ABSTRACT
INTRODUCTION Instrumental activities of daily living (IADLs) are those activities that require a higher level of cognitive functioning than activities of daily living (ADLs). They are multistep activities that are critical to successful independent living within a community and include such areas as occupation, driving, financial management, medication administration, household management, and computer technology (1,2). Deficits in these areas may be among the first indicators that an individual is having challenges with reasoning skills, intellectual abilities, and memory. IADLs may also become the first “battleground” for the caregiver and the person with dementia in terms of what are appropriate independent activities for the person with dementia. It becomes a fine balance between an individual’s autonomy and the safety of the person, family, and/or the community. As the disease progresses, the individual has increased memory and visuospatial deficits, declines in problem-solving abilities, impaired decision-making skills and logical sequential reasoning skills, and consequently exhibits increased anxiety. Therefore, they become less able to accomplish these multistep activities. Because their insight into their abilities is diminished, what appears abundantly clear and logical to a caregiver or a doctor will have little relevance or meaning to the individual with dementia.
