Construct: Assessment of complex activities of daily living
Description of Measure: Lawton’s Instrumental Activities of Daily Living (IADL) Scale was developed to assess more complex activities (termed “instrumental activities of daily living”) necessary for functioning in community settings (e.g., shopping, cooking, managing finances). The capacity to handle these complex functions normally is lost before basic “activities of daily living” (e.g., eating, bathing, toileting) which are measured by ADL scales. Therefore, assessing IADLS may identify incipient decline in older adults or other individuals who are otherwise capable and healthy (Graf, 2008, pg. 53).
The Lawton IADL Scale takes approximately 10 to 15 minutes to administer. It contains 8 items that are rated with a summary score from 0 (low functioning) to 8 (high functioning). This scale can be administered through an interview or by a written questionnaire. The patient or a caregiver who is familiar with the patient can provide the answers. The scale is ideal for community-dwelling older adults, as well as those who have been admitted to a hospital, short-term skilled nursing facility, or rehabilitation facility. However, the scale is not ideal for use with older adults who reside in long-term care facilities where IADLS are often performed with the assistance of staff (Graf, 2008, pg. 54). In caregiving research, the scale is commonly used in combination with an Activities of Daily Living scale to assess the intensity of care provided (e.g., Fredman et al., 2009, Fredman et al., 2019).
The IADL has been used in over 3000 published studies. There is considerable evidence for its reliability and concurrent validity (Loewenstein & Mogosky, 1999), but there is some indication that the IADL is more suitable for assessing women than men (Kane & Kane, 1981).
The Lawton IADL scale is also available in Chinese.
References
Fredman, L., Doros, G., Ensrud, K. E., Hochberg, M. C., & Cauley, J. A. (2009). Caregiving intensity and change in physical functioning over a 2-year period: Results of the Caregiver-Study of Osteoporotic Fractures. American Journal of Epidemiology, 170(2), 203-210. doi: 10.1093/aje/kwp102
Fredman, L., Ranker, L. R., Strunin, L., Smith, M. L., & Applebaum, K. M. (2019). Caregiving intensity and mortality in older women, accounting for time-varying and lagged caregiver status: The Caregiver-Study of Osteoporotic Fractures Study. The Gerontologist, 59(5), e461-e469. doi: 10.1093/geront/gny135
Graf, C. (2008). The Lawton Instrumental Activities of Daily Living Scale. American Journal of Nursing. 108(4), 53-62.
Kane, R. A., & Kane, R. A. (1981). Assessing the elderly: A practical guide to measurement. Lexington, MA: Lexington Books.
Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179-186.
Loewenstein, D. A., & Mogosky, B. J. (1999). The functional assessment of the older adult patient. In In P. Lichtenberg (Ed.), Handbook of assessment in clinical gerontology (pp. 529-554). New York: John Wiley & Sons.