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Instrumental Activities of Daily Living (IADLs) are often defined as activities that are learned as an adolescent and that one requires to be fully independent. IADLs often involve more complex tasks and are more cognitively-demanding compared to the basic activities of daily living.
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What are Instrumental Activities of Daily Living?
Instrumental activities of daily living include:
- Cooking
- Shopping
- Communication by phone or email
- Managing finances
- Transportation
- Housekeeping
When a person carries out IADLs, they rely on coordination, judgement and other cognitive abilities that begin to change as dementia progresses. Thus, even in the mild stage of dementia when persons living with dementia are still able to perform other activities of daily living well, they are more likely to struggle with IADLs. It is important to note changes in your loved one’s ability to perform instrumental activities of daily living, as it is often an early indicator of whether your loved one has developed dementia. Prognosis for dementia is greatly improved with early diagnosis and treatment.
Supporting Your Loved Ones in Instrumental Activities of Daily Living
You can adapt these activities to suit your loved one’s needs and mobility level.
Over time, changes to your loved one’s vision and short-term memory for information such as phone numbers may make it difficult for them to contact others over the phone. If they are using a smartphone, there are apps available which can be used to minimise visual noise on the screen display and increase text for easy reading, such as ONY phone. These are often referred to as ‘elder-friendly launchers’. You can also consider making a phone-book or wall poster with their contacts’ photos next to the phone numbers in suitably large font. There are also senior-friendly phones such as the Jitterbug or picture phones.
Image: Picture Phone (Picture Dialer Phone Box from HQTelecom)
Managing bills can be daunting for anyone. Cognitive decline affects judgement and calculation in people living with dementia differently. To support your loved one with this IADL, you can identify specific aspects of finances your loved one is struggling with. This could be forgetting to pay bills on time, overspending or forgetting important information like PIN numbers. You may consider signing them up for automatic bill payments, or setting withdrawal limits. Have a conversation with them to explore methods of working around these issues and affirm aspects of finances they have been managing well.
Your loved one may have difficulty keeping track of whether they have taken their daily medication, especially if they have been prescribed medication to manage more than one ailment. You can find detailed tips on how to help them manage their medication here.
Packing and cleaning the house will become more challenging for persons living with dementia over time. Problems with coordination, and the loss of bone density typical of older adult may make it unsafe for your loved one to handle the procedural tasks of housekeeping alone. They may also forget the function and location of housekeeping tools such as the vacuum cleaner.
You can make a list of which regular chores required in the regular maintenance of the house your loved one is still able to manage. You could also consider breaking these chores down into steps, and assist with the steps your loved one has difficulty managing. Identify and remove furniture and items in the house that may be obstacles to your loved one while they are cleaning and ensure hallways are well-lit. Planning a routine together can also help your loved one to keep track of chores they are in-charge of.
Cooking may not be safe for persons living with dementia if their coordination and memory are significantly impacted. This may lead to forgetting to turn off the stove or leaving food unattended. Loose clothing like long pajamas may pose a safety risk of catching fire on hot surfaces.
You may gradually need to take over cooking and safety-proof your kitchen (i.e., switching off the gas regulator and using socket covers). If your loved one living with dementia considers cooking to be important or an integral part of their routine, try to keep them involved in the process by asking them to help with simpler tasks. This could include mixing ingredients and washing vegetables. Several senior-friendly or adaptive kitchen tools are designed to make such tasks easier for seniors. Some of these tools may have designs that feel unfamiliar to the person living with dementia (for example, tools that have multiple handles). As much as possible, pick items that resemble tools your loved one is already familiar with. You can also label your kitchen drawers and label tools according to their function to make locating them easier for your loved one.
Image: Chef Craft Measuring Cups with Large Print (Left), North Coast Medical Adjustable Gripping Tool (Center), OXO Good Grips Mixing Bowls (Right)
In the mild to moderate stages of dementia, your loved ones may start to feel disoriented in their surroundings and have difficulty calculating change when making payment. If possible, accompany them while they are shopping. You can stay with them while letting them handle as much as they are able to.
It may help to visit shops that your loved one is familiar so that shopkeepers can recognise them, and plan visits for off-peak hours so the environment is less likely to be disorienting. If possible, get support from people living in the neighbourhood, including stall owners at your nearby hawker centre, to look out for your loved one when they are shopping. Try to make a simple shopping list and help your loved ones locate the items where necessary.
As your loved one’s dementia progresses, their executive function which also involves their ability to concentrate will decline. Driving involves several cognitive demands, such as remembering directions and interpreting traffic signals. Your loved one may be distracted by peripheral traffic or slowed judgement to different signals. You can assess their comfort with driving and whether it may be necessary for them to seek alternative forms of transport. Find more information on how to aid your loved one in driving and taking public transport.
Your loved one may need more support from you and other family members as their abilities change with the progression of dementia. Avoid comparing what they were able to do in the past with what they can do now. Viewing the activity as something you are doing together with your loved one and affirming them when tasks are completed (even if they are not done perfectly) can help to maintain your loved one’s interest and feeling of agency over these tasks. This in turn builds their sense of accomplishment and confidence.
