ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

Where does this geriatric care manager start when a family is eager to help an aging parent?  The answer is an assessment. It is a bevy of questions that are asked to determine how best to approach the issues at hand. Some of the questions I ask are unique to the situation, but others are basic: Activities of Daily Living aka ADL’s and Instrumental Activities of Daily Living aka IADL.

Activities of Daily Living tell about an adult senior’s ability for self-care. Is a parent able to feed herself? This does not include preparing a meal or even chewing or swallowing the food, it is bringing food to one’s mouth. Dress and undressing without assistance, from underwear to shirt and tie.  Toileting: is the older adult able to ambulate independently or with a walker or wheelchair to the toilet?  Transferring:  can the person independently move from one place to another, from a bed to a chair?  Personal hygiene: can an older person bathe themselves, brush their hair, their teeth?

While the Activities of daily living provide a gauge as to whether an adult can live safely on their own, the Instrumental Activities of Daily Living, are also of important consideration. IADL’s include the ability to manage money this would include paying bills in a timely manner. The ability to go grocery shopping or to use a food delivery service. Getting to and from doctors’ appointments.  Household chores including doing laundry, hand washed or otherwise, and selective house cleaning.

Beyond these two significant areas, an assessment will look at the finances of the older adult to determine if there can be alternate living arrangements or home care paid for privately or thru an entitlement program. Knowing about family support within the geographic area in which the older adult resides is important. The role that can be played by adult children living at a distance. The physical, emotional and cognitive conditions the senior may be confronting, and the ability to take the corresponding medications responsibly. The “story” of the senior’s life. Personality traits, occupation, significant events that may influence how best to approach a parent. Who might it be in the family or beyond the family that may have the greatest chance of influencing the senior?

By combining responses to ADL’s, IADL’s, and the topics discussed above, this geriatric care manager can help families take the first step to bringing a parent to a healthier and safer way of living.  To this end, health care directives and a power of attorney should be in place to ensure that next steps can be taken without complications.

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

As Aging Life Care Professionals®, when we are asked to assist with securing placement in a nursing home, there are many questions we ask beyond the physical and cognitive conditions that are prompting the move. Primary among those questions is: what was mom or dad’s occupation? Those families who have parents in their mid-eighties and beyond often reply by giving dad’s occupation and the fact that mom was a homemaker.

Remembrances of lifelong professions can be retained long after actual employment or the responsibilities of raising a family have ceased.  Take Gene, a retired fireman who had been diagnosed with dementia.  On the day he arrived at the nursing home, being the conscientious firefighter he once was, he spotted a fire extinguisher and was headed straight to his job. Fortunately, his daughter positioned herself to block his access.

For mothers and wives of this era, the role of family nurturer is often rooted in the person. This is not to say that fathers have not played prominent roles, but for mothers or other women that have been employed in caregiving roles, it is not a job that finished at five. In later years, should there be cognitive loss accompanied by agitation we, as Aging Life Care Professionals, look to guide the family in ways to lessen the anxiety their loved one may be experiencing. Nonpharmacological approaches are preferable. One such method is doll therapy.

Doll therapy is just what it says. It is providing a person with a doll, that she/he can hold, cuddle, talk to, even dress and undress.  The latter helping with finger dexterity and hand-eye coordination. The doll can give a person a sense of comfort and purpose with the goal being redirecting the anxiety and bringing a parent to a sense of calm and contentment. Beyond this, a doll can be a starting point for reminiscence, asking a parent to recall their days as a new parent, bearing in mind that it is the long-term memory that is most vivid.

Research studies have shown both increased happiness and increased social interaction using doll therapy. But doll therapy is not without controversy. Some feel the dignity of a parent is compromised using a doll.  Other concerns are that dolls are demeaning and infantilize older adults. A passerby may look at a person with a doll and remark that the senior looks “cute” holding a doll. Not the way a relative wants their spouse or parent to be perceived.

As Aging Life Care Professionals, our approach is a person-centered one. To each client, we bring a toolbox of suggestions, techniques and resources. While the use of doll therapy is one such example, we customize the guidance, recognizing the unique needs of each client while working together with families to ensure practical and realistic outcomes.

The Anatomy of an Appetite: Aging and Our Relationship to Food

The Anatomy of an Appetite: Aging and Our Relationship to Food

Many of life’s events involve food. From the grandest of celebrations to the smallest of gatherings, there is always a place for food. As an Aging Life Care Professional®, I recall a wonderful get together this care manager had organized to celebrate a client’s birthday, her ninetieth… I thought.  She so enjoyed her birthday cake. It was only after I re-did the math that I realized my enthusiasm was premature; Dorothy had another twelve months to go to before she reached her 90th year.

Dorothy took great pleasure in eating her birthday cake. But such enthusiasm for food is not shared by all adult seniors.  There are a variety of factors that may contribute to a decrease in appetite: the side effects of a medication, dentures that do not fit, loss of taste, feelings of loneliness as a senior sits down to a table for one and a myriad of medical conditions.  A wince as an older adult bites into an apple or a change in appetite after the start of a new medication are symptoms that may require a visit to the dentist or a call to the prescribing doctor.

The potential for resolving the nutritional problem described above are far more likely than the changes an adult senior experiences as the end of life approaches.  He or she may lessen their food intake and ultimately refuse all nourishment. Family members are justly concerned, confused and frequently feel guilty.  Often, they fear they are starving a loved one to death if food, liquid or some form of artificial nutrition is not provided.  For an adult senior with advanced dementia, the scenario is made more complex.  As the dementia progresses it impacts on that part of the brain that controls swallowing. The chance of choking increases. In either of these scenarios it is important to recognize as the end of life nears the body adjusts to the slowing down process and minimal amounts of nutrition or liquids are needed, if at all. Now the focus becomes comfort care. Moistening the mouth with a special sponge, applying lip balm or offering a small amount of water through a straw, teaspoon or syringe.

Aging Life Care Professionals understand that while parents may have left specific directives for no heroic measures, a daughter may find it too cruel to discontinue nourishment or fluids. A son may hope for a last-minute miracle or a spouse may feel that only time will dictate when to say the last good-bye.  As Aging Life Care Professionals, it is our role to hold the hand of our client and reach out our other hand to support the family in whatever their decision may be.


Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in New Rochelle, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of older adults. She has recently been appointed to the board of directors of New Rochelle Cares, a non-for profit organization devoted to helping senior adults live safely and fully at home.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Living a Heart-Healthy Life…With a Scoop of Ice Cream

Although American Heart Month is about to end, heart disease among adult seniors shows no signs of letting up. In fact, it is the number one cause of death in older adults and has been for the last two decades.

According to Dr. Jeannette Yuen, a cardiologist in the Scarsdale Medical Group in Harrison, New York, the most common types of cardiac disease are: Coronary heart disease, where plaque builds up in the arteries that inhibits blood flow; Arrhythmia, an abnormal heart rhythm that develops due to changes in the electrical impulses through the heart; Heart attack, which occurs when the blood flow to a part of the heart is blocked by a blood clot; and heart failure, when the heart’s muscle becomes too damaged to pump blood to the heart.

While chest pain is one of the prominent symptoms associated with heart disease, there are other symptoms not to be ignored: pressure and/or heaviness in the chest that can be mistaken for indigestion, shortness of breath, palpitations, a rapid heartbeat, sweating and nausea.  For women, there can be a group of unique symptoms: extreme fatigue, pain in one or both arms, back, neck or jaws. Also, there may be shortness of breath without chest pain.

As Aging Life Care Professionals®, we recognize that in the senior population heart disease may co-exist with other chronic conditions. Treatment for one condition may have a negative effect on another condition. It is for this reason that we obtain a full medical history, such as medications that are currently being taken and ones that have resulted in adverse reactions. We guide the caregivers so that they are aware of the symptoms that are out of the norm and recognize the importance of having open channels of communication between our clients and their physicians.

For both the family and the Aging Life Care Professional, there are no sweeter words than to hear a family member “is stable.” To that goal, if, for example, a pacemaker has been implanted, it is important to have it tested at regular intervals. It is also important to take medications as directed, not skip a dose, or abruptly stop a medication without consulting with a cardiologist.  While the importance of exercise has always been touted to strengthen the heart and improve circulation, as care managers, we must question if such expectations are realistic based on the physical and cognitive conditions of our clients.

Finally, there is the inevitable recommendation to eat a healthy diet. While this is certainly important, it is also important to include moments that are simply for the joy of them. I choose to go with poet Jenny Joseph, who wrote: “When I am old I will wear purple with a red hat that doesn’t go, and doesn’t suit me.”  To which I add, while wearing purple with a red hat, I will eat ice-cream, whenever the urge comes over me. If not now, then when?


About the Author: Miriam Zucker, LMSW, ACSW, C-ASWCM, is the founder of Directions in Aging based in Westchester County, New York. For over two decades she has assisted families in customizing plans of care and developing effective strategies to meet the needs of senior adults.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Can an Adult Senior Remain at Home? …That is the Question

Can an Adult Senior Remain at Home? …That is the Question

As an eldercare consultant, I am familiar with the statistic that close to 90% of adult seniors, have expressed a desire to remain in their homes for as long as possible. The terminology in the world of eldercare is “aging in place.”

My lack of surprise about aging at home, while corroborated by AARP, has its source in the adult children who visit my office frustrated that their parents feel there is no compelling reason for them to move out of their house. A typical scenario as described by a son or daughter: no bathroom or only a half bathroom on the main floor, stairs that must be ascended or descended to get to the kitchen, no direct access to the outside without holding on to a hand rail that is unstable accompanied by a walkway that is crumbling, nonstop repairs both large and small.

Sitting across from these adult children, I understand their unease. They are often wakeful at night, distracted at work, consumed with the responsibilities of calling the plumber, roofer or making sure a path has been shoveled after a snowstorm.  I also know from talking with adult seniors the comfort that comes with continuing to reside in a lifelong home. Change is never easy or welcomed.  So, what’s an eldercare consultant to do?

For this consultant, the major consideration is safety. There is no compromise on this issue. To ensure this safety there are three necessary requirements. First, the willingness of a parent to agree to whatever modifications should be made to the house. First, the readiness of the parent to accept home care if necessary and first, the financial wherewithal and/or community support services to achieve these outcomes.  Yes, they are all number one priorities.

To this end, I frequently visit the parents in their home. Often, mom and dad need to be heard and understood, with a focus on empathy. Once they know I understand their situation, it is easier to start to effect change. The secret is small steps. With each step, it is validating their willingness to undertake necessary changes. That validation provides the incentive for the next step until a safe living environment is accomplished.

But please don’t think I come with a magic wand. Sometimes the ideal, or even close to it, becomes unachievable. It may be the staunch autonomy of a parent or it is the symbiotic relationship of husband and wife who create such a strong wall (yes, this one is achievable), that adult children, the family favorite, or even this eldercare consultant cannot convince them that they are putting their safety at risk. Then Father Time steps in and removes aging at home as a choice. A fall, noncompliance with medication, or one of those all too frequent storms we’ve been having here in Westchester County, may result in a whole new aging in place definition and destination.