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An individual's ability to live independently is often determined by that person's capacity for self-care and ability to engage in various activities of daily living (ADLs). Basic or self-care ADLs include such everyday behaviors as attention to hygiene, bathing, dressing, feeding, and toileting. Complex or instrumental activities of daily living (IADLs) include such tasks as cooking and meal preparation, medication administration, financial management, use of communication devices (e.g., telephone), and use of transportation (e.g., driving a vehicle). In older individuals, increasing frailty or declines in cognitive ability are heralded by declines in IADLs followed by declines or disruptions in basic ADLs. Consequently, health care providers routinely evaluate the older individual's level of independence in, versus support needed across, a range of IADLs and ADLs. ADL functioning may be assessed in three ways: self-report, informant (caregiver) report, or performance of actual ADL tasks. The most common method of ADL assessment is self-report or informant report through informal interview. The individual or primary caregiver (e.g., spouse, adult child) is asked whether the individual requires assistance in any of a range of ADL tasks. Formal self-report questionnaires obtain this information in a standardized way. Lawton and Brody (1969), for example, developed an ADL questionnaire that can be completed either by the individual or by an informant. The questionnaire includes a range of both ADL and IADL behaviors, and the respondent rates each item according to whether he or she is entirely independent in the task (2 points), requires assistance to complete the tasks (1 point), or is entirely dependent on someone else for task completion (0 points). The questionnaire is scored by summing the item responses, with lower scores reflecting greater dependence and need for assistance in IADLs and ADLs. The Older Americans Resources and Services Instrument (OARS),...
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