Monitoring Care of the Older Adult Functional Assessment of the Older Adult II

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Monitoring Care of the Older Adult Functional Assessment of the Older Adult II. Myriam Edwards MD Geriatrician, Assistant Professor, and Geriatric Medicine Fellowship Program Director Hurley Medical Center / Michigan State University. Lakshmi Gowda MD Geriatric Medicine Fellow - PowerPoint PPT Presentation

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Geriatric Assessment

Monitoring Care of the Older AdultFunctional Assessment of the Older Adult IIMyriam Edwards MD Geriatrician, Assistant Professor, andGeriatric Medicine Fellowship Program DirectorHurley Medical Center / Michigan State UniversityLakshmi Gowda MD Geriatric Medicine FellowHurley Medical Center / Michigan State UniversityGeriatric Education Center of Michigan

1Learning Objectives

Monitoring care and summaryDiscuss the altered presentation of illness in older adultsRecognize the importance of ongoing monitoring of functional status

Information about functional performance is important in caring for the older adult and complements information about that person s medical status. Knowledge of a person s functional strengths and weaknesses is necessary to guide decisions about goals of care, the need for services, and the appropriateness of the living situation. Physicians may underestimate functional disabilities in older persons [1 ],partly because physicians tend to use global rather than specific measures of function [2 ].To increase physician effectiveness in identifying functional disability, brief but systematic functional assessment of geriatric patients should be integrated into the office visit.

The initial functional assessment serves as a baseline for future comparison. Because the assessment includes measurable parameters, changes in function can be followed over time. If interventions are put into place successfully, then one can look for measurable improvements in function. A decline in function should prompt evaluation for an acute medical illness.

Community-based care is most effective if provided by a health care team that is knowledgeable about that person s baseline functional status.Geriatric Education Center of Michigan activities are supported by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Public Health Service Act, Title VII, Section 753(a).

This module was developed byMark Ensberg, MDGeriatric Education CenterMichigan State UniversityFunctional AssessmentCognitivePhysicalPsychologicalSocial SupportEnvironment

3Review: Functional Assessment What? (Dimensions of functional assessment)Is it Medical? Or Functional?Goals of CareMaintain FunctionRehabilitation (improve function)Support (expected decline) Monitor Effectiveness of InterventionsMeasure of OutcomeFunctional Assessment (Review)4Functional Assessment WHY?

The tendency to assume that weight loss is caused by an unrecognized malignancy or existing or new medical problem should be resisted. Although these possibilities cannot be ignored, weight loss should also trigger questions about the person s dietary pattern, meal preparation, grocery shopping, and social support. Functional AssessmentMonitor InterventionsReview of Medication List Drug Side Effects

Monitoring Medical Intervention:Balance Medical Rx and Function6Examples: MonitoringCompression FractureAtrial fibrillationPolypharmacy

7Managing PolypharmacyIncreased Confusion

Unsteadiness & Falls

Nausea or Constipation

Depression or Anxiety

8ENVIRONMENTInstrumental Activities of Daily Living:9Weight lossTalking Points Safe and successful independent living requires a fit between a persons functional capabilities, available support, and characteristics of the environment.This slide contains exactly the same information as Slide 3 looks at it in a different way. (A similar diagram can be found on page 3 of the Primer)The BOX represents the environment in which the person lives: home, a relative s home, assisted living facility, adult foster care home, or nursing home -- each has unique characteristics that can either facilitate or hinder successful living.There are 3 dimensions of function that are necessary for successful living in the home environment: 1. Cognitive impairment may affect decisions related to meal preparation and medication administration. This may threaten independent living. 2. Physical (gait & balance, ADLs) impairment may lead to falls and possible injury. This would threaten independent living. 3. Psychological depression may lead to poor initiative and malnutrition. Anxiety may also have consequences that threaten independent living. The caregiver/support network may need to: (a) guide decision-making, (b) assist with ambulation & ADLs, and (c) serve as the persons primary source of psychological or spiritual support.Quality of Life10Remind them of how conducting functional assessments help optimize the older adults quality of life.

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