Effects of Dementia on Instrumental Activities of Daily Living

Man on the phone looking at a bill
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Instrumental Activities of Daily Living (IADLs) are tasks that are more complicated than simple activities of daily living (which include functions such as bathing, eating, and dressing). IADLS involve functions that are necessary to function independently such as medication administration, housekeeping, finances, food preparation, laundry, transportation, and shopping.

How Dementia Affects IADLs

IADLs require a higher level cognitive ability than ADLs. Since many IADL tasks are different from time to time, the ability to proceed on "auto-pilot" mentally is limited. For example, in managing finances, one day's calculation is different from the next, and preparing meals requires multiple steps in a certain order. 

A decline in IADLs might be one of the earlier signs of mild cognitive impairment, a condition where there is evidence of cognitive decline that sometimes, but not always, progresses to dementia. Areas of cognitive impairment that make IADLs difficult include multi-step processing, executive functioning such as planning and decision-making, and memory.

If you notice a loved one having difficulty with IADLs, a physician assessment is important to rule out potentially reversible causes of dementia symptoms and to facilitate early diagnosis options.

Why It Might Be Challenging to Assess IADLs

One challenge in assessing a person's IADL ability is that due to physical limitations, some people require assistance even though they might be cognitively intact.

Another difficulty in evaluation is that some adults may never have done some of the tasks being assessed. For example, in a very traditional relationship, the male may never (or rarely) have cooked a meal and the woman might never have managed the finances. Thus, an inability in these areas might not signal a cognitive decline as much as identify an unlearned task.

How You Can Help

There are several ways you can support someone who's struggling to maintain independence in daily life. These include:

  • Medication administration systems
  • Set up a rotating schedule of family and friends to assist with laundry and housekeeping
  • Arrange Meals on Wheels
  • Assist the person with dementia in designating a power of attorney for finances and monitor their finances closely
  • Hire home health care services or companions for shopping and assistance in the home​

Sources:

Alzheimer's & Dementia, Volume 8, Issue 6, November 2012, Pages 536–543. A New Informant-Based Questionnaire for Instrumental Activities of Daily Living in Dementia.

The Hartford Institute for Geriatric Nursing, New York University, College of Nursing. 2013. The Lawton Instrumental Activities of Daily Living (IADL) Scale.

Journal of Alzheimer's Disease.  2014;42(1):291-300. Regional Fluorodeoxyglucose Metabolism and Instrumental Activities of Daily Living Across the Alzheimer's Disease Spectrum.