FUNCTIONAL ASSESSMENT

Functional impairment is defined as difficulty performing, or requiring the assistance of another person to perform, one or more of the following Activities of Daily Living (ADL)

2 types
Basic Activity of Daily Living are activities necessary to maintain physiologic functioning like bathing, ambulation, toileting, transferring, eating, drinking etc. Functional Assessment will determine the level of assistance or caregivers need of the patient. Instrumental Activity of Daily Living are activities which people make use or instruments and aspects of cognition like combing, using telephone, shopping etc. Functional assessment can disclose a more subtle disabilities and the need for a more

functional assessment - is a multidimensional and often interdisciplinary diagnostic process, which assesses and quantifies an older adults medical, psychosocial and functional status.

Uses of Functional Assessment:

It can decrease the number of medical specialist visits and overall health care costs and increase patient satisfaction and quality of life. Used to determine the current and future health care and psychosocial needs of frail elderly. The comprehensive assessment of the frail elderly patient provides useful diagnostic and prognostic information and serves as a baseline for better understanding immediate and longterm patient and family needs and wishes. It is used to develop a comprehensive plan for therapy and future care decisions and can also help in the process of long-term care decision-making.

It is also to prevent further loss of function and to maintain the self-care status of many elders. It helps the nurse in identifying care giving or health problems or conditions which might necessitate nursing intervention like the risk for fall. It determines the level of independence, strength and safety of the elders.

MEASURING INSTRUMENTS
1.Katz ADL Scale 2. Lawton-Brody IADL Scale 3. Get Up and Go Test and Timed Get Up and Go Test 4. Clock Drawing Test 5. Mini-Mental Exam 6. Geriatric Depression Scale.

Katz Index of Independence in Activities of Daily Living (ADL) is the most used scale to screen for basic functional activities of older patients.

The IADLs are assessed using the Lawton-Brody Instrumental Activities of Daily Living (IADL) Scale which can also be administered by trained office staff

The Get Up and Go Test 3 (see below) is a practical balance and gait assessment test for an office assessment. The Timed Up and Go Test 4 is another test of basic functional mobility for frail elderly persons. Balance can also be evaluated using the Functional Reach Test. In this test the patient stands next to a wall with feet stationary and one arm outstretched. They then lean forward as far as they can without stepping. A reach distance of less than six inches is considered abnormal. If further testing is advisable,

get Up and Go Test Staff should be trained to perform the Get Up and Go Test at check-in and query those with gait or balance problems for falls. Rise from an armless chair without using hands Stand still momentarily Walk to a wall 10 feet away Turn around without touching the wall Walk back to the chair Turn around Sit down Individuals with difficulty or demonstrate unsteadiness performing this test require further assessment
.

Clock Drawing Test Screening for cognitive functioning can be done easily and quickly MINI-MENTAL ASSESSMENT a test for cognitive status Geriatric Depression Scale (GDS) is a 15-item questionnaire that can be completed in writing or during an interview.

CONDITIONS AFFECTING GERIATRIC FUNCTIONAL STATUS

Shoulder function Hand function Vision Hearing Cognition Bladder Continence Nutrition Alcoholism Stress Depression Balance