What’s the Difference Between ADLs and IADLs? An OT Perspective

Anyone who is exposed to occupational therapy for any amount of time will become familiar with the similar sounding phrases “ADLs” and “IADLs.” What do these terms mean? Why are they so important to occupational therapy? What is the difference between ADLs and IADLs?

To understand the answer to all of these questions, first we need to understand what “occupations” occupational therapy addresses with patients and clients.

We will be covering these aspects from the lens of a practicing occupational therapist and certified occupational therapy assistant, so you’ll get the answer from actual experts that work with these domains. This article will be helpful for you whether you are an OT student, a prospective OT or COTA, or a patient, family member or anyone in between who is looking for the differences between ADLs and IADLs. 

First, What is an Occupation?

Many times, when someone first encounters occupational therapy, they assume that the occupation in question is their job. However, in therapy terms, and occupation is anything that occupies your time, or tasks that need to be done.

For example, some of our time is spent each day getting dressed, washing up, eating, and more. For some of us, this also includes activities like work or school, cooking, cleaning, and driving. Some days we are able to engage in social activities, volunteer work, and playing games or sports.

Occupational therapy can help us overcome obstacles in any of these areas. However, these occupations fall into broader categories called Areas of Occupation. Two of these groups are ADLs (Activities of Daily Living, also called Basic Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living).

What are ADLs?

ADLs, or basic ADLs, are the most fundamental occupations in everyone’s life. Each of us must participate in these tasks regularly, no matter where we are in life or how much we are able to complete ourselves.

ADLs include things like:

• Dressing
• Grooming
• Bathing
• Eating
• Feeding
• Toileting

These self care tasks are the tasks that must be completed to get us ready to face the world.

When talking about ADL completion, it is also important to look at levels of independence/levels of assist. In occupational therapy, all tasks and assessments must be objectively measured. It would not be enough to simply say “he dresses himself with some help but needs a lot of help to take a shower.” Instead, we look at the percentage of the task that can be completed independently.

Occupational therapists are the experts at breaking down activities into their smaller parts. For example, in order to use the bathroom, there are three steps: removing clothing, personal hygiene, and putting clothes back on. Because it is broken down into three parts, we are able to accurately say that someone who needs help with only one of those tasks needs 66% assistance with using the toilet. From there, we can come up with strategies to help this person increase their independence in their toileting skills and any other ADL tasks that they have difficulty with. 

What are IADLs?

Instrumental activities of daily living (IADLs) on the other hand, are not quite as fundamental. These are tasks that some of us complete, but not everyone. For example, some of us manage finances, medications, preparing meals, taking care of others, or taking care of pets.

Generally, these tasks extend further than ourselves and involve outside forces or other parties. Many of these tasks are more commonly accepted to be outsourced to others. For example, having a cleaning service or meal delivery service can help manager difficulties in those areas.

Because these activities depend on our personal circumstances, this is where occupational therapy becomes more specialized and individualized. Beyond breaking down the smaller steps within each activity, occupational therapists are also trained in identifying obstacles and developing plans to overcome them.

For example, if someone is unable to take care of their pet because they can’t bend down to feed them, an OT might recommend adaptive equipment to make the task itself more manageable. However, those that don’t own pets don’t need to worry about overcoming this particular obstacle.

The Difference Between ADLs and IADLs

Both ADLs and IADLs are critical areas of treatment within occupational therapy. When developing a treatment plan to help meet a patient’s needs, ADLs and appropriate IADLs need to be taken into consideration. However, the way these two areas of occupation are incorporated into a treatment plan will largely depend on the patient.

As mentioned above, ADLs are the most fundamental and essential activities. These are generally considered the skills needed to live independently. As such, someone who needs help with ADLs will most likely be focusing on addressing these basics first. As their treatment develops, they are able to focus on other occupations, including IADLs.

When Does an OT Address ADLs?

Almost always! As an OT, I’ve always said that addressing impairments with ADLs and self-care is such a critical focus as occupational therapy practitioners. So when do we see the need to do this?

AOTA states that OT practitioners address ADLs “when a client has difficulty performing essential daily tasks [ADLs/IADLs] needed for independence and self-care.” This can be due to a myriad of situations and conditions including, but not limited to:  

• Post-injury or surgery
• Acute illness
• Chronic conditions
• Age-related decline
• Developmental conditions
• Acute or chronic neurological conditions

When seeing patients with anything newly impacting their ability to complete their ADLs and self-care, we are able to pinpoint what is causing the difficulty and then address it with the appropriate occupational therapy interventions, no matter what setting we are seeing the person in. 

An Example of Addressing ADLs with a Client

Picture a man named Bill. Bill lives alone with his cat and takes care of his yard himself. One day, Bill has a fall and breaks his hip. Following hip surgery, he will need therapy to help him return to his way of living. Most likely, he will need help with dressing himself, primarily his pants and shoes. He will also need help with bathing himself and moving around safely.

Before he even leaves the hospital, Bill’s OT will help him work on these ADLs to return home safely. Depending on how severe his injuries are, he may even enter a short term rehab facility to get more therapy. Since more time has passed and Bill has made more progress, in this short term rehab facility he will hopefully become independent with some, if not all, of his ADLs.

At this point, OT will begin to work on IADLs. As a pet owner, Bill will need to practice feeding and cleaning up after his cat, working in his yard, cooking, and cleaning the house. Most likely, he will be discharged from this rehab facility before mastering these tasks. Once he arrives home, he will likely be linked up with a home health occupational therapist to ensure he is safe at home. Here he will spend some time reviewing ADLs in his home environment, then practice his higher level IADLs. Any outside services to help him, such as a yard maintenance service or grocery delivery, can also be set up to help him.

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As we can see, ADLs and IADLs are both essential to all of our daily lives. Occupational therapists and occupational therapy assistants both play a crucial role in helping people achieve greater independence in their ADLs and IADLs.

Whether we are working with people recovering from illness or injury, managing chronic conditions, or going through developmental challenges, we can provide people with the tools and education to help those with ADL difficulty thrive.

If you are a patient or caregiver with any questions about how OTs can help with ADLs, let us know in the comments below! If you are an OT practitioner with any other thoughts, please also let us know. 

This post was cowritten by Michel Moniger, COTA/L and Sarah Stromsdorfer, OTR/L.