Functional Assessment in the Older Adult



The aging process in humans is a complex biochemical process which include all the changes  taking place socially, psychologically and physically.  The aging process is inevitable with signs and symptoms occurring throughout the body systems.   The process and it effects depends on genetics and environmental factors and is different from person to person.  It also interferes with the growth and development of the body tissues which increase the risk of a variety of immune system disorders.   

Functional status assessment is fundamental to geriatric care.  Functional status can be described as "an individual's ability to perform normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being" (National Palliative Care Research Center, 2011).   Decline in function is measured by an individual's loss of independence in activities of daily living (ADLs, IADLs) over a period of time.  A change in functional status is often the only or the first sign of illness or exacerbation of a chronic condition.  Functional decline in hospitalized older adult patients include pressure sore, pre-existing functional impairment, cognitive impairment, and low social activity. Clinical outcomes of patients who exhibit functional decline were nursing home placement and death.  Functional assessment is key in the examination of every older adult to monitor for how well the individual is coping in all aspects of their lives.  The nurse should consider how well the patient walks, follows instruction, undresses themselves, and maneuvers.  

The information from a functional assessment can provide objective data to assist with targeting individualized rehabilitation needs or to plan for specific in home services such as capabilities, facilitating early recognition of changes that many signify a need either for additional resources or for a medical work up for the patient.  There are many functional status assessment tools available to monitor a patients ability to perform daily task and the ability to self manager.  Some common tool used include :

  • The Northwestern Geriatric Functional Status Review Instrument
  • The Lawton Instrumental Activity of Daily Living Tool
  • Katz Index of Independence in Activities of Daily Living (ADL)
  • Comprehensive Geriatric Assessment (CGA)
  • Mobility Assessments
  • Physical examination
Nursing interventions include:
  • Conducting comprehensive and interdisciplinary geriatric assessments of physical, psychosocial, and functional status at admission.
  • Encourage activity during hospitalization (and at home) with structured exercises, progressive resistance strength training, and walking programs, in coordination with rehabilitation therapies (physical and occupational)
  • Implement early mobilization for acute and critically ill patient based establish protocols.
  • Ensure assistive devices are in used: hearing aids in place; glasses on; walker or cane.
  • Use of environmental enhancements for eldercare including handrails, uncluttered hallways, large clocks and calendars, elevated toilet seats, and door levers.
  • Integrate established protocols aimed at reducing the risk of geriatric syndromes and improve self care, continence, nutrition, mobility, sleep, skin care, cognition, and minimizing adverse effect of selective procedure (e.g. Urinary catherization).
  • Evaluated the appropriateness of medications, minimizing the use of sedative-hypnotic medications, and ensuring correct medication dosing; monitoring responses to drug therapy and ensuring medication reconciliation during hospitalization and at discharge.
  • Promote safety while encouraging independence and maintaining dignity
  • Integrate geriatric interdisciplinary team training with use of geriatric specialists and acute care for elderly and geriatric resource nurses models of care
  • Consider participation in best practice models for elder care (American Academy of Nursing’s Expert Panel on Acute and Critical Care, 2007). 

Key Nursing Diagnosis are:

  • Self care deficit
  • Activity intolerance
  • Impaired physical mobility
  • Impaired gas exchange
  • Social Isolation
  • Powerlessness
  • Urinary incontinence
  • Altered sleep pattern
  • Compromised family coping
  • Fatigue
  • Risk for fall
  • Risk for infection
  • many more....

Education of the patient, family and staff are important to improve self care outcomes and decrease functional decline of the patient

Key nursing theory is Dorothy Orem's self care theory of nursing, which emphasis the importance of patients being self sufficient and the need for individual self care.   The theory explains how nurse need to promote self care in patients so they feel autonomy and can move back to state of wellness and functional independence

Case study - Case study demonstrating the important of improving functional independence and providing interventions to help patient's to achieve that goal. 

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