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Functional Status

Functional Status. Important predictor of morbidity and mortality Important predictor of institutionalization. Functional Status. Tell me about function before anything else

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Functional Status

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  1. Functional Status • Important predictor of morbidity and mortality • Important predictor of institutionalization

  2. 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

  3. What should you tell me? • ADLs – self care • IADLs – ability to live independently

  4. Activities of Daily Living (ADL) • D Dressing • E Eating • A Ambulation • T Transfers • T Toileting • H Hygiene • Grooming • Bathing

  5. Activities of Daily Living (ADL) • A Ambulation • B Bathing • C Continence • D Dressing • E Eating • F Falls /Transfers • G Grooming

  6. Instrumental Activities of Daily Living (IADL) • S Shopping • H Housekeeping • Cleaning • Laundry • A Accounting = $ • F Food Preparation • T Telephone • T Transportation • T Taking Medications

  7. Instrumental Activities of Daily Living (IADL) • M Meds • M Meals • M Money Management • M Marketing • T Telephone • L Laundry • C Car / Transportation

  8. Medicare Current Beneficiary Survey ww.cms.hhs.gov/mcbs Functional Status of US Elderly, 2002

  9. Inouye. JAMA 1998; 279:1187-1193 Predictive Value of Function

  10. Predictive Value of Function Lubitz. NEJM 2003; 349:1048-55

  11. Functional decline in the elderly A Chain is only as strong as its weakest link

  12. Cognitive Medical Polypharmacy Nutrition Functional Decline Social support Special senses Incontinence Environmental

  13. Assess Function • ADL, IADL - Self-Report, Surrogate Report • Direct Observation • “Get up and go” test • Office • Bedside • Home Safety Assessment – Physical therapy • Nutritional Assessment

  14. Assess Cognitive Impairment • Mini-Mental State Exam • Mini-Cog • Don’t forget to do it

  15. Set Functional Goals • Optimize Independence • Treat Impairments • Apply Adaptive Strategies • Support ADL & IADL Needs • Least Restrictive Setting

  16. Reaching Functional Goals • Teamwork • Care Givers • Community resources for IADL assistance • Physical therapist • Occupational therapist • Speech therapist • Social work • Nutritionist • Pharmacist

  17. Summary: AMP UP Function • When caring for older adults… • Assess Function • Maximize Function • Prevent Functional Decline • Use a team approach • Patient-Centered Goals

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