Module 4 Functional Assessment Essay

Module 4 Functional Assessment

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Competency 1.  Define functional assessment and the terminology related to functional assessment.

 A variety of instruments and methods are available for conducting functional assessment on the older adult:  Katz Activities of Daily Living index (ADL), the Barthel Instrumental Activities of Daily Living index (IADL), PULSES Profile, SPICES, and the Older American Resources and Services (OARS) assessment.

1. Functional Assessment is a comprehensive evaluation of the physical and cognitive abilities required to maintain independence. Assessment tools provide objective measures of physical health, activities of daily living (ADLs), instrumental activities of daily living (IADLs), and psychological and social functioning.  In a more narrow sense, function can be defined as “the ability to function in the arena of everyday living”.
2. Activities of Daily Living (ADLs) are the basic daily activities of bathing, dressing, toileting, continence, transfer / mobility, grooming, and feeding. The Katz ADL Index has been the most reliable and easy to use.  It gathers information by observation on bathing, dressing, toileting, eating, transferring, continence, and grooming.
3. Instrumental Activities of Daily Living (IADLs) are the basic daily activities needed to live independently in the community – shopping, food preparation, cooking, using the telephone, doing laundry, housekeeping, managing medications, managing finances, maintaining a home and property, performing duties of employment or volunteer work, and traveling (driving or using public or private transportation systems).
4. Psychological Function is assessed by measuring cognitive mental and affective functions independently (See Module 5).
5. Social functioning includes social interactions and resources, subjective well-being and coping, and person-environment fit.

 Competency 2.  Describe some characteristics of functional decline in older persons.

1. The incidence of chronic conditions increases with age (arthritis, hypertension, heart disease, hearing impairment, orthopedic impairment, and cataract).
2. Persons over 65 years of age use approximately one-third of available physician resources, and one-fourth of total medications prescribed, and they constitute more than two-fifths of acute hospital admissions.
3. In 2002, there were an estimated 35.6 million (12.3%) people age 65 or older, and it was estimated that 2% of the population was age 85 and older. By 2030, there will be about 71.5 million older persons.  The 85+ population will increase from 4.6 million in 2002 to 9.6 million in 2030 and 19 million by 2050.
4. Functional decline, as measured in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), is more prevalent with age (20% of older persons over 65 years require assistance with ADLs; 45% of older persons over 85 years require assistance with ADLs).

 Competency 3.  Identify comorbid conditions that might impact negatively on the functional status of an older adult.

 Acute illness

1. Alteration in nutrition and / or hydration
2. Chronic illness
3. Delirium
4. Dementia
5. Economics
6. Environment
7. Medications
8. Psychiatric comorbidities, especially depression
9. Psychological / social stressors.

Module 4 Functional Assessment