Activities of Daily Living: Tips for the Caregiver
Activities of daily living (ADLs) are the everyday activities
involved in personal care such as feeding, dressing, bathing,
moving from a bed to a chair (also called transferring), toileting
and walking. Physical or mental disabilities can restrict a person's
ability to perform personal ADLs. It is extremely difficult to
depend on another person to perform these basic tasks. It can
also be difficult for the new caregiver to undertake these tasks
for a loved one. When a friend or family member becomes disabled,
the inclination of the caregiver is to over-care.
Caregivers will almost always benefit from learning:
- The significance of ADLs in the in the world of caregiving,
- What type of ADL care is needed in a specific caregiving
- How to perform ADL care appropriately to meet the unique
needs of your loved one.
Significance of ADLs
Activities of daily living is a commonly used term in the health
care and professional caregiving world to describe a person's
ability to care for him or herself. Often the ability or inability
to perform specific ADLs is used as qualifying criteria for special
services or programs. For example, services that measure ADLs
as a part or all of their eligibility criteria include:
- Adult Day Services
- Assisted Living
- Home Health Services
- The Virginia Caregiver Grant Program
- Nursing Homes, and
As a caregiver you should ask the health care professionals
in your life to tell you how they use ADLs to determine eligibility
for services or to make a plan of care.
Types of Care
In evaluating an individual, a plan of care must be developed
that allows for meeting both the physical and psychosocial needs
of the care recipient. There are two types of goals associated
with a plan of care: rehabilitative and habilitative.
If the inability to provide self-care is the result of a health
crisis such as a stroke, the care recipient may be totally dependent
and require assistance with all ADLs. However, this dependence
may be temporary and there may be an excellent prognosis for
full or partial recovery. In such cases, the plan of care is
rehabilitative with the goal of restoring independence.
Some diseases, such as dementia of the Alzheimer's type, cause
a gradual loss of the ability to provide self-care. The plan
of care in such cases is then habilitative with the goal of helping
the person to function at their highest level.
Caregiver Tips for ADL Care
Evaluate the severity of the condition and develop a plan.
It is difficult to predict the long-term effects of an event
such as a stroke or of Alzheimer's disease. The first decision
to be made is: Who is the caregiver? Families may be unable to
provide the needed care. With the guidance of the health care
professionals families must answer this question. Next, they
must be educated about what care is needed and how to provide
it. Families need this information even if they will not be the
direct caregiver, as they will be the most important partner
of the health care professional.
- Help only when help is necessary. This often presents
the greatest challenge. We all have been conditioned to see
people who are unable to care for themselves as sick. We confine
them to bed and do for them what they can in fact do for themselves.
While acceptable in early life, this type of care can be the
death knell for an older person. Even short periods of confinement
can result in serious muscle loss and weakness.
- Break big tasks into small tasks. If the plan
is rehabilitative, as with a stroke, the care recipient may
be overwhelmed by the inability to perform simple tasks. Depression,
fear and humiliation are major obstacles. If tasks are too
complex, the care recipient may feel frustrated and defeated.
If the care is habilitative, as with dementia, the care recipient
may have permanently lost the ability to complete complicated
tasks. Presenting the care recipient with such tasks can result
in angry, even violent outburst that can result in injury to
- Encourage movement and exercises. This is essential
in rehabilitative and habilitative care. Mobility increases
independence and decreases complications due to inactivity.
Exercises that put the major muscle groups through the full
range of motion (ROM) must be encouraged. If the care recipient
is unable to do ROM exercises independently, then these must
be done passively. This means that the caregiver moves the
affected limb through the ROM. It is important to remember
that even the smallest efforts, if done consistently, will
lead to greater independence. Complication of immobility include
muscle wasting, pneumonia, constipation, edema (swelling),
pressure ulcers, urinary problems, osteoporosis, and blood
- Provide training as needed. Regaining lost abilities
or learning new ways of doing things is never easy. Caregivers
must first learn what to do and how to do it. Then they must
teach their care recipient. It may be easier and quicker for
the caregiver to perform the task, but this temptation must
be resisted. Over caring for someone can result in severe,
even permanent physical and psychological harm. Even though
someone may not be able to bathe their own body completely
- a wash cloth and encouragement can go a long way to maintaining
dignity and some sense of control. Being able to accomplish
bathing his or her own face can be a major triumph for a person
recovering from a stroke.
- Encourage the use of assistive devices.
Mobility aids include wheelchairs, canes and crutches and walkers.
Sensory assistive devices include: vision aids, hearing aids
and dentures. Other assistive devices include everything from
uniquely designed eating utensils, to special devices that
facilitate enjoyment of hobbies such as reading, playing music,
and gardening. These
devices encourage independence. Physical Therapists and
Occupational Therapists are specially trained health professionals
who can teach care recipients and caregivers about these devices
and how to use them correctly.
- Recognize the need for dignity. Care must be provided
in a manner that preserves dignity. The humiliation of losing
the ability to self-toilet can be worsened by insensitive care.
Closing doors, avoiding excessive exposure, allowing choice
and participation in care is essential. Frequent clothing changes
for people who are incontinent is critical. Daily shaves, frequent
manicures, and regular visits to the hairdresser can also contribute
to the care recipient's sense of well being. Encouraging independence
is important, as is knowing how to intervene when the care
recipient's attempts at self-care are inadequate.
- Recognize changes in skin condition. The skin
is the largest organ of the human body and the condition of
the skin is a barometer of health. Dry skin is a normal part
of aging. Keeping the skin clean (using oil-based cleansers)
and well lubricated is especially important for the care recipient
who has lost mobility. Caregivers must assist the care recipient
with frequent position changes is the care recipient is unable
to do so independently. Skin should be examined regularly for
signs of pressure, especially on the bony parts of the body.
If pressure is not relieved, bedsores (pressure ulcers) can
form. If left untreated these ulcers can penetrate through
the skin, into the muscle and bone. Pressure ulcers are extremely
painful and often require surgical repair.
- Monitor nutrition closely. Eating a well-balanced
diet is especially important for people who are very ill. Two
common, serious hindrances to good nutrition are difficulty
swallowing and problems with chewing. Food may need to be pureed
and liquids thickened to facilitate swallowing and to prevent
choking. Care recipients wit dementia may have a greater caloric
need. Serving six small meals is often preferable to the traditional
three meals per day. Also, speak with your health care professional
about the benefits of a nutritional supplement.
- Provide for psychosocial needs. Care recipients
who are ill or disabled have an increased need for acceptance
from family, friends and care providers. Entertainment and
social interaction are essential to all of us; especially if
we are recovering from an illness or living with a deteriorating
health condition. Caregivers should observe closely for signs
of withdrawal and isolation. Care recipients with dementia
often benefit from activities such as music and reminiscence
therapy. Reminiscence therapy is remembering the past by looking
at pictures or talking about different events.
Author: Christine Stacy, BS, RN, Adult Care Education Consultants
Last Updated: Tuesday, May 22, 2001
Copyright © 2001 Senior
Last Reviewed By: Christine Stacy, BS, RN, Adult Care Education
Last Reviewed: Thursday, March 14, 2002
Reprinted with permission from SeniorNavigator.com