UMMS CRIT Module III: Functional Assessment of Older Adults Gerry Gleich, MD University of...
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Transcript of UMMS CRIT Module III: Functional Assessment of Older Adults Gerry Gleich, MD University of...
UMMS CRIT Module III: Functional Assessment of Older Adults
Gerry Gleich, MDUniversity of MassachusettsDivision of Geriatrics
UMMS CRIT 2010 Module III: 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
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
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
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
What should you tell me?
• ADLs – self care
• IADLs – ability to live independently
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Activities of Daily Living (ADL)
• D Dressing
• E Eating
• A Ambulation
• T Transfers
• T Toileting
• H Hygiene
– Grooming
– Bathing
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Instrumental Activities of Daily Living (IADL)
• S Shopping• H Housekeeping
– Cleaning– Laundry
• A Accounting = $• F Food Preparation• T Telephone• T Transportation• T Taking Medications
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Medicare Current Beneficiary Survey www.cms.hhs.gov/mcbs
Functional Status of US Elderly, 2002
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
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Inouye. JAMA 1998; 279:1187-1193
Predictive Value of Function
0
20
40
60
80
100
01
2+
Functional Risk Group
Charlson Index
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
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
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Functional decline in the elderly
Final common pathway of many problems
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Functional Decline
Cognitive
Medical
Nutrition
IncontinenceEnvironmental
Special senses
Social support
Polypharmacy
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Assess Function
• ADL, IADL - Self-Report, Surrogate Report
• Direct Observation
– “Get up and go” test
• Office
• Bedside
– Home Safety Assessment – Physical therapy
– Nutritional Assessment
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Assess Cognitive Impairment
• Mini-Mental State Exam
• Mini-Cog
• Don’t forget to do it
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Set Functional Goals
• Optimize Independence
– Treat Impairments
– Apply Adaptive Strategies
• Support ADL & IADL Needs
• Least Restrictive Setting
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Reaching Functional Goals
• Teamwork
– Care Givers
– Community resources for IADL assistance
– Physical therapist
– Occupational therapist
– Speech therapist
– Social work
– Nutritionist
– Pharmacist
UMMS CRIT 2010 Module III: Functional Assessment
Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation
Summary: AMP UP Function
• When caring for older adults…
– Assess Function
– Maximize Function
– Prevent Functional Decline
– Use a team approach
– Patient-Centered Goals