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Functional Assessment of the Frail Elderly
Determine is this appropriate, ie. too frail?
Often only the initial phase of rehabilitation but holistic approach critical.
Unfortunately, in acute care, facility-centred as opposed to fully client-centred. Much better in RCU/PCU/Rehab.
Often the rehabilitation process is completed as outpatient and/or in the client’s home.
Functional Assessment cont’d
Cognition – MMSE, FAB, MOCA
Functional Pain Control – meds. vs. function
Role Blurring – multi-disciplinary team approach
Collateral, collateral, collateral
Typical Occupational Performance Issues
ADL
Assess but minimal opportunity to address in acute care
A few basic dressing/washing tips
Primarily identify limitations being specific as possible
Often important for client to do as much for themselves as possible
Key issue is often toileting – effects on skin integrity
Typical Occupational Performance Issues cont’d
IADL
Again identify deficits/limitations/unmet needs
Very limited opportunity to address in acute care
Usually provide input home care needs following assessment using a representative task (look at mobility, balance and endurance performing task as well as processing skills.
Ramps – very expensive and often big.
Typical Occupational Performance Issues cont’d
Home Access Stairs into home – outside, inside, railings
Ramp versus porch-lift – greater than 4 steps, recommend porch-lift
Provide ramp specifications as appropriate
Often look at acceptable risk given situation – house-trapped vs. contracting infection in nursing home. (1, 2). Psychological impact and affects on confusion.
Balance / deconditioning
Typical Occupational Performance Issues cont’d
Transfers
Fear of falling can often be as debilitating as actual fall
Frail elderly twice as likely to fall, slightly over half the falls occur in the elderly occur outside the home and of those in the home many occur at night and in or on the way to the bathroom.(3,4,5)
Typical Occupational Performance Issues cont’d
Transfers continued:
• Equipment – consider factors affecting use (6)
Toilet – safety frame vs. bar and/or RTS
Tub/shower – bath board, chair or bench, bars, hand-held shower. Lift - $$$$.
Commode – regular vs. drop-arm Superpole Wiping aid, mechanical cleaning seat
Cane, 2ww, 4ww, wheelchair
Typical Occupational Performance Issues cont’d
Mobility – in conjunction with PT
Need to consider need to carry items
Home setup critical to usage as is client’s ability and willingness to learn to do things in a different way
Typical Occupational Performance Issues cont’d
Mobility continued:
• If wheelchair – realistically usable and user friendly (for client and/or care-giver)
Arm style Swing-away detachable footrests Light-weight
Rear wheel location, wheel type and castor style
Seating features
Conclusion Need to look at the overall goals of care first
Inceased awareness of when referral to an occupational therapist and geriatric team can help your aging clients to maintain independence and remain at home as they become more frail.
Greater appreciation of the complexity and detail needing to be attended tp when looking at functional issues, how they are addressed and their impact on a patient’s overall health.
References1. Haley RW, Culver DH, White JW, Morgan WM & Emeri TG. The nationwide
nasocomial infection rate – a need for vital statistics. American Journal of Epidemiology 1985; 121: 159-167.
2. Nicolle LE, Garibaldi R, Strausburgh LJ. Infections and antibiotic resistance in nursing homes. Clinical Microbiology Review 1996; 9: 1-17.
3. Northridge ME, Nevitt MC, Kelsey JL and Link B. Home hazards and falls in the elderly: the role of health and functional status. American Journal of Public Health 1995; 85: 509-15.
4. Bergland A, Jarnlo G & Laake K. Predictors of falls in the elderly by location. Aging Clinical and Experimental Research 2003; 15: 43-50.
5. Bleijlevens MH, Diedericks JP, Hendricks MR, van Haastreqt JC, Crabolder HF & van Eijk VT. Relationship between location and activity in injurious falls: an exploratory study. Published online BMC Geriatrics 2010; 10:40 (18 June 2010).
6. Kraskowsky LH & Finlayson M. Factors affecting older adults’ use of adaptive equipment: review of the literature. American Journal of Occupational Therapy 2001; 55(3): 303-10.
Questions
Contact information:
Greg Parsons
473 – 2729
