The Land of the ADLs: Measuring Your Life as You Age

elderly couple preparing food

Once you enter the twilight years (somewhere between 50 and 110 years old depending upon who you ask), your life is measured by a narrow set of skills known as ADLs and IADLs and several standardized tests. You need to know about these because they are used to determine just about everything: housing, government aid, medical care, and your ability to self-govern.

What are ADLs and IADLs?

The ADLS, short for Activities for Daily Living, are skills required to manage your basic physical needs. They include personal hygiene, dressing, toileting, transferring or ambulating, and eating. You should be able to bathe or shower, pick out appropriate clothing and dress yourself, timely use the toilet, move from chair to bed and walk or wheel yourself, and feed yourself. The ADLs involve more of your motor function than your memory.

The IADLs, short for Independence in Activities of Daily Living, are more complex. These are the skills required for you to lead an independent life at home. They include telephone use, shopping, food preparation, housekeeping, laundry, medication management, handling finances and driving or using public transportation. The IADLs are where a short-term memory deficit will often first become evident. 

Screening for Cognitive Dysfunction

There are several tests that are commonly used to screen for cognitive dysfunction. The first is the Montreal Cognitive Assessment, known as MOCA. This is a rapid screening test that assesses attention and concentration, executive functions, memory, language, visual constructional skills, conceptual thinking, calculations and orientation. The maximum score is 30.

On the MOCA, you will be asked to draw a clock, copy a cube, name some animals, remember some words, tap when you hear a vowel read to you from a list, and count backwards.

The second test is the Mini-Mental State Examination, or MMSE. It measures deficits in orientation, executive function, memory/recall, attention and language.  

ON the MMSE, you will be asked questions from a script. Subject areas could include current date and season, your location, repeating from a list of words, spelling a word backwards, writing a complete sentence, following written instructions, and following oral instructions. 

The maximum score on both tests is 30. You want to score high.  

The third test is the Geriatric Depression Scale. It is a 15-question screening tool for depression in older adults. The maximum score is 15, and you do not want to score high on this one. Zero is the best score.

Certificate of Medical Examination

If someone is really worried about you, then they might ask a doctor to examine you and then complete a Certificate of Medical Examination, known as the CME. That is a form used by a court to determine if you are legally incapacitated and in need of a guardian.  

The doctor will first evaluate your physical condition and then evaluate your mental functioning. If the mental diagnosis includes dementia, then the physician will opine whether you should be placed in a secured facility for the elderly, administered medications appropriate for the care and treatment of dementia and whether you have sufficient capacity to give informed consent for those medications.

The doctor then states if an improvement in your physical condition and mental functioning is possible. In detail, the doctor will describe your cognitive deficits and your ability to make responsible decisions. The doctor then opines whether you are totally or partially incapacitated.  

At the end of the report, the doctor will determine whether you have the ability to attend a court hearing.

That summarizes your aging, all neatly wrapped up on acronyms, standardized tests and forms. Not as reassuring as it might be, is it?

Virginia Hammerle is an attorney with Hammerle Finley Law Firm whose practice includes probate law, estate planning and contested litigation.  To receive her newsletter contact her at legaltalktexas@hammerle.com.