Functional Assessment
Screening of Older Adults
The quality of life is
determined by its
activities.
Aristotle
Functional Screening is
important because…
• Chronological age is poor indicator of ability.
• Hospitalized older adults are at high risk for
loss of function skills.
– Environmental constraints
(IV’s, catheters, side rails)
– Decreased expectations for
performance (ageism)
– New disabilities or illness
• Loss of functional abilities is
a major cause of institutionalization.
What do you think?
What would be your first
impression of this man if the
first time you met him he was
in a gown, lying in a hospital
bed, trying to pull out his IV,
and was confused?
What if you knew he was 70
years old?
What would you assume about
his level of function?
What if…..?
you knew he was a
regular surfer and
ran a multi-million
dollar company?
Would that change
your expectations of
his function? Why or
why not?
The goal of a functional assessment
screening is to…
restore or improve health
monitor changes
enhance independence
identify disabilities
screen for issues needing further
assessment and referral
 evaluate the need for community resources
and equipment
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Environmental
Community
Physical
Extended family
Living
environment
Psychological
Socioeconomical
Functional assessment includes all of these components.
Functional Assessment Screening
A systematic review
of these areas
•
•
•
•
•
•
•
•
•
•
Vision / Hearing
Mobility (arms, legs)
Oral / Nutrition
Elimination
Cognitive
ADL and IADL*
Home Environment
Social Support
Chronic Pain
Medications
* ADL: Activities of Daily Living; IADL: Independent Activities of Daily Living
When doing an assessment…
• Assess, don’t assume.
• Watch, don’t just ask.
• Obtain baseline information:
it is important to know what
is normal for this individual.
• Identify what helpers,
equipment, and supports make doing
activities of daily life possible.
Vision Screening
• Condition of glasses
• Snellen chart
• When was the
last eye exam?
Minimum is every two years. If
diagnosed with diabetes or an
eye condition such as
glaucoma, eye exams could be
as frequent as every 6-12
months.
Hearing
• Whisper test (Stand
behind the person and
whisper a word in each
ear.)
• Finger rub
(Stand behind the
person and rub two
fingers together by
each ear.)
Keep going, there is more
Hearing
• Cerumen
– Build up interferes
with the conduction
of sound.
• Hearing aids
Cerumen
– Check batteries
frequently; they last
anywhere from less than
a week to less than a
month.
– Can cause an increase of
cerumen impaction.
Upper Extremities
Can the individual…
• touch the palms of
the hands to back of
the head?
• reach up over the
head?
• touch the hands
together behind the
waist?
Upper Mobility is needed for…
• Combing and washing
hair
• Getting items off a shelf
• Putting on a shirt
What other activities
require upper
mobility?
Lower Extremities
• “Get Up and Go” Test
–
–
–
–
Get up from a chair
Walk 10 feet
Turn around and walk back
Sit down again
• Problems with the above correlate with
abnormal gait and increased risk of falling.
Oral Screening
Inspect the oral cavity and
check …
– the condition of teeth
– the condition and fit of dentures
– for oral lesions or infections such
as candidiasis
Ask…
• Do you have any problems eating
or swallowing?
• When was your last dental
appointment?
Quadruple A’s of Nutrition
• Appearance
Does the person look well
nourished?
• Appetite
How is the person’s appetite?
• Access
Does the person have access to
funds to buy food? Get to the
store?
For more information: DETERMINE nutrition
screen for older adults in Optimal Aging
Competency
• Ability
Can the person prepare own
meals? Open cans? Cook
safely?
Elimination: “DRIP”
D
R
- Delirium, Depression, Dementia
- Retention, Restricted mobility
and/or environment
I
- Infection, Inflammation,
P
- Pharmaceuticals, Polyuria
Impaction
If incontinence is a new problem, it must be evaluated further.
Cognitive Function
• Delirium
– onset hours to days
• Depression
– onset weeks to months
• Dementia
– onset months to years
Remember!
If an older adult was not confused a few hours or days
ago, his or her confusion usually indicates an acute
problem that requires prompt evaluation.
For more information: The Three Ds of Confusion in the Adapting Care Competency
Cognitive Function
Screening Tools
• Short Blessed Test
(SBT)
• Geriatric Depression
Scale (GDS)
• Cornell Depression
Scale
These tools do not diagnose
a condition. They merely
indicate that further follow-up
is necessary.
Activities of Daily Living
Ask if need help with
activities done every
day, such as …
–Bathing and
grooming
–Ambulation
–Transfers
–Toileting
–Eating
–Dressing
Instrumental Activities of Daily Living
Ask if need help with
activities which are more
complex, such as …
• Writing
• Reading
• Cooking
• Cleaning
• Shopping
• Doing laundry
• Going up stairs
• Using the telephone
•
•
•
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Outside activities
Managing medications
Managing money
Transportation
Home Environment
• Ask if have trouble going
up and down stairs.
• Ask if have had any falls
inside or outside of the
home.
• What kinds of safety
hazards should you
assess that might be
present in the home?
Social Support
• Who would be
able to help in
case of illness
or emergency?
• What
community and
family resources
are available?
Chronic Pain
• Do you
experience pain
that prevents you
from doing
certain activities?
Medications
• What medications
do you take?
• What are the
medications for?
• Do you have any
trouble taking them?
Caregivers
Being a caregiver is
hard work. It is not
unusual for a
caregiver to neglect
his or her own health
while taking care of a
loved one.
Be sure to ask the
caregiver how he or she is doing and what ways
he or she is using to take care of self.
Remember:
Preserving, nurturing,
measuring, recording, and
communicating function are
the core of good geriatric care.
Functional Assessment Screening of Older Adults was prepared by
Catherine Van Son, Ph.D., R.N., for the Older Adult Focus Project,
OHSU School of Nursing.