UMMS CRIT Module I: Functional Assessment of Older Adults Gerry Gleich, MD Division of Geriatric...

UMMS CRIT Module I: Functional Assessment of Older Adults

Gerry Gleich, MDDivision of Geriatric MedicineUniversity of Massachusetts Medical School

UMMS CRIT 2012 Module I: Functional Assessment

Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation

Functional Status

• Important predictor of morbidity and mortality

• Important predictor of institutionalization



Functional Status

• Tell me about function before anything else

• If you must tell me about an elderly person’s age, gender, and

medical problems first… Tell me about their functional status

next



What should you tell me?

• ADLs – self care

• IADLs – ability to live independently



Activities of Daily Living (ADL)

• D Dressing

• E Eating

• A Ambulation

• T Transfers

• T Toileting

• H Hygiene

– Grooming

– Bathing



Activities of Daily Living (ADL)

• A Ambulation

• B Bathing

• C Continence

• D Dressing

• E Eating

• F Falls /Transfers

• G Grooming



Instrumental Activities of Daily Living (IADL)

• S Shopping• H Housekeeping

– Cleaning– Laundry

• A Accounting = $• F Food Preparation• T Telephone• T Transportation• T Taking Medications



Instrumental Activities of Daily Living (IADL)

• M Meds

• M Meals

• M Money Management

• M Marketing

• T Telephone

• L Laundry

• C Car / Transportation



0%10%20%30%40%50%60%70%80%90%

100%

65-74 75-84 85+

3-6 ADLDeficits

1-2 ADLDeficits

IADL DeficitOnly

Independent

Medicare Current Beneficiary Survey ww.cms.hhs.gov/mcbs

Functional Status of US Elderly, 2002



0

20

40

60

80

100

01

2+

Functional Risk Group

Charlson Index

Inouye. JAMA 1998; 279:1187-1193

Predictive Value of Function



Functional Status at Age 70

Life Expectancy (in years)

Annual Health Care Costs

Independent 14.3 $4,600

IADL Deficit Only 12.4 $8,500

1 + ADL Deficit 11.6 $14,000

Predictive Value of Function

Lubitz. NEJM 2003; 349:1048-55



Functional decline in the elderly

A Chain is only as strong as its weakest link



Functional Decline

Cognitive

Medical

Nutrition

IncontinenceEnvironmental

Special senses

Social support

Polypharmacy



Assess Function

• ADL, IADL - Self-Report, Surrogate Report

• Direct Observation

– “Get up and go” test

• Office

• Bedside

– Home Safety Assessment – Physical therapy

– Nutritional Assessment



Assess Cognitive Impairment

• Mini-Mental State Exam

• Mini-Cog

• Don’t forget to do it



Set Functional Goals

• Optimize Independence

– Treat Impairments

– Apply Adaptive Strategies

• Support ADL & IADL Needs

• Least Restrictive Setting



Reaching Functional Goals

• Teamwork

– Care Givers

– Community resources for IADL assistance

– Physical therapist

– Occupational therapist

– Speech therapist

– Social work

– Nutritionist

– Pharmacist



Summary: AMP UP Function

• When caring for older adults…

– Assess Function

– Maximize Function

– Prevent Functional Decline

– Use a team approach

– Patient-Centered Goals

UMMS CRIT Module I: Functional Assessment of Older Adults Gerry Gleich, MD Division of Geriatric...

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