Tracking ADLs and IADLs helps caregivers adapt

Sep 03, 2025 12:57PM ● By Laird Landon, PhD

For anyone caring for a loved one with a chronic or disabling condition, the demands increase over time. Beyond the emotional load, caregivers are often worn out by the daily tasks their loved one can no longer manage.

A key measure of this support is activities of daily living (ADLs) and their companion tasks, instrumental activities of daily living (IADLs). These are widely used by nurses, assisted living facilities and memory care units to determine how much care is needed. They also help family caregivers anticipate and adjust to their loved one’s changing needs.

ADLs include the basic self-care skills most people master by age 10: walking, eating, dressing, toileting, bathing and transferring (moving from bed to chair, for example).

IADLs are more complex life skills, typically learned by age 20, that support independence: managing finances and transportation, shopping and meal preparation, housecleaning, home maintenance, communicating and managing medications.

For those with neurocognitive disorders, IADLs often decline first. Mismanaging money, forgetting recipes or getting lost are common early warning signs. As the saying goes, these are the skills “learned last and forgotten first.” ADLs, in contrast, are “learned first and forgotten last.”

In the early stages, taking over IADLs may not be too burdensome, especially if a caregiver is already familiar with the tasks. However, couples often divide responsibilities, which can make the transition more difficult.

When my wife Marilyn could no longer handle our accounting and taxes—a task I’d always avoided—it was a very painful adjustment.

The middle stage is when caregiver burden greatly increases. Loss of ADLs such as walking, dressing and bathing marks this stage, and these tasks are physically and emotionally demanding.

Tracking ADLs and IADLs is often more important than knowing the exact diagnosis, since people with the same disease can lose function in different ways. As the Alzheimer’s Association notes, “When you’ve met one person with Alzheimer’s, you’ve met one person with Alzheimer’s.”

Geriatrician David Dosa, MD, puts it this way in his book “Making Rounds with Oscar,” the story of a nursing home cat with an uncanny gift for sensing when residents are in their final hours.

“Doctors often make the mistake of pursuing diagnosis. I’m here to tell you the name of the disease doesn’t matter. What patients care about is whether it will change the way they live—will they be able to walk, care for themselves or their loved ones, or will it hurt?”

For caregivers, understanding and monitoring ADLs and IADLs is essential to planning, adjusting and sustaining care over time.

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