Instrumental activities of daily living (IADL) are types of activities that someone can do for another person without involving contact, such as grocery shopping, finances, and cooking, while ADL are activities that involve all activities
in personal self-care. If assistance is required with ADL, it will be hands-on assistance such as toileting, bathing, and dressing. Table 3 provides tips for how to manage ADL and IADL in the context of the Reisberg Alzheimer’s Scale.
Table 3. Management of ADL/IADL Through the Reisberg Stages AD Stage ADL/IADL
Caregiver Supportive Activities
Early
Dressing
• Encourage choice • Give autonomy to actively participate in dressing
Personal hygiene
• Provide comb and brush along with encouragement to groom themselves • Aid with shaving, if needed
Bathing and toileting • Assist with bathing/shower as needed • Establish specific bath time
• Help with toileting when needed; respect modesty • Provide easy-to-remove clothing to assist with bladder control • Provide wet wipes for easy cleaning • Monitor for safety • Engage patient in food selection; encourage choice and participation • Engage in grocery shopping, meal preparation, and clean-up • Provide adaptive utensils, as needed • Encourage patient to serve and feed themselves • Cut food, if necessary • Monitor for safety
Eating
Middle
Dressing
• Limit options; encourage choice of comfortable clothing • Create environment to support independence • Allow time for dressing • Aid as needed • Encourage independence • Use adaptive supplies (e.g., hairbrush) • Limit time; stay focused on cleanliness and ease
Personal hygiene
Bathing and toileting • Initiate and monitor bathing activities
• May have to offer sponge bath in kitchen sink • Schedule bathroom visits • Provide direct assistance, as needed • Use dry shampoo if necessary
Eating
• Provide patient with a plated meal • Create protective environment for eating—switch to plastic, easy-to- hold cups and cutlery, if needed • Encourage independences, but provide eating support as needed • Limit choices, but offer options even when assistance is needed to select • Selections should be comfortable, easy to launder, and easy to put on and remove • Continue to encourage independence
Late Note: At this stage of the disease process, the patient will need assistance with most (if not all) ADL/IADL due to the severity of their impaired abilities. Hands-on assistance will be required for all these activities; however, attention should be given to maintaining dignity and engagement when possible.
Dressing
Personal hygiene • Provide as much assistance as needed to maintain appearance • Move slowly; help as needed with shaving, nail clipping, moisturizing • Gestures and directives should be simple and limited to one word • Display pictures of hygiene activities, if possible Bathing and toileting • Provide complete bathing care using supportive durable medical equipment (DME), as needed • Monitor closely with timed, structured bathroom checks
• Patient will lose ability to control bowels and will be incontinent • If using adult diaper supplies, monitor to avoid rashes and maintain cleanliness • Meal should be plated (and at the right temperature) and set out for patient • Adaptive utensils should be utilized • Monitor liquid intake • Provide adequate time for eating • Don’t rush • Patient may need assistance to be able to eat
Eating
Note: Adapted from Borda et al., (2020)
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Book Code: PCIL1525
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