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Lawton Instrumental ADL Scale
Lawton Scale: Assesses complex skills needed for independent living. Note: This tool uses the modern scoring system (0-8 for all genders), abandoning the historical omission of food/laundry for men.
Select best descriptor for each
A. Ability to use telephone
B. Shopping
C. Food Preparation
D. Housekeeping
E. Laundry
F. Mode of Transportation
G. Responsibility for own medications
H. Ability to handle finances
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Detecting early functional decline in community-dwelling older adults.
Assessing independent living capability (can the patient live alone safely?).
Evaluating the impact of mild cognitive impairment (MCI) or early dementia on daily life.
Identifying specific areas where home support services are needed.
IADLs vs. ADLs
Basic ADLs (Katz/Barthel) measure survival skills (eating, toileting, bathing). Instrumental ADLs (Lawton) measure the complex, higher-order skills needed to live independently in a community (managing finances, taking medications, cooking). IADLs are typically lost before basic ADLs in the progression of dementia.
Section 2
Formula & Logic
Scoring
8 domains assessed: Telephone, Shopping, Food Prep, Housekeeping, Laundry, Transport, Medications, Finances.
Historically scored 0-8 for women, 0-5 for men (excluding food, housekeeping, laundry due to 1960s gender roles).
Modern practice scores all 8 domains for all genders (0-8 scale).
Score 1 for independence (or needing minor help), 0 for dependence.
Interpretation
Score 8
High function. Capable of living independently.
Score < 8
Deficits present. Requires targeted support (e.g., Meals on Wheels, dosette box).
Section 3
Pearls/Pitfalls
The Cognitive Connection
Loss of IADLs—specifically managing finances and medications—is often the very first clinical sign of executive dysfunction in early Alzheimer's disease. A decline in the Lawton score should trigger immediate cognitive screening.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
Assessment of older people: self-maintaining and instrumental activities of daily living.
Lawton MP et al. • Gerontologist.. 1969;9(3):179-86. Original development establishing the conceptual difference between basic and instrumental activities.
Section 6
Origins
Powell Lawton and Elaine Brody
Developed in 1969 at the Philadelphia Geriatric Center. They recognized that existing scales (like Katz) were too basic to capture the nuanced decline of community-dwelling seniors, leading them to conceptualize "instrumental" functions that require higher neuropsychological organization.
