Functional Assessment in the Older Adult

Rationale behind Functional Status Assessments

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.  

Purpose of functional status assessments: 

• To determine the presence and severity of a illness
• To measure a individuals's need for care
• To monitor changes in functional status over a time period
• To maintain cost effective clinical care. 

• Current disease or illness affecting functional status
• Vision and Hearing: glasses, hearing aids
• Skin assessment:  skin breakdown, elasticity, pressure sores
• Mobility: Is patient using assistive devices? balance, fine motor skills, range of motion, strength, flexibility, fall risk, previous fall.   
• Continence: urinary and bowel
• Nutritional Status: look for evidence of malnutrition
• Mental and Cognitive status: early dementia, Alzeimers disease, and depression, Neurological assessment, cognitive abilities and memory monitoring, mood and behavior patterns, following directions. 
• Home Environment:  safety and security, functionality of home  
• Social Support: Family support, means of transportation
• Fall, gait and balance assessment
• List of Medication
• Family history: history of familial functional illnesses such as early onset Alzeimers, dementia, depression.
• Past medical history
• Activities of daily living (ADLs)- basic activities such as transferring, ambulation, bathing, brushing teeth, eating, etc. 
• Instrumental ADLs - complex activities such as using the telephone, preparing meals, arranging transportation, managing finances, and care taking ability
• Psychosocial:  Depression, grief, anxiety, loneliness.
• Pain management 
• Physical Examination
• Braden scale - for predicting pressure sore risk
• Depression scale 
• Pain scale (Herbert, 2007)