In this blog series, we examine the differences between activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and what happens when they become difficult for a person.
In part one of our blog series “ADLs vs. IADLs,” we defined activities of daily living (ADLs) as the essential self-care tasks—such as bathing and dressing—that a person must manage to live independently. In part two we explored options when ADLs become challenging. It is equally important to understand the distinction between ADLs and instrumental activities of daily living (IADLs).
What are IADLs exactly?
Instrumental activities of daily living (IADLs) are the everyday, often more complex tasks that enable a person to live independently within the community. Examples include:
- Managing money and paying bills
- Grocery shopping
- Preparing meals
- Using transportation or driving
- Managing medications and healthcare appointments
- Using a phone or other technology
- Keeping the home reasonably clean and safe
Clinicians such as occupational therapists and geriatric specialists use IADLs to assess how well someone can handle the cognitive and physical demands of daily life. These tasks help determine whether a person can remain safe, healthy, and self-sufficient in their own home and community.
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The difference between ADLs and IADLs
Although the terms are sometimes used interchangeably, ADLs and IADLs refer to different levels of function. ADLs are the basic personal care tasks—bathing, dressing, toileting, transferring, eating, and basic mobility—required for safe day-to-day living. IADLs are the more complex tasks needed to manage a household and remain independent in the community, like shopping, paying bills, and organizing medications.
It is common for IADL abilities to decline before ADL abilities. Difficulty with IADLs can therefore be an early indication that additional help or care services may soon be necessary.
How IADLs affect safe, independent living
Managing IADLs effectively is often the difference between merely living alone and truly living independently. A person may be able to dress and feed themselves yet struggle to stay independent if they cannot shop for groceries, manage prescriptions, or access transportation to maintain health and social connections.
Population studies show IADL limitations are common and are closely linked with chronic health issues and cognitive decline. These limitations increase the risk of adverse outcomes, including more emergency visits and unplanned moves to higher levels of care such as assisted living. Consequences can include missed medications, poor nutrition, financial difficulties from unpaid bills, and social isolation from mobility challenges.
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Early signs that IADLs are becoming a problem
Healthcare professionals—occupational therapists, nurses, and geriatricians—are trained to assess cognitive and physical function to determine when IADLs are becoming difficult and whether care services or a higher level of support is needed. Family members and caregivers can also watch for common warning signs, including:
- Unpaid bills, missing payments, or confusion managing finances
- Missed doses, incorrect medications, or difficulty understanding dosing instructions
- Skipped grocery trips, heavy reliance on processed food, or unintended weight loss or gain
- Avoiding driving, missing appointments, or trouble arranging transportation
- Neglected home upkeep and safety issues, such as piles of unopened mail or spoiled food
- Difficulty using a phone or managing appointments, which can lead to social isolation or missed healthcare
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Confronting IADL red flags head-on
Occasional lapses—like forgetting a medication once or missing a bill payment—are common with aging. However, when problems with IADLs become frequent, they are more than inconveniences: they are measurable signs that additional support may be needed. Recognizing these signs early allows families and care teams to plan appropriate interventions, whether that means help at home, community services, or considering a move to a supportive living environment.
In next week’s blog post, the fourth and final installment of our “ADLs vs. IADLs” series, we will review common options when IADLs become difficult and offer practical steps to assess and address long-term IADL needs.