Functional Assessment of Older Adults

2 Objectives  Define functional assessment and the terminology related to functional assessment.  Describe some characteristics of functional decline in older persons.  Define functional assessment and the terminology related to functional assessment.  Describe some characteristics of functional decline in older persons.

3 Objectives  Identify comorbid conditions that might impact negatively on the functional status of an older adult.  Assess function using validated tools.  Plan strategies to promote / maintain optimal function in older adults.  Identify comorbid conditions that might impact negatively on the functional status of an older adult.  Assess function using validated tools.  Plan strategies to promote / maintain optimal function in older adults.

4 Terminology  Functional Assessment  Activities of Daily Living (ADLs)  Instrumental Activities of Daily Living (IADLs)  Psychological function  Social functioning  Functional Assessment  Activities of Daily Living (ADLs)  Instrumental Activities of Daily Living (IADLs)  Psychological function  Social functioning

5 Characteristics of functional decline  Chronic conditions increase with age – arthritis, HTN, heart disease, hearing impairment, cataract  Older persons use 1/3 of physician resources, 1/4 of total medications prescribed, and 2/5 of hospital admissions

6 Functional decline  35.6 million over 65 (2002) Who are limited by chronic condition? (from 2000 data)  26.1% of those 65 – 74 (young-old)  45.1% of those 75+ (old old)  73.6% of those 80+ (oldest old)  35.6 million over 65 (2002) Who are limited by chronic condition? (from 2000 data)  26.1% of those 65 – 74 (young-old)  45.1% of those 75+ (old old)  73.6% of those 80+ (oldest old)

7 Comorbid conditions  Acute illness  Alteration in nutrition and / or hydration  Chronic illness  Delirium  Dementia  Economics  Environment  Medications  Psychiatric comorbidities – depression  Psychological / social stressors  Acute illness  Alteration in nutrition and / or hydration  Chronic illness  Delirium  Dementia  Economics  Environment  Medications  Psychiatric comorbidities – depression  Psychological / social stressors

8 Functional assessment tools Katz Activities of Daily Living (ADL) Older American Resources and Services Assessment (OARS)  Bathing  Dressing  Toileting  Transferring  Continence  Feeding Katz Activities of Daily Living (ADL) Older American Resources and Services Assessment (OARS)  Bathing  Dressing  Toileting  Transferring  Continence  Feeding KATZ ADL Try This Assessment Series available on Hartford Institute website at

9 Functional assessment tools  Ability to Telephone  Shopping  Food Preparation  Housekeeping  Laundry  Ability to Telephone  Shopping  Food Preparation  Housekeeping  Laundry Lawton Instrumental Activities of Daily Living (IADL) Mode of Transportation Responsibility for Own Medication Ability to Handle Finances Mode of Transportation Responsibility for Own Medication Ability to Handle Finances

10 Functional assessment tools PULSES Profile  Physical Condition  Upper Limb Function  Lower Limb Function  Sensory Components  Excretory Functions  Support Factors PULSES Profile  Physical Condition  Upper Limb Function  Lower Limb Function  Sensory Components  Excretory Functions  Support Factors

11 Functional assessment tools SPICES  Sleep Disorders  Problems  Incontinence  Confusion  Evidence of Falls  Skin Breakdown SPICES  Sleep Disorders  Problems  Incontinence  Confusion  Evidence of Falls  Skin Breakdown SPICES Try This Assessment Series available on Hartford Institute website at

12 Functional assessment tools Timed “Get-up and Go” Test – Ambulation  Rise from a chair  Stand still momentarily  Walk toward the wall  Turn around  Walk back to chair  Turn around  Sit down  Rise from a chair  Stand still momentarily  Walk toward the wall  Turn around  Walk back to chair  Turn around  Sit down

13 Strategies for optimal functioning  Exercise and physical activity  Design environments with handrails, wide doorways, raised toilet seats, etc.  Judicious use of medications  Regular exam for cancer prevention and other diseases  Alternatives to restraints  Exercise and physical activity  Design environments with handrails, wide doorways, raised toilet seats, etc.  Judicious use of medications  Regular exam for cancer prevention and other diseases  Alternatives to restraints

14 Strategies for optimal functioning  Minimize bed rest  Optimize nutritional patterns  Maintain vaccination status  Provide information to caregivers on causes of functional decline related to acute and chronic conditions.  Minimize bed rest  Optimize nutritional patterns  Maintain vaccination status  Provide information to caregivers on causes of functional decline related to acute and chronic conditions.

15 Summary  Defined functional assessment  Described functional decline  Comorbid conditions  Reviewed assessment tools  Strategies for optimal functioning  Defined functional assessment  Described functional decline  Comorbid conditions  Reviewed assessment tools  Strategies for optimal functioning

16 QUESTIONS?