PREPARED BY: PAKSAH BANEZ-MANGA, RN, MN

LEVEL4 FACULTY-CN,WMSU

FUNCTIONAL ASSESSMENT

FUNCTIONAL ASSESSMENT
LEARNING OBJECTIVES: at the completion of the
lecture, the students can
Define Functional Assessment
Describe the importance of a functional
assessment
Discuss the components of a
o
o
o
o

Physical Health Assessment

A self-Care Assessment
Psychological Assessment
Social Assessment

FUNCTIONAL ASSESSMENT
Is a systematic method of evaluating the
older adults ability to function within the
environment
Why is it Necessary?
It identifies the self-care abilities and deficits
of the older adult in order for needs to be
matched with services.

For example:

IMPORTANT USES OF FUNCTIONAL

ASSESSMENT FINDINGS

Acquisition of a database to use as a

basis for comparison
Identification of individual patient needs
Identification of specific self-care deficits
Providing a foundation to develop an
individualized care plan
Providing data for referral to special
services to promote independent health
care, day care , or housekeeping services
to promote independent living
Providing a means to evaluate treatment
and rehabilitation

COMPONENTS OF A FUNCTIONAL ASSESSMENT

Physical health Assessment

The goal of the Physical health
Assessment is to determine the
over all health and fitness of the
gerontological client
It provides much of the
information needed for the
portion of the FA.

PHYSICAL HEALTH ASSESSMENT

When an older person is admitted to the

care facility, the nurse performs the
admission interview to obtain the overall
health history.
When interviewing the nurse must allow
more time for the interview because the
health history spans more than 50 years.
The nurse may need to validate the
information from the family member or
significant other.
Health assessment is obtained as soon after
admittance to the facility as possible,
usually within the first few hours.

GUIDELINES FOR OBTAINING HEALTH HISTORY

General instructions:
General requests for information may
prompt a discussion of health
information. Making some or all of the
following questions unnecessary.
Social, cultural, developmental,
educational levels are assessed
throughout the interview
During the interview note the individuals
openness and readiness to learn

CURRENT HEALTH
Suggested opening statement please tell
me about your current health.
How would describe your general health?
Do you have any chronic problems, such as
diabetes, high blood pressure, arthritis, or
heart disease?
Have you had any weight loss or gain within
last year? Within the last several weeks?
Do you have any pain, unusual sensations,
or lack of sensation?

Do you have any cough, shortness of breath,

other trouble breathing? Do you cough up any
sputum? If yes, describe the sputum.
Do you have any headaches, dizziness,
weakness, fainting spells, or excessive
sweating?
Do you have any swelling?
Are there any discharges or drainage from
anywhere?
Does your heart ever race, pound, skip a beat,
or have any other unusual sensations?
Tell me all the medications you take, including
prescription, over-the-counter, or home
remedies.

PAST HEALTH
Suggested opening statement: It would help in
planning your care if you tell me about your past
health.
Were you immunized, (given shots or
vaccinated) for any disease?
Have you had a tetanus vaccination?
What childhood disease did you have?
Examples are measles and chickenpox.
As an adult, what illnesses have you had that
came and went, such as pneumonia or blood
clots?

PAST HEALTH

Were you ever treated for any mental

problems, such as depression?
What surgeries have you had?
Did you ever injure yourself and then
receive treatment? Do you ever fall?
Were you ever in the hospital for any
reason?
Have you ever had an allergic reaction
to medicine, such as penicillin? Do you
have any other allergies?

GENERAL HEALTH HABITS

Suggested opening statement: Please tell me
about your general health habits.
Are you on a special diet? What food do you
normally eat?
Do you have any problem eating, such as trouble
swallowing or have nausea or vomiting after
eating?
Do you drink caffeinated beverages such as
coffee, tea, or carbonated drinks?
How many glasses of water do you drink in 1 day?
How many hours do you usually sleep at night?
Do you take naps? Do you have any problems
sleeping? What type of sleeping problems?

What are your bowel habits? Do you use

laxatives, suppositories, or enemas? Do you ever
have diarrhea?
Tell me about your bladder habits. Do you urinate
often during the day? How much do you urinate?
Small amounts or fairly large amounts? Do you
have any problems urinating? Do you get up at
night to go to the bathroom?
What type of exercise do you engage in? how
often do you exercise? Do you drink any alcoholic
beverages? If so, what kind and how often?
Do you smoke? If so, what and how often?
Do you wear glasses, a hearing aid, or dentures?
Describe hearing loss and any vision loss.
Do you use a cane, crutches or walker?
Tell me about your memory.

NURSING FOCUS
Suggested opening statement: Please tell me
about your needs.
What are your strengths? Your
weaknesses?
What concerns do you have?
What questions can I answer for you?
What kinds of help do you need?
What could the nursing staff do to be the
most helpful to you?

SELF CARE ASSESSMENT

The

self-care assessment tells us how well

the older person is able to care for himself(
i.e. perform ADLs)in his environment.
It identifies what self-care activities could
be performed before entering the facility
and how much help, if any. Was needed in
performing self-care activities.
Nursing facility sometimes foster
dependence. In an effort to complete the
tasks such as eating, bathing or toileting.

KATZ INDEX OF INDEPENDENCE IN ACTIVITIES

OF DAILY LIVING
ACTIVITIES
POINTS (1 OR 0)

INDEPENDENCE:
(1 POINT)
NO supervision, direction
or personal
assistance

DEPENDENCE:
(0 POINTS)
WITH supervision,
direction, personal
assistance or total care

BATHING
POINTS:___________

(1 POINT) Bathes self

completely or needs
help in bathing only a single
part of the
body such as the back,
genital area or
disabled extremity.

(0 POINTS) Needs help with

bathing more
than one part of the body,
getting in or
out of the tub or shower.
Requires total
bathing.

DRESSING
POINTS:___________

(1 POINT) Gets clothes from

closets and
drawers and puts on clothes
and outer
garments complete with
fasteners. May
have help tying shoes.

(0 POINTS) Needs help with

dressing self
or needs to be completely
dressed.

TOILETING
POINTS:__________

(1 POINT) Goes to toilet,

gets on and
off, arranges clothes,
cleans genital area
without help.

(0 POINTS) Needs help

transferring to
the toilet, cleaning self or
uses bedpan or
commode.

TRANSFERRING
POINTS:___________

(1 POINT) Moves in and out

of bed or chair
unassisted. Mechanical
transferring aides
are acceptable.

(0 POINTS) Needs help in

moving from
bed to chair or requires a
complete
transfer.

CONTINENCE
POINTS:___

(1 POINT) Exercises
complete self control
over urination and
defecation.

(0 POINTS) Is partially or
totally
incontinent of bowel or
bladder.

FEEDING
POINTS:___________

(1 POINT) Gets food from

plate into
mouth without help.
Preparation of food
may be done by another
person.

(0 POINTS) Needs partial or

total help
with feeding or requires
parenteral feeding.

TOTAL POINTS = ______ 6 = High (patient independent) 0 = Low (patient very dependent)

MODIFIED BARTHEL INDEX IS SCORED

Item

Unable to
perform
task

Substanti
al help
required

Moderate
help
provided

Minimal
help
required

Fully
independ
ent

Personal
hygiene

Bathing
self

Feeding

10

Toilet

10

Stair
0
Climbing

10

Bladder
control

10

ambulati 0
on

12

15

Or
wheelch
air

Chair/be
d
transfer

12

15

U-Upper limb functions: self-care

activities (drink/feed, dress
upper/lower, brace/prosthesis, groom,
wash, perineal care) dependent
mainly on upper limb function:
1. Independent in self-care without
impairment of upper limbs
2. Independent in self-care with some
impairment of upper limbs
3. Dependent on assistance or
supervision in self-care with or
without impairment of upper limbs.
4. Dependent totally in self-care with
marked impairment of upper limbs.

PULSES PROFILE
The PULSES profile and Barthel Index assessment
tools are use to assess the functional ability. These
tools measure physical capabilities that the person can
and cannot do and how much assistance the elderly
person needs.
P-Physical condition: includes diseases of the viscera
(cardiovascular, gastrointestinal, urologic, and
endocrine) and neurologic disorders:

Medical problems sufficiently stable that medical or

nursing monitoring is not required more often than 3month intervals.

Medical or nurse monitoring is needed

more often than 3-month intervals but
not each week.
Medical problems are sufficiently
unstable as to require regular medical
and/or nursing attention at least weekly.
Medical problems require intensive
medical and/or nursing attention at least
a daily (excluding personal care
assistance only)

L-Lower limb functions: mobility (transfer

chair/toilet /tub or shower, walk,stairs.wheelchair)
dependent mainly on lower limb function:
1. Independent in mobility without impairment of
lower limbs
2. Independent in mobility with some impairment in
lower limbs, such as needing ambulatory aids, a
brace, or prosthesis, or else fully independent in a
wheelchair without significant architectural or
environmental barriers.
3. Dependent on assistance or supervision in mobility
with or without impairment of lower limbs, or partly
independent in a wheelchair or when there are
significant architectural or environmental barriers
4. Dependent totally in mobility with marked
impairment of lower limbs.

S-Sensory components: relating to

communication (speech and hearing) and
vision
1. Independent in communication and vision
without impairment
2. Independent in communication and vision
with some impairment such as dysarthria,
mild aphasia or need for eyeglasses or
hearing aid, or regular eye medication
3. Dependent on assistance, or an
interpreter or supervision in
communication or vision
4. Dependent totally in communication or
vision

E-Excretory functions (bladder and

bowel):
1. Complete voluntary control of bladder
and bowel sphincters
2. Control of sphincters allows normal
social activities despite urgency or
need for catheter, appliance, or
suppositories; able to care for needs
without assistance
3. Dependent on assistance in sphincters
4. Frequent wetting or soiling from
incontinence of bladder or bowel
sphincters.

S-Support factors: consider

intellectual and emotional
adaptability, support from family
unit, and financial ability
1.

2.

Able to fulfill usual roles and

perform customary tasks
Must make some modification in
usual roles and performance of
customary tasks

Cont.
1. Dependent on assistance,
supervision, encouragement, or
assistance from a public or private
agency because of any of the
above considerations
2. Dependent on long- term
institutional care (e.g. chronic
hospitalization, nursing home)
excluding time-limited hospital for
specific evaluation, treatment, or
active rehabilitation.

SCORING
For PULSES- the best possible score is 6, and the
worst is 24. a score of 16 or more indicates severe
disability.
The PULSES profile gives an overview of mobility,
self care and psychosocial functioning.
The PULSES profile can be used to monitor
changes in function.

Scoring
The Barthel Index focuses on self-care abilities and
persons mobility.
The score of 100 is the maximum possible score and
indicates independence in all items listed. Areas of
judgment and cognitive function are not assessed,
and problems in these areas may prohibit the
elderly paerson