1. Functional Assessment Adam Burrows, MD Boston University Geriatrics Section Copyright Boston University Medical Center

2. Importance of Function Initial Assessment –Function = Starting Point Diagnosis Care Plan Episodic Assessment –Change in Function Sign of Medical Problem Concept of Diminished Functional Reserve

3. Definition of Function Independence & Disability Activities of Daily Living –Basic ADLs –Advanced ADLs (IADLs) “DEATTH SHAFTTT”

4. Basic ADLs D Dressing E Eating A Ambulation T Transfers T Toileting H Hygiene –Grooming –Bathing

5. Advanced ADLs (IADLs) S Shopping H Housekeeping –Cleaning –Laundry A Accounting = $ F Food Preparation T Telephone T Transportation T Taking Medications

6. ADL/IADL Assessment

7. FRAILTY COMORBIDITY DISABILITY MOBILITY IMPAIRMENT COGNITIVE IMPAIRMENT

8. Mobility Impairment –Medical Cardiovascular Pulmonary Musculoskeletal –Neurologic Stroke Neurodegenerative –Sensory

9. Cognitive Impairment –Dementias Alzheimer’s disease Vascular dementia Other –Mental illness Chronic Late-life

10. Assessment of Function Self-Report Surrogate Report Direct Observation –“Get up and go” test Clinic Bedside –Home Safety Assessment

11. Functional Goals Optimize Independence –Treat Impairments –Apply Adaptive Strategies Support ADL & IADL Needs Least Restrictive Setting

12. Medicare Current Beneficiary Survey www.cms.hhs.gov/mcbs Functional Status of US Elderly, 2002

13. Inouye. JAMA 1998; 279:1187-1193 Predictive Value of Function

14. Lubitz. NEJM 2003; 349:1048-55 Predictive Value of Function Functional Status at Age 70 Average Life Expectancy (years) Annual Health Care Costs ($) Independent14.3$4600 IADL Deficit Only12.4$8500 1+ ADL Deficit11.6$14,000