Help overcome daily challenges

Many people experience problems in daily living because of age, chronic illnesses or health-related disabilities. Those difficulties restrict their ability to perform self-care. This inability for self-care is a common reason why older people seek help from outsiders, move to assisted living communities, or enter nursing homes.

The daily living skills most affected by aging and chronic illnesses or disabilities include self-care activities that most people learn in early childhood and tend to take for granted as they mature. These include basic survival tasks such as dressing, bathing, grooming, using the toilet, moving in and out of bed or a chair, and eating. They also include activities for maintaining an independent life such as cooking, cleaning, doing the laundry, shopping, handling money, writing checks, driving, using public transportation, and using the telephone.

Health professionals have coined two terms to cover these activities: ADL and IADL. You may hear these terms used in discussions of your problems. ADL stands for “activities of daily living,” and include the basic tasks of dressing, bathing, grooming, using the toilet, eating, walking, or getting in and out of bed. IADL stands for “instrumental activities of daily activities,” referring to activities for maintaining a household and an independent life such as cooking, cleaning, laundry, sewing, and similar tasks.

Problems in doing daily living tasks arise for many reasons and are closely linked to other health problems. For example, people with congestive heart failure or pulmonary (lung) disease may lack the physical endurance or stamina to manage household tasks like cleaning, cooking, and laundry on their own. People with arthritis may be unable to perform the small, precise movements of the hands and arms needed for daily tasks. Failing eyesight and hearing can also make self-care more difficult. Inability to take medicines correctly may be related to problems such as being unable to read instructions, open bottles, get a glass of water, not having the finger dexterity to handle small pills, and even not remembering to take the medicine in the first place.

These problems are often a matter of degree; for example, an older person may be able to dress himself or herself except for reaching to put on shoes and tie shoelaces, or managing difficult fasteners (especially zippers and snaps that close in the back). If that is the case, self-care abilities can be improved simply by changing the kinds of clothes worn and the way they are fastened. One person may be able to eat independently except for cutting foods or handling liquids without spilling them. At the other extreme, another person may not be able to bring a spoon to his or her mouth at all, or may even have difficulty swallowing food. Often these problems arise gradually and may not even be considered a problem for some time. For example, the first signs may be fatigue in performing common tasks or an observation that things that used to take just a few minutes are now taking much longer.

In most cases, the person needing help will be the best judge of his or her own need for help with daily living. If you are worried about the person you are caring for, you should discuss these issues openly and with sensitivity. To understand the problem, it is necessary to understand the person. The exception is when daily living problems arise because of a disease that affects memory, such as Alzheimer’s disease or, at times, stroke, Parkinson’s disease, and other illnesses. In those cases, difficulties in daily living may be due more to forgetting to perform a task or how to complete it correctly rather than in physically doing the task. If memory is a factor, the help needed usually involves reminders, coaching, and assistance to ensure the person’s safety and completion of the activity.

Issues of self-care and problems in living are highly personal and involve the routines and rituals of daily life that are well established. Each person needing help, is likely to have strong preferences for details of how and when help is provided. A person will feel loss of control when strangers are involved with their intimate daily lives. The best way to avoid an intense sense of helplessness is for the person to retain as much control as possible.  Our goal is to help people find ways to overcome their challenges and stay as independent as possible for as long as possible.