Functional Assessment
- Determine the nature of the presenting complaint (dyspnea in a fit 88 yo who has just flown back from Paraguay is different from dyspnea in a frail 72 yo who rarely leaves the house and requires daily home care);
- Start planning early for ED discharge (a left Colles fracture in a right-handed tennis-playing 82 yo vs in a walker-dependent 76 yo who lives alone)
Commonly Used Markers of Function
ADLs
Activities of Daily Living
One way to remember them is: “the things you do during the first twenty minutes of your day.”
- Transferring
- Toileting
- Bathing
- Dressing
- Feeding
- Continence
As a minimum:
For ED discharge the patient needs to be able to transfer out of bed and leave the department.
After ED discharge the patient needs to be able to use a toilet and be able to feed himself or be fed.
IADLs
Instrumental Activities of Daily Living
One way to remember them is: “the things you learned to do when you left your parents’ house.”
- Meal preparation
- Housekeeping
- Medication management
- Finances
- Transportation/Driving
- Shopping
- Phone and use of technology
Successful ED discharge will require a plan in place to ensure that at least the first three IADLs are intact – if not independently by the patient then provided by a caregiver.
Important Note
Get Up and Go Test
“Get up and Go Test.” Instruct the patient to get out of the bed, walk 10 feet, turn around, walk back, and sit down. This also can be used to test cognitive ability since it involves following instructions and performing a complex task.
Reference: Timed Get and Go Test, Podsiadlo, JAGS; 1991, 39(2):142-148 – View the EuroPMC article
- Watch the video below for an example of the “Get Up and Go” test.
Discussion: Functional Assessment
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i do this.
Walk near the pt
ok
yes
good info
always
ok
ok
It can work well for people who have been in care for a while. maybe not an acute setting if a fracture is expected.
ok
very clearly capable patient…would be nice to see example and commentary on more questionable case
I would walk along side the patient just in case they get off balance or fall
I agree
I like they way to remember ADLs vs IADLs
ok
.
interesting concept
Interesting good simple vedio
good functional assessment
I do this prior to discharge
I don’t think I’ve done it. I will now though
easy test to determine basic functioning
good check
Get up and try this out
Good check.
Slippers are fall hazard. Provider should be within arms reach of patient while is being evaluated for safety.
good
He did well with his road test. Although his slippers are a falls hazard.
I like this demonstration
good info
important notes to consider when assessing the elderly
not walking behind the pt is a good way for him to fall
easy test to determine basic functioning
assessment should always be done on ADLs to ensure pt is getting the proper assistance
walk wit him in case he falls
good encouragement
good encouragement
see how they’re able to function independently
always good to encourage pt ambulate
patient is able to ambulate and able to coordinate his steps, can leave the ED
good test
good test
Good road test, but someone should walk along beside the patient and perhaps have patient followed with wheelchair, in case patient unable to tolerate travel
agreed
Gait assessment is very underrated
Excellent full upright ambulation
Excellent full upright ambulation without ataxia.
Often walk with the patient to ensure they aren’t overly unsteady
great test. have been doing a modified version of it with my elderly patients.
nice and simple, straight forward test.
easy
It is a good idea to walk beside the patient in case he/she fails. Also ask if they usually use a cane or walker at home before you start the test (or it is a guaranteed fail).
I always stay close to the patient in case they will fall
In My language it is a road test.
good comparison
quick and easy
patient was able to do it,i agree
well nice interview
se hace una evaluación completa y adecuada
buena forma de evaluar
Easy and practical evaluation
muy bien
Very nice. I will try that with my patients.
🙂
xx
aa
a very easy was to test basic function
nice move by the doc blocking the slippers from sliding away with his foot
I’m glad you noticed!
patient is able to ambulate and able to coordinate his steps, can leave the ED
Patients appear to be physically able to ambulate and follow commands in this aspect seems ok to go home.
the patient was asked to get up and about and he did very well I agree he is ok to go