Functional assessment
It is an evaluation of the person's ability to carry out the basic self-care activities of daily living
(ADLs), such as bathing. eating, grooming, and toileting.
Commonly used tool that is thought to be the most appropriate for assessing functional status in
older adults is the Katz Activities of Daily Living.
Functional ability
It is determined by the dynamic interplay of the frail elder's physiologic status; emotional and
cognitive statuses; and the physical, interpersonal, and social environments.
Functional Screening is important because...
Chronological age is poor indicator of ability.
Hospitalized older adults are at high risk for loss of function skills
o Environmental constraints (TV's, catheters, side rails)
o Decreased expectations for performance (ageism)
o New disabilities or illness
o Loss of functional abilities is a major cause of institutionalization.
The goal of a functional assessment screening is to...
restore or improve health,
monitor changes
enhance independence
identify disabilities
screen for issues needing further
assessment and referral
evaluate the need for community resources and equipment
Functional Assessment Screening
Vision / Hearing Mobility (arms, legs)
Oral / Nutrition
Elimination
Cognitive
ADL and IADL*
Home Environment
Social Support
Chronic Pain
Medications
When doing an assessment...
Assess, don't assume.
Watch, don't just ask.
Obtain baseline information: it is important to know what is normal for this individual.
Identify what helpers, equipment, and supports make doing activities of daily life possible.
Vision Screening
Condition of glasses
Snellen chart
When was the last eye exam?
Minimum is every two years. If diagnosed with diabetes or an eye condition such as glaucoma,
eye exams could be as frequent as every 6-12 months.
Hearing
Whisper test (Stand behind the person and whisper a word in each ear.)
Finger rub (Stand behind the person and rub two fingers together by each ear.)
Upper Extremities
Can the individual...
touch the palms of the hands to back of the head?
reach up over the head?
touch the hands together behind the waist?
Upper Mobility is needed for....
Combing and washing hair
Getting items off a shelf
Putting on a shirt
Lower Extremities
"Get Up and Go" Test
-Get up from a chair
-Walk 10 feet
-Turn around and walk back
-Sit down again
Problems with the above correlate with abnormal gait and increased risk of falling.
Oral Screening
Inspect the oral cavity and check.
the condition of teeth
the condition and fit of dentures
for oral lesions or infections such as candidiasis
Ask...
Do you have any problems eating or swallowing?
When was your last dental appointment?
Quadruple A's of Nutrition
Appearance
o Does the person look well nourished?
Appetite
o How is the person's appetite?
Access
o Does the person have access to funds to buy food? Get to the store?
Ability
o Can the person prepare own meals? Open cans? Cook safely?
Elimination: "DRIP"
D - Delirium, Depression, Dementia
R - Retention, Restricted mobility and/or environment
I - Infection, Inflammation, Impaction
P- Pharmaceuticals, Polyuria
If incontinence is a new problem, it must be evaluated further
Cognitive Function
Delirium
o Onset hours to days
Depression
o Onset weeks to months
Dementia
o Onset months to years
Remember
If an older adult was not confused a few hours or days ago, his or her confusion usually indicates an
acute problem that requires prompt evaluation.
For more information The Three Ds of Confusion in the Adapting Care Competency
Cognitive Function Screening Tools
Short Blessed Test (SBT)
Geriatric Depression Scale (GDS)
Cornell Depression Scale
These tools do not diagnose a condition. They merely indicate that further follow-up is necessary.
Activities of Daily Living
Ask if need help with activities done every day, such as ...
Bathing and grooming
Ambulation -Transfers
Toileting
Eating
Dressing
Instrumental Activities of Daily Living
Ask if need help with activities which are more complex, such as
Outside activities
Managing medications
Writing
Reading
Cooking
Cleaning
Managing money
Transportation
Shopping
Doing laundry
Going up stairs
Using the telephone
Home Environment
Ask if have trouble going up and down stairs.
Ask if have had any falls inside or outside of the home.
What kinds of safety hazards should you assess that might be present in the home?
Social Support
Who would be able to help in case of illness or emergency?
What community and family resources are available?
Chronic Pain
Do you experience pain that prevents you from doing certain activities?
Medications
What medications do you take?
What are the medications for?
Do you have any trouble taking them?
Caregivers
Being a caregiver is hard work. It is not unusual for a caregiver to neglect his or her own health
while taking care of a loved one.
Be sure to ask the caregiver how he or she is doing and what ways he or she is using to take care
of self.
Remember:
Preserving, nurturing, measuring, recording, and communicating function are the core of good geriatric
care.
