Preceptor Guide

ADL/IADL

Printable Versions of Materials needed to create station:

• Sign for Station 2
• Preceptor Guide
• Case A
• Case B

Guide for Preceptors:

NOTE: the information posted just below is identical to that in the printable version of the preceptor guide above.

Two case vignettes are available for this activity. Many students have not been exposed to this terminology or concept prior to the geriatrics clerkship, so explanation is needed before asking the students to read the vignettes. We use the following mnemonics:

ADLs	IADLs
Dressing	Shopping
Eating	Housekeeping
Ambulating/Transferring	Accounting
Toileting/Incontinence care	Food Preparation
Hygiene (bathing, grooming)	Telephoning
	Transportation

After this discussion, the students are asked to read the vignettes and fill out the prepared sheet evaluating the ADLs and lADLs for vignette case A and B.

Case A: The case of Mr. Smith represents a very common occurrence of progressive cognitive and functional decline in an older adult. In examining his ADLs, the students should be able to identify that Mr. Smith is fully independent with eating, toileting and grooming. His independence with ambulation has been preserved with the aid of an assistive device (cane). He is currently dependent in dressing due to his arthritis and difficulty with small buttons and straps. This often leads to a worthwhile discussion of what assistive devices (button hooks, Velcro shoes) or clothing modifications (pull-over shirts, elastic pants) may return Mr. Smith to independent dressing.

Mr. Smith has become quite dependent for his lADLs. He relies on his family for shopping, accounting, food preparation and transportation. This nicely leads to a discussion of community resources that are available in many locations to assist older adults with these functions, such as grocery store delivery services, meals on wheels or congregate meal sites and public transportation. These are also services that most assisted living facilities are prepared to cater,

The ADL that is not mentioned in Mr. Smith's case is bathing. It can be helpful to point out to students that this is often the first ADL to decline in older adults. The IADL that is not specifically mentioned in this case is housekeeping. It might be inferred from the case that Mr. Smith's family does the housekeeping; the question should still be asked.

Case B: Just prior to surgery, Mrs. Jones was intact in the following ADLs (implied): dressing, eating, toileting, grooming. She was impaired in ambulation and bathing. Mrs. Jones was intact in telephoning but required assistance with several of her lADLs, including food preparation, shopping and transportation. At the beginning of her rehab stay, Mrs. Jones requires assistance with all of her ADLs except eating. She is dependent for assistance with all of her lADLs except accounting and telephoning. This case leads well to a discussion of the goals of rehabilitation, being to maximize functional independence. A successful rehabilitation for Mrs. Jones would be for full independence in all ADLs and lADLs. However, this is not a reasonable goal for some patients who are less functional prior to surgery or who are cognitively impaired.

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