive function. IADLs are commonly confused with basic activities of daily living (ADLs). The major domains of ADLs are feeding, dressing, bathing, and walking. In contrast with IADLs, ADLs are necessary for basic functional living. Deficits in performing ADLs may indicate the need for home healthcare or placement in a skilled nursing facility.[1]
Issues of Concern
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Issues of Concern
Multiple scales or instruments exist for the evaluation of IADLs. These include but are not limited to, Lawton and Brody IADL, Health and Retirement Study Care Questionnaire, and Pfeffer Functional Activities Questionnaire. Each instrument includes its definition of IADL disability. Therefore, in analyzing cognitive impairment, the results differ depending on which instrument the evaluator used. One significant limitation of all these instruments is that they are often self-reported. People are biased toward their abilities to perform specific tasks, and thus, they may either overestimate or underestimate their abilities. Another major issue arises when examiners use IADL instruments to detect the probability of dementia in mildly cognitively impaired (MCI) individuals. Studies have shown that there is no difference in performing certain IADLs between MCI individuals with dementia and MCI individuals without dementia, which may be because current instruments are not sensitive to subtle changes. For example, an individual may have no driving issues but trouble adhering to traffic laws. On the Lawton and Brody IADL questionnaire, this individual would receive full points in evaluating the mode of transportation. Although IADL instruments are widely helpful, they may require some refinements.[2][3][4][5]
Clinical Significance
Despite some limitations, the assessment of IADLs remains useful in determining an individual's cognitive function. Individuals with MCI who have impairments performing IADLs are more likely to develop dementia. The ability to perform IADLs is the first to decline in individuals with Alzheimer disease, while the ability to perform basic activities remains unimpaired. This finding can be helpful to healthcare professionals in detecting early-onset Alzheimer and dementia. In most hospitals, the interdisciplinary approach to healthcare has become a popular concept. Physicians, nurses, occupational therapists, and physical therapists share knowledge and patient care skills in rehab facilities. As stated before, occupational therapists generally assess ADLs and IADLs. Reports from occupational therapists can help analyze the functional and mental status of the patient. Studies have shown physical disability is a strong risk factor for cognitive decline. Thus, physicians and occupational therapists must work closely together to minimize the risk of physical disability and limit cognitive decline. Understanding the importance of assessing ADLs and IADLs is crucial, as it can be a useful screening tool for dementia in the elderly population.[6][7][8][9][10]
Nursing, Allied Health, and Interprofessional Team Interventions
Nursing staff and other home health aides can assist patients with IADLs, including cooking, cleaning, laundry, and managing finances. These services can be provided in various facility arrangements, from nursing homes to home care.
References
Edemekong PF, Bomgaars DL, Sukumaran S, Schoo C. Activities of Daily Living. StatPearls. 2024 Jan:(): [PubMed PMID: 29261878]
Hopkins RO, Suchyta MR, Kamdar BB, Darowski E, Jackson JC, Needham DM. Instrumental Activities of Daily Living after Critical Illness: A Systematic Review. Annals of the American Thoracic Society. 2017 Aug:14(8):1332-1343. doi: 10.1513/AnnalsATS.201701-059SR. Epub [PubMed PMID: 28463657]
Level 1 (high-level) evidenceNygård L. Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment? Acta neurologica Scandinavica. Supplementum. 2003:179():42-6 [PubMed PMID: 12603250]
Ciro CA, Anderson MP, Hershey LA, Prodan CI, Holm MB. Instrumental activities of daily living performance and role satisfaction in people with and without mild cognitive impairment: a pilot project. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2015 May-Jun:69(3):6903270020p1-10. doi: 10.5014/ajot.2014.015198. Epub [PubMed PMID: 25871600]
Level 3 (low-level) evidenceGold DA. An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment. Journal of clinical and experimental neuropsychology. 2012:34(1):11-34. doi: 10.1080/13803395.2011.614598. Epub 2011 Nov 4 [PubMed PMID: 22053873]
Hall JR, Vo HT, Johnson LA, Barber RC, O'Bryant SE. The Link between Cognitive Measures and ADLs and IADL Functioning in Mild Alzheimer's: What Has Gender Got to Do with It? International journal of Alzheimer's disease. 2011:2011():276734. doi: 10.4061/2011/276734. Epub 2011 May 25 [PubMed PMID: 21660245]
Ahn IS, Kim JH, Kim S, Chung JW, Kim H, Kang HS, Kim DK. Impairment of instrumental activities of daily living in patients with mild cognitive impairment. Psychiatry investigation. 2009 Sep:6(3):180-4. doi: 10.4306/pi.2009.6.3.180. Epub 2009 Aug 3 [PubMed PMID: 20046393]
Farias ST, Mungas D, Reed BR, Harvey D, Cahn-Weiner D, Decarli C. MCI is associated with deficits in everyday functioning. Alzheimer disease and associated disorders. 2006 Oct-Dec:20(4):217-23 [PubMed PMID: 17132965]
Rajan KB, Hebert LE, Scherr PA, Mendes de Leon CF, Evans DA. Disability in basic and instrumental activities of daily living is associated with faster rate of decline in cognitive function of older adults. The journals of gerontology. Series A, Biological sciences and medical sciences. 2013 May:68(5):624-30. doi: 10.1093/gerona/gls208. Epub 2012 Oct 25 [PubMed PMID: 23105042]
Barberger-Gateau P, Dartigues JF, Letenneur L. Four Instrumental Activities of Daily Living Score as a predictor of one-year incident dementia. Age and ageing. 1993 Nov:22(6):457-63 [PubMed PMID: 8310892]
Level 2 (mid-level) evidence