Inventory of Activities of Daily Living

       DATE:           TIME (24hr): 

Scoring guide:
0 = Normal
1 = mildly impaired but does by self or with minimal assistance
2, 3, 4 = requires minor or major assitance, may be fully dependent
(If never did activity, note and score according to related abilities)

1. Ability to use phone, television, internet, communication modalities
[]   0 = Operates telephone on own initiative, looks up and dials numbers, finds desired TV shows, uses internet.
[]   1 = Dials a few well known numbers, difficulty using TV-remote, trouble with internet use.
[]   2 = Answers telephone but does not dial, watches TV passively, no internet use.
[]   3 = Does not use telephone at all (could if necessary), watches TV, unable to discuss content.
[]   4 = Incapable of using telephone, does not watch TV.

2. Shopping: clothes, household items, groceries
[]   0 = Takes care of all shopping needs independently.
[]   1 = Shops independently for small purchases.
[]   2 = Needs to be accompanied on any shopping trip.
[]   3 = Completely unable to shop.

3. Food (If never prepared meals, note and score according to related abilities)
[]   0 = Plans, prepares, and serves adequate, balanced meals independently.
[]   1 = Prepares adequate meals if supplied with ingredients.
[]   2 = Heats and serves prepared meals, or prepares meals.
[]   3 = Needs to have meals prepared and served.

4. Housekeeping, cleaning, laundry, taking out garbage, litter
[]   0 = Maintains house, appropriate involvement for keeping order, can do personal laundry, good level of cleanliness.
[]   1 = Performs light daily tasks such as dish washing, bed making, laundering small items, rinsing socks.
[]   2 = Performs light daily tasks but cannot do laundry, maintain acceptable level of cleanliness without assistance.
[]   3 = Needs help with all home maintenance tasks.
[]   4 = Is unable to participate in any housekeeping tasks.

5. Proper and safe use of old, new appliances in home
[]   0 = Can heat water, cook food, turn off stove after use, use dishwasher, washing machine.
[]   1 = Can use familiar appliances, difficulty with new things, can use on-off controls, heat simple items, e.g., use toaster.
[]   2 = Cannot use appliances safely, turn off stove, use on-off controls.

6. Mode of Transportaion, traveling out of neighborhood, driving, taking public transport
[]   0 = Travels independently on public transportation or drives own car.
[]   1 = Arranges own travel via taxi, but does not otherwise use public transportation.
[]   2 = Travels on public transportation when assisted or accompanied by another.
[]   3 = Travel limited to taxi or automobile with assistance of another.

7. Remembering appointments, family activities, holidays, responsibility for own medication
[]   0 = Makes and keeps appointments, arranges activities for family, vacation. Is responsible for taking medication dosages at correct time.
[]   1 = Forgets scheduled appointments, participates less in activity planning. Takes medication if prepared in advance in separate dosages.
[]   2 = Is not capable of making appointments, planning activities, dispensing own medication.

8. Ability to handle finances, write checks, pay bills, balance checkbook, assemble taxes
[]   0 = Manages financial matters independently (budgets, writes checks, pays rent and bills, balances checkbook, does banking), keeps track of income, assembles tax records. Makes good financial decisions, buys appropriate gifts.
[]   1 = Manages daily purchases, but needs help with major purchases, business affairs, taxes.
[]   2 = Incapable of handling money.

Total Instrumental ADL Score (Max = 23)

9. Toilet, proper use of bathroom
[]   0 = Cares for self at toilet completely, no incontinence. Cares for self at toilet, no incontinence.
[]   1 = Needs to be reminded or needs help in cleaning self, may have rare accidents.
[]   2 = Soiling or wetting while asleep more than once a week, usually continent.
[]   3 = Soiling or wetting while awake more than once a week, frequently continent.
[]   4 = No control of bowels or bladder, fully incontinent.

10. Feeding
[]   0 = Eats without assistance at meal time.
[]   1 = Eats with minor assistance, needs help serving food, cleaning up after meals.
[]   2 = Feeds self with moderate assistance and is untidy.
[]   3 = Requires extensive assistance for all meals, may be fed by someone else.
[]   4 = Does not feed self at all and resists efforts of others to feed him/her.

11. Dressing
[]   0 = Dresses, undresses, and selects clothes from own wardrobe.
[]   1 = Dresses and undresses self, with minor assistance.
[]   2 = Needs moderate assistance in dressing or selection of clothes.
[]   3 = Needs major assistance in dressing, but cooperates with efforts of others to help.
[]   4 = Completely unable to dress self and resists efforts of others to help.

12. Grooming (neatness, hair, nails, hands, face, clothing)
[]   0 = Always neatly dressed, well-groomed, without assistance, cuts own fingernails.
[]   1 = Grooms self adequately with occasional minor assistance, e.g., in shaving.
[]   2 = Needs moderate and regular assistance, supervision in grooming, brushing, combing hair.
[]   3 = Needs total grooming care, but can remain well-groomed after help from others.
[]   4 =Actively negates all efforts of others to maintain grooming.

13. Physical Ambulation
[]   0 = Goes about grounds or city.
[]   1 = Ambulates within residence or about one-block distance.
[]   2 = Ambulates with assistance of another person, railing, cane, walker, or wheelchair.
[]   3 = Sits unsupported in chair or wheelchair, but cannot propel self without help.
[]   4 = Bedridden more than half the time.

14. Bathing
[]   0 = Bathes self (tub, shower, sponge bath) without help or reminding.
[]   1 = Bathes self with help in getting in and out of tub. May need reminding.
[]   2 = Washes face and hands only, but cannot bathe rest of body.
[]   3 = Does not wash self, but is cooperative with those who bathe him or her.
[]   4 = Does not try to wash self and resists efforts to keep him or her clean.

Total Basic ADL Score (Max = 24)

15. Global Function
[]   0 = Able to live independently without assistance.
[]   1 = Because of memory problems, requires at least weekly visit by outside support person.
[]   2 = Requires daily help to function, needs caregiver, can be left alone for less than one hour.
[]   3 = Requires help in all areas of function during day; cannot be left alone or requires medication for behavioral control.

Total ADL Score (Max = 50)

  TOTAL  Activities of Daily Living:      (range = 0 - 50)

  0 -    5     normal, depending on age, education, complaints
  6 -  10     possible impairment
11 -  20     mild impairment
21 -  30     moderate impairment
31 -  40     severe impairment
41 -  50     profound/complete impairment

Note that this is a continuum of approximate descriptions, not a rigid classification.


Electronic form developed by J. Wesaon Ashford, M.D., Ph.D., August 27, 2021
This electronic form is not protected by copyright.

Items from pior validated Global Assessment of Dementia form:
Ashford JW, Kumar V, Barringer M, Becker M, Bice J, Ryan N, Vicari S.
Assessing Alzheimer severity with a global clinical scale.
Int Psychogeriatr. 1992 Summer;4(1):55-74.

Form updated 8/27/2021 with reference to:
FAQ (Functional Activities Questionnaire): Marshall GA, et al. Curr Alzheimer Res. 2015;12(5):493-502.
ADCS - ADL Inventory: Galasko D, et al. Alz Dis Assoc Dis. 1997;11 Sup2:S33-9.
AD8: Galvin JE, et al. Neurology. 2006;67(11):1942-8.

For analysis showing much higher reliability of the Global Assessment against another scale, see:
Ashford JW, Schmitt FA. Modeling the time-course of Alzheimer dementia. Curr Psychiatry Rep. 2001 Feb;3(1):20-8.

There is no individual or agency that takes responsibility for the results obtained
with this test or this form.