How Activities of Daily Living (ADLs) Affect Health, Independence, and Caregiving
What are Activities of Daily Living (ADLs), and why are they important? Uncover their impact on health, identity, and the strategies that support them.
Healthy aging is less about avoiding change altogether and more about managing the effects. The aim is to preserve physical and mental function while embracing new perspectives and priorities.
Aging is a gradual yet profound process that starts long before most of us think about it—often in early adulthood. The changes begin slowly, almost imperceptibly, affecting everything from how our cells function to how we respond to stress, both physically and mentally. Rather than a single event or a number on a birthday cake, aging unfolds over decades, bringing subtle shifts that can impact energy, appearance, cognitive ability, and resilience. However, despite all that’s spoken about the downsides of growing older, aging is as much about growth and adaptability as it is about loss.
When we speak about aging, we’re really looking at three distinct dimensions: chronologic age, biologic age, and psychologic age. Each of these plays a role in how we feel, how we’re perceived, and even in how long we live. Chronologic age is simply the number of years we’ve been alive. It’s the most obvious marker, but also the least informative when it comes to health and vitality. Biologic age, on the other hand, reflects the actual condition of our cells, tissues, and organs. This is why some people in their 60s feel vigorous and active, while others in their 40s feel worn out. Lastly, psychologic age speaks to our mindset—how old or young we feel, which shapes how we interact with the world, and how we perceive our potential.
As we grow older, the body’s systems face subtle, sometimes barely noticeable changes. Each decade of life brings shifts that affect how we look, feel, and function. Muscles may lose mass and strength, a natural process that starts around age 30. Joints might become stiffer, a combination of cartilage thinning and ligaments losing elasticity. The heart and lungs, though resilient, also experience wear over time, which can make strenuous physical activities feel a bit harder. However, not all age-related changes are inevitable, and many are preventable or manageable through consistent habits like regular exercise and a balanced diet.
Meanwhile, sensory changes—particularly with sight and hearing—are some of the first signs of aging. Eyesight often begins to change in mid-life as the lens of the eye loses flexibility, making close-up reading harder (a condition called presbyopia). Similarly, hearing high-pitched sounds gradually becomes challenging, due to a natural decline in hearing known as presbycusis.
While chronological age is a simple number, biologic age tells a truer story of physical and cellular changes—some evident, others hidden within. For example, while many people experience muscle loss and diminished bone density in their later years, these changes occur faster in some than others, partly due to genetics and partly due to lifestyle.
On another level, psychologic age reflects the mindset with which a person approaches life. A person who is engaged, forward-looking, and invested in the world around them can maintain mental youthfulness, and this attitude can influence physical health, sometimes profoundly. Psychologic resilience and outlook, then, are just as much a part of the aging process as physical symptoms, serving as a key determinant in how people adapt to the changes ahead.
So often, the question arises: is this symptom “just aging,” or is it something more? Normal aging includes predictable physical changes: eyesight fades a bit, hearing may decline, and memory becomes less sharp. The lens of the eye, for instance, begins to stiffen in mid-life, making close-up focus difficult, a change that all but the lucky will encounter. Yet, knowing when a change is “normal” versus a signal of disorder can be less clear. Memory changes that affect daily life or cognitive function may signify more than aging alone—diseases like Alzheimer’s often show up first as noticeable memory loss but go much further than the misplaced keys of everyday forgetfulness.
When these changes start affecting daily life, it’s important to know that distinction: aging alone, while unpreventable, can be managed; disorders may need to be actively addressed.
Every system in the body is affected by aging, each in a different way.
In many, the first signs of aging appear as subtle losses in strength or flexibility. Bone density, for instance, peaks in our 20s and 30s, gradually diminishing with age. For some, the loss remains mild, while for others, it develops into conditions like osteoporosis, where bones become fragile and susceptible to fractures.
Our joints, the hinges on which our movements rely, wear down over time. Cartilage thins and ligaments become less elastic, leading to stiffness and, often, pain. Regular exercise, especially strength training and weight-bearing activities, can counter some of these effects, supporting joint health and helping us stay agile even in older age. Yet, overdoing it, especially in high-impact sports, can lead to wear that might accelerate joint damage, so moderation and low-impact options can be key allies.
Vision changes are perhaps the most common early sign of aging. By the time we reach our 40s, the lens of the eye often loses its flexibility, leading to presbyopia, the familiar struggle to read fine print up close.
Hearing, too, is impacted by the years, especially after decades of noise exposure. Known as presbycusis, this condition makes high-pitched sounds, like the chatter of children, harder to distinguish. And while louder speaking might seem like a solution, often it’s not enough to overcome this change, as clarity of sound also diminishes.
Even taste and smell, often taken for granted, gradually fade. Sweet and salty flavors are the first to go, with only faint traces of these tastes by one’s 70s. As the sense of smell wanes, some older adults lose interest in food, which affects nutrition and overall health.
The heart, like any other muscle, experiences wear and tear, which is why blood pressure often rises with age. The stiffening of arteries, combined with the heart’s reduced ability to respond to stress, explains why sudden physical exertion or illness can be riskier in later life. Similarly, lung capacity decreases over time as elasticity in lung tissue fades, reducing oxygen levels slightly and making heavy breathing more strenuous.
To counter these changes, aerobic exercise and balanced diets rich in heart-healthy fats (think olive oil and salmon) are powerful tools. These activities keep the heart more responsive and help maintain healthy blood pressure levels, making life’s stresses feel more manageable.
As the aging process progresses, certain organ functions start to lag, which can affect even basic routines.
While digestive function generally holds steady, minor changes can impact comfort. The stomach holds less food, and processing dairy, in particular, can become problematic. Lactase, the enzyme needed to digest lactose, diminishes with age, making milk, cheese, and yogurt uncomfortable for some. Intestinal movement also slows, raising the risk of constipation, a problem that can be aggravated by a low-fiber diet and inadequate hydration.
Age-related changes also impact bladder control. Muscles in the urinary tract may weaken, making it harder to fully empty the bladder and more common to experience urgency or incontinence. Kidney function also declines subtly, leading to a decreased ability to filter blood efficiently. While symptoms may be minimal, these changes can compound health problems when illnesses or medications stress the kidneys further.
While older adults may experience a mild decrease in reaction time and the ability to process new information, cognitive aging varies widely. Neuroplasticity—the brain’s ability to rewire itself—allows it to compensate for cell loss to a surprising extent. In fact, research increasingly shows that cognitive engagement, like puzzles, reading, or learning new skills, helps preserve brain function.
Memory loss, especially for short-term information, is nearly universal after age 70, though these changes are often manageable. Studies suggest that memory exercises, combined with physical activity and social engagement, can bolster mental sharpness and even boost mood.
As we age, our immune system also gradually becomes less efficient, increasing vulnerability to illnesses. Vaccines are vital to reduce risk, especially for flu and pneumonia, which can have severe consequences in older adults. Studies suggest that moderate exercise can help improve immune response, but aging’s toll on immune cells is inevitable to some degree, so maintaining a healthy lifestyle becomes crucial.
Aging well isn’t a destination—it’s a journey you take over decades. Emphasizing healthy habits can improve the quality of later years, and studies support that even starting these routines later in life offers benefits to your healthspan.
The field of aging research has been growing, with medicine increasingly geared toward improving quality of life as we grow older. Advances in geriatric care, preventative medicine, and genetics offer hope for aging with more ease and grace than ever before. As the global population ages, supporting health in later years becomes a priority not only for individuals but also for communities and policymakers.
Aging doesn’t have to be feared; it is life’s longest chapter and can be filled with rich experiences, deep connections, and wisdom. Those who approach it proactively find it often holds new possibilities—an opportunity to reflect, connect, and grow in ways that younger years don’t afford.