Instrumental Activities of Daily Living (IADLs)

Instrumental Activities of Daily Living, or IADLs, are tasks that a person must complete to live independently in the community.

Some of the more common IADL tasks include:
• Meal preparation – includes tasks involved in preparing both cold and hot foods.
• Household cleaning – includes sweeping, vacuuming, dusting, washing dishes, cleaning bathrooms, etc.
• Yard work – includes mowing grass, raking leaves, pruning shrubs, and other tasks.
• Clothing care/Laundry – includes washing, drying, folding and putting away clothing.
• Time management – includes telling time, reading a calendar, following a schedule and making appointments.
• Using communication devices – includes using a landline phone, cellphone, computer, intercom, and medical alert device.
• Money management – includes counting and using money, managing bank accounts, and following a budget.
• Community mobility – includes arranging for transportation, using public transportation, and locating various places in the community.
• Shopping – includes identifying which stores sell specific goods, making shopping lists, and planning routes for shopping trips.
• Managing medications – includes taking medications as prescribed, learning which medications treat which conditions, learning about possible side effects, and discussing medications with health care providers.

This is not an inclusive list, but includes many of the tasks that occupational therapists encounter when providing treatment to patients.

Evaluation of IADL Skills
IADL skills are usually evaluated through observation and checklist style assessments. Some standardized tests are also used. The following chart reviews some formal assessments for IADL skills.

The following videos discuss and demonstrate the administration of IADL evaluations:

Graded Treatment of IADL Skills

IADL training is usually introduced after the patient has made progress in ADL training and shows potential to be able to live independently. Occupational therapy treatment for IADLs is provided in both rehabilitation settings where patients are working to regain the ability to complete IADL tasks, and in school or transitional settings where teenagers and young adults are learning how to complete IADL tasks for the first time.

Treatment of IADL skills is usually completed using a top-down approach, where the patient’s ability to participate in the functional task is used as the basis for grading activities. If a patient’s ability is low, training in the tasks will start with basic tasks. If a patient’s ability is higher, tasks will be introduced that are more complex. As patients gain the skills necessary to complete basic tasks, more complex tasks are introduced in a graded sequence.

The following chart will give examples of how to grade IADL activities that build skills sequentially from basic to more advanced. The chart is organized with 5 sequential activities for each task, with level 1 being the most basic and level 5 being the most advanced. The tasks are graded according to the level of cognitive and perceptual function required as well as physical ability.

The tasks presented are examples and are not the only tasks involved in the area listed.

IADL Videos
The following videos demonstrate task analysis and/or demonstration of IADL tasks.

References
 * Fisher, A. G. (2006a). Assessment of Motor and Process Skills: Vol. 1. Development, standardization, and administration manual (6th ed.). Fort Collins, CO: Three Star Press.
* Lawton, M.P., and Brody, E.M. “Assessment of older people: Self-maintaining and instrumental activities of daily living.” Gerontologist 9:179-186, (1969).
* Kohlman, L.K. (1992). Kohlman Evaluation of Living Skills. Maryland: The American Occupational Therapy Association, Inc.