Activities of Daily Living

Obtain a structured ADL and IADL baseline in older adults with a fall, recent hospitalization, stroke, suspected cognitive disorder, new caregiver dependence, mobility decline, or before a high-stakes intervention. Functional disability is associated with mortality and long-term-care admission, including among patients with multimorbidity. jaccjaccComprehensive Geriatric Assessment to Optimize the Management of Older Patients With Transthyretin Cardiac Amyloidosis

Do not label all dependency as frailty. Disability denotes difficulty or dependency in ADL or IADL and may be an outcome of frailty, but it may also result from a discrete event such as injury; this distinction matters when estimating procedural risk or targeting reversible contributors. jaccjaccFrailty Assessment in the Cardiovascular Care of Older Adults

In cardiovascular procedural evaluation, document baseline function rather than relying on age alone. For adults considered for transcatheter aortic valve replacement, functional status contributes to risk stratification, and comprehensive geriatric assessment extends the evaluation to sensory deficits, multimorbidity, polypharmacy, nutrition, falls, cognition, mood, and social circumstances. jaccjaccTAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series

For community-dwelling adults, structured assessment with modified Katz ADL is recommended in falls evaluation; the same guideline identifies the Nottingham Extended Activities of Daily Living scale or Barthel Index as options for structured assessment of functional ability, particularly personal care and care-home populations. Oxford AcademicOxford AcademicWorld guidelines for falls prevention and management for older adults Document the instrument, respondent, task-level dependence, and whether assistance is due to capacity, environmental access, or an established household role.

Assess IADL even when basic ADL are intact. IADL includes activities required to function outside the home and maintain independent living, such as transportation, telephone use, finances, medication management, housekeeping, shopping, and meal preparation. jaccjaccComprehensive Geriatric Assessment to Optimize the Management of Older Patients With Transthyretin Cardiac Amyloidosis A normal basic ADL screen should not end the evaluation when there are missed doses, unpaid bills, unsafe cooking, inability to obtain food, or loss of driving or transit independence.

Use direct task questions rather than a global question about independence. New difficulty managing money can result from impaired cognition, poor vision, transportation barriers, or hand arthritis; each mechanism directs a different next action. ScienceDirectScienceDirectLawton Instrumental Activities of Daily Living Scale - an overview | ScienceDirect Topics For example, a medication-management deficit warrants reconciliation of actual bottles and administration process, whereas a finance-management deficit warrants assessment for errors, exploitation risk, and the need for a reliable designated helper.

When IADL decline is disproportionate to basic ADL decline, prioritize cognitive, executive, visual, and access barriers. Screen cognition with a clock-drawing test, Montreal Cognitive Assessment, or Trail Making Test Part B; executive-function testing is specifically relevant because medication management, finances, planning, and community navigation require more than basic self-care capacity. Escalate to formal neuropsychological assessment when screening and collateral history leave clinically consequential uncertainty. Oxford AcademicOxford AcademicWorld guidelines for falls prevention and management for older adults

When transfers, toileting, dressing, or bathing are impaired, define whether the proximate limitation is mobility, balance, weakness, coordination, sensory loss, visual-perceptual dysfunction, pain, or cognition. In patients after stroke, occupational therapy assessment should examine motor function, sensation, coordination, visual perception, and cognition in relation to actual daily tasks. Wolters KluwerWolters KluwerRole of occupational therapy after stroke : Annals of Indian Academy of Neurology

When disability coexists with falls or fear of falling, use the functional assessment as part of a multifactorial falls evaluation. The falls guideline recommends structured ADL/IADL assessment, cognitive screening, and evaluation of fall-risk-increasing drugs; age, prior falls, and need for ADL assistance were common fall-risk factors in a cohort of older inpatients. Nature+1NaturePsychotropic medication and in-hospital falls in older adults: a cohort-based secondary analysis with exploratory stratification among users | Scientific ReportsOxford AcademicWorld guidelines for falls prevention and management for older adults

Distinguish a recent decline after stroke from stable chronic dependence because it changes rehabilitation urgency and goals. Once medically stable, begin coordinated multidisciplinary rehabilitation; occupational therapy directed at personal ADL uses individualized, graded task practice, task adaptation, assistive technology, environmental modification, and patient-caregiver education. AHA Journals+1AHA JournalsOccupational Therapy for Adults With Problems in Activities of Daily ...Wolters KluwerRole of occupational therapy after stroke : Annals of Indian Academy of Neurology

A positive ADL or IADL screen should generate explicit orders and ownership, not only a notation of “needs assistance.” For post-stroke disability, occupational therapy interventions include assessment, treatment, adaptive techniques, assistive technology, and environmental modification; therapy focused on personal ADL has been associated with greater independence than no occupational therapy. AHA Journals+1AHA JournalsOccupational Therapy for Adults With Problems in Activities of Daily ...Wolters KluwerRole of occupational therapy after stroke : Annals of Indian Academy of Neurology

Set goals in observable task terms: transfer safely to the toilet, organize and take medications with a defined support system, prepare a simple meal using adaptive methods, or complete a bathing routine with specified equipment and supervision. Occupational therapy after stroke uses individualized, graded tasks to retrain motor, sensory, visual, perceptual, and cognitive skills in the context of functional activity while educating caregivers. Wolters KluwerWolters KluwerRole of occupational therapy after stroke : Annals of Indian Academy of Neurology

Include caregivers in the plan when a patient needs cueing, supervision, or physical help. Functional assessment should distinguish the patient’s own capacity from the help currently provided, because unnecessary assistance can overestimate dependency and may obscure potentially remediable ability. ScienceDirectScienceDirectOverestimated functional dependency in older patients: Can we blame gender difference, unneeded assistance or assessment tools? - ScienceDirect Reassess task-level status after the planned rehabilitation interval, transition of care, or change in health status with the same scale and collateral informant when possible.

Use function as a longitudinal outcome, not only a baseline descriptor. In older adults undergoing TAVR, baseline and 1-year trajectories have been characterized using a composite of unassisted ADL, IADL, and higher-function tasks; therefore, preprocedure counseling should address expected functional recovery as well as survival and technical procedural risk. jaccjaccTAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series

Disability is associated with increased mortality and long-term-care admission, and functional status is a central element of comprehensive geriatric assessment. jaccjaccComprehensive Geriatric Assessment to Optimize the Management of Older Patients With Transthyretin Cardiac Amyloidosis In cardiovascular care, frailty has demonstrated prognostic value with risk ratios often exceeding 2, but disability and frailty are overlapping yet distinct constructs; document both rather than substituting an ADL score for frailty assessment. jaccjaccFrailty Assessment in the Cardiovascular Care of Older Adults

Escalate to a comprehensive geriatric assessment when multiple domains are abnormal, when the trajectory is unclear, or when a major intervention may have limited functional benefit. A multidomain evaluation includes physical health, vision, hearing, multimorbidity, polypharmacy, nutrition, balance and falls; functional status; cognition and mood; and social context. jaccjaccTAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series

For a patient being considered for TAVR, severe comorbidity, physical disability, slow gait, advanced dementia, poor rehabilitation candidacy, limited life expectancy, and high surgical risk may influence discussions of expected benefit; cited futility considerations are based on expert opinion rather than primary outcomes research. jaccjaccTAVR in Older Adults: Moving Toward a Comprehensive Geriatric Assessment and Away From Chronological Age: JACC Family Series Use this information for shared decision-making and goal-concordant planning, not as an automatic exclusion rule.