A key to the appropriate design of technology to support a person is assessing the needs of the person. Meeting the needs though technology is not simple and this section considers a problem with using a traditional form of assessment. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) - ADLs and IADLs are measures of dependency. The degree of difficulty people experience in carrying out ADLs and IADLs denotes their level of dependency. Information on dependency in the elderly population in Great Britain is recorded in the General Household Survey. ADLs relate to personal care tasks of bathing and washing, dressing, feeding, getting in and out of bed, getting to and from the toilet and continence management. IADLs relate to domestic tasks such as shopping, laundry, vacuuming, cooking a main meal and handling personal affairs.
Source: S Sutherland (1999) “Glossary of terms” in With Respect to Old Age: Long Term Care - Rights and Responsibilities, HMSO, UK

ADLs generally include the following:
• bathing
• continence
• dressing
• feeding
• going to the toilet
• transferring (moving from one position to another).

IADLs refer to core activities of independent living and include:
• managing finances
• preparing meals
• doing housework
• shopping
• remembering to take medications.

The key elements of an assessment measure is to emphasises independence, rather than other aspects of function, but whilst respecting how need is expressed by the person assessed. ADLs and IADLs provide a useful tool to measure and quantify behaviours and a frame of reference from which to compare and judge people’s performance to certain tasks. Although some forms of ADL and IADL use a qualitative assessment protocol many do not and actually quantify a person’s activities, this lessens the real activities and pigeon holes them into standardised compartments for easier reference and comparison.

A considerable body of research use instrumental ADLS and/or IADLS as the basis of developing technological solutions and many fail because they miss the critical aspects of a person’s life, such as their activity patterns and routines. For example: Mrs X might have not problems with washing, dressing, feeding, toileting, but it might take her over one hour to get from her bedroom down stairs to the kitchen. Her movements do not inhibit her activities as such, she can still do everything, it just takes longer. Moreover due to her manoeuvrability problems the amount of tasks she can complete are less than someone more manoeuvrable. In many standard ADL tests many of Mrs X’s problems might not be picked up.

A further difficulty with ADLs and IADLs is that they are standardised to specific occupations and categories. In other words the ADLS you might observe for a person with suspected dementia are different from a person with parkinson's disease or a person with a leg amputation. This in one way is perfectly obvious, as ADLs are a method of collecting specific data on a person's ability to cope with specific tasks and act as an assessment of teh person both in a medical and social way. But on the other hand this simplicity is exactly the reason why they fail to take into account the real needs of a person. By scoring specific activities it is clear that the overview is a generalisation of the person, not a snapshot of true glimpse into their life and how they live and cope with everyday events. This is further compounded by the pseudo medico-social orientation of the ADLs and IADLS. Depending on who administers the ADL the results will always be different. If it is a medically orientated professional such as an Occupational Therapist then they might well pick up on latent medical conditions but fail to enquire about other more social aspects, where as if the same test is administer by a social care professional then the social and psychological aspects of the person might well be stressed rather than the medical. Furthermore ADLs are useful at providing insight into the particular circumstance of a person at that time but not how they will be once technology has been introduced. The introduction of technology will change how people interest in their homes and their activities and routines might be ruined if these elements are missed in the design assessment process.

It is clear that ADLs are more than useful and valuable but only as part of an assessment and really their application in designing a technology to support a person (a user)are somewhat limited as an hour spent with the person for whom the technology is to designed ill illicit enough usable data to ensure a fairly good fit of technology to need. Moreover if the user is consulted and made aware of the elements of the design and the rationale of the design, as should other stakeholder provide their input and the result should be a design that meets the true needs of the user.

MDDS seeks to assist in the assessment process and fill some of the gaps that might have occurred if a professional is using ADLs as the main assessment process.