From the Guidelines
Access to transportation is considered an Instrumental Activity of Daily Living (IADL) according to the most recent and highest quality study. IADLs are complex skills needed for independent living and include activities such as managing finances, shopping, meal preparation, housekeeping, managing medications, using the telephone, and doing laundry. The study published in 2024 in the Mayo Clinic Proceedings 1 lists transportation arrangement as one of the IADLs, which is essential for independence and accessing community resources.
Key Points
- IADLs are complex skills needed for independent living
- Transportation arrangement is considered an IADL according to the most recent study 1
- IADLs include activities such as managing finances, shopping, meal preparation, housekeeping, managing medications, using the telephone, and doing laundry
- Transportation ability may be assessed as part of a functional evaluation, and it supports many IADLs like shopping and attending medical appointments
Evidence
The study published in 2024 in the Mayo Clinic Proceedings 1 provides the most recent and highest quality evidence, which lists transportation arrangement as one of the IADLs. Other studies, such as the one published in 2012 in the Journal of the National Comprehensive Cancer Network 1, also support this classification. However, the 2024 study is given more weight due to its recency and high quality.
Clinical Implications
In clinical practice, assessing a patient's ability to arrange and use transportation is essential for evaluating their independence and ability to access community resources. This assessment can inform treatment plans and interventions to support patients in maintaining their independence and quality of life. Therefore, access to transportation should be considered an essential component of IADLs in clinical evaluations.
From the Research
Definition of Instrumental Activities of Daily Living (IADL)
Instrumental Activities of Daily Living (IADL) are complex daily tasks that are important for independent living. Examples of IADLs include:
- Managing finances
- Cooking
- Cleaning
- Managing health care
- Phone use
- Transportation
Access to Transportation as an IADL
Access to transportation is considered an IADL, as it is a complex task that requires cognitive and physical abilities. According to 2, the choice of transportation means can impact the risk of decline in IADL among older adults. The study found that passive means of transportation, such as driving or being driven, were associated with a higher risk of decline in IADL compared to active means of transportation, such as walking or cycling.
Assessment of IADLs
There are various assessment tools available to evaluate IADL performance in older adults, including the Lawton Instrumental Activities of Daily Living Scale and the Katz Index of Independence in Activities of Daily Living 3. These tools assess an individual's ability to perform various IADL tasks, including transportation.
Importance of Transportation in IADLs
Transportation is an essential IADL that enables individuals to participate in various activities, such as shopping, socializing, and accessing health care services. According to 4, managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline.
Classification of IADLs
IADLs can be classified into different categories, including:
- Managing finances
- Cooking
- Cleaning
- Managing health care
- Phone use
- Transportation
- Housework According to 5, IADLs can be grouped into three classes: no BADL limitation-no IADL limitation, no BADL limitation-IADL impairment, and BADL impairment-IADL impairment.
Activity Limitation Stages
Activity Limitation Stages can be used to define and monitor groups of adult community-dwelling Medicare beneficiaries 6. These stages quantify severity and specify the activities that people are still able to perform without difficulty. For example, at ADL-I, people are guaranteed to be able to eat, toilet, dress, and bathe/shower without difficulty, whereas they experience limitations getting in and out of bed or chairs and/or difficulties walking.