FUNCTIONAL ASSESSMENT

Evaluation of the older adult's functional abilities is a key component in gerontologic health care. Medical diagnoses alone are incomplete without an assessment of function. Two older adults with similar medical diagnoses of arthri­tis, hypertension, and osteoporosis, for example, can be at opposite ends of the spectrum of functional abilities.

TABLE 3-1 Common Health Problems in the Elderly
Health Problems	Percentage With Problems
Arthritis	49
Hypertension	36
Hearing impairment	30
Heart disease	27
Orthopedic impairments	18
Cataracts	17
Sinusitis	12
Diabetes	10

 

Assessing functional status can be done in many dif­ferent ways, using a variety of methods. Measures of func­tion should attempt systematically and objectively to evaluate the level at which an individual is functioning in a variety of areas, including biologic, psychological, and social health.

Selection of a screening tool to measure function de­pends on the purpose of data collection, the individual or target population to be assessed, availability and applica­bility of the instruments, reliability and validity of the screening tools, and the setting or environment. An issue that arises when assessing function is the question of ca­pability versus performance. For example, an older adult may be able to bathe without supervision; however, the long-term care facility where the person resides may dis­courage it for safety reasons. Among the more commonly used assessment tools are those that measure the ability to perform ADL and the patient's cognitive function.

When evaluating levels of function, determination of the older adult's ability to perform ADL and instrumental ADL (IADL) should be included. Activities of daily living are basic self-care tasks, such as bathing, dressing, groom­ing, ambulating, transferring (e.g., from a chair to bed), feeding, and communicating. Instrumental activities of daily living are more complex tasks that are necessary to function in society, such as writing, reading, cooking, cleaning, shopping, laundering, climbing stairs, using the telephone, managing money, managing medications, and using transportation. The IADL tasks indirectly examine cognitive abilities as well because they require a certain level of cognitive skills to complete.

Several tools are available for measuring functional status. One of the more commonly used tools is the Index of Activities of Daily Living. Developed by Katz in 1963 and revised in 1970, it summarizes performance in six functions: bathing, dressing, toileting, transferring, con­tinence, and feeding. It is used as an assessment tool to determine the need for care and the appropriateness of treatment and as a teaching aid in rehabilitation settings. Through questioning and observation, the rater forms a mental picture of the older adult's functional status as it existed during a 2-week period preceding the evaluation, using the most dependent degree of performance.⁴¹,⁴² Nu­merous studies using the Katz Index tool show significant validity and reliability. The advantage of the tool is that it is easy to administer and provides a "snapshot" of the older adult's level of physical functioning. The disadvan­tage is that it does not include IADL categories that are of equal importance, especially for older adults living in the community.