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Activities of daily living are basic routine tasks that most healthy individuals can perform without assistance. These activities include personal care tasks such as eating, dressing, bathing, toileting, managing continence, and transferring (moving from 1 position to another). The ability to perform activities of daily living is an essential measure of an individual's functional status. The inability to perform basic activities of daily living may lead to unsafe conditions and a poor quality of life. The healthcare team should be aware of the importance of assessing activities of daily living in patients to help identify those who require assistance, whether for temporary rehabilitation or long-term care planning. This activity is designed to enhance the healthcare team's understanding of activities of daily living and their critical role in patient care. Methods for assessing functional status, identifying barriers to independence, and developing care plans that promote patient safety, autonomy, and quality of life are addressed. Participants gain knowledge to better recognize when patients need support and collaborate effectively across disciplines to address identified needs. The interprofessional team is better equipped to integrate activities of daily living assessments into routine care, improve patient outcomes, and coordinate the delivery of appropriate interventions and resources. Objectives: Differentiate between basic activities of daily living and instrumental activities of daily living to guide appropriate care planning. Identify risk factors that may contribute to a patient's decline in the ability to perform activities of daily living. Implement evidence-based tools to assess basic and instrumental activities of daily living. Collaborate with interprofessional team members to develop strategies for assessing patients with limitations in activities of daily living. Access free multiple choice questions on this topic.

Activities of daily living (ADLs) refer to the basic skills necessary for individuals to independently care for themselves, such as eating, bathing, and mobility. The term was first coined by Sidney Katz in 1950.[1][2] ADLs is used as an indicator of a person's functional status. The inability to perform ADLs leads to a patient's dependence on others or assistive devices, significantly increasing their risk of adverse health outcomes. The inability to perform essential ADLs may lead to unsafe living conditions and a poor quality of life. Assessing an individual's ability to perform ADLs is crucial, as these are predictors of admission to nursing homes, the need for alternative living arrangements, hospitalization, and paid home care. The outcome of a treatment program can also be assessed by reviewing a patient's ADLs.[3][4][5][6] Nurses are often the first members of the interprofessional team to recognize a decline in a patient's functional status during hospitalization; therefore, routine screening of ADLs is essential, and nursing assessments of ADLs should be conducted for all hospitalized patients. Hospitalization for an acute or chronic illness can impact a person's ability to achieve personal goals and maintain independent living. Chronic diseases progress over time, resulting in a physical decline that may lead to a loss of ability to perform ADLs. In 2011, the United States National Health Interview Survey found that 20.7% of adults aged 85 or older, 7% of those aged 75 to 84, and 3.4% of those aged 65 to 74 required assistance with ADLs.[7][8]

Although many healthcare professionals can assess ADLs, clinicians, advanced practice providers, nurses, occupational therapists, and physical therapists are most commonly involved in these evaluations. Effective communication among team members is critical for safe discharge planning and ongoing care support. Patients who are unable to perform ADLs may require rehabilitation services or in-home assistance. Impairments such as difficulty dressing or toileting can lead to poor hygiene and a reduced quality of life. Difficulty ambulating or transferring increases the risk of falls and social isolation, potentially leading to further complications. An inability to eat independently can result in malnutrition, dehydration, and further decline. Referrals to occupational therapists, physical therapists, and dietitians should be made as appropriate. Routine assessment of functionality should be standard practice for patients of all ages. An interprofessional team that communicates and collaborates effectively ensures optimal patient evaluation, discharge planning, and follow-up care. Nursing staff should promptly report ADL concerns to the medical team, and the broader clinical team should coordinate with home health and social work services to provide necessary support. Home health nursing staff must monitor for any deterioration in ADLs and communicate changes to the clinical team. Accurate ADL assessment is crucial for ensuring patient safety, effective care planning, qualification for paid services, and efficient healthcare cost management.[5][29]

The implications and significance of changes in a patient's ADLs vary among the different stakeholders involved in the patient’s care, including the following: Case managers, nurses, and social workers Primary care clinicians Home health or skilled nursing agencies Physical and occupational therapists Long-term care insurance providers Government agencies Nurses and care managers assess and collect information on a person's ability to perform ADLs. The data enable them to plan for each individual's continuum of care. Clinicians use these assessments to formulate and develop a care plan, which is then provided to the home health agency or skilled nursing agencies. These agencies then select the appropriate staff needed for each client. Physical and occupational therapists work according to the care plan and document the patient's progress in ADLs to ensure that rehabilitation goals are achieved to the greatest possible extent. Insurance providers and government agencies use ADL assessments to determine the patient's qualifications and pay for the services rendered.[5][30]

Nurses and occupational therapists assess basic and instrumental ADLs daily in all hospitalized patients. Accurate assessment, planning, intervention, and evaluation of ADLs can be the deciding factor between a patient maintaining independence or requiring daily assistance. Although various tools are available for use during daily shift assessments, nurses should be aware of each patient's specific needs for assistance with ADLs. When a patient is at risk for a change in ADLs, nurses should assist the patient and report to interprofessional team members to establish a new care plan. Possible nursing diagnoses recognized by the North American Nursing Diagnosis Association International include altered health maintenance, defined as a state in which an individual lacks sufficient physiological or psychological energy to resist or complete required or desired daily activities. Other possible nursing diagnoses include risk of injury, activity intolerance, social isolation, or ineffective family coping.