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functional assessment
Assessment of functional status.
Functional status is the ability to function in the arena of everyday living.
Clinical significance:
1) essential to medical decision making
2) not assessed in traditional medical problem list
3) other measures (e.g. mental status) do not always predict function
4) function inversely correlates with mortality & nursing home placement (& probably quality of life)
Procedure:
use of formal measures of functional status:
1) advantages
a) specificity, uniformity
b) uses prompts for acquistion of information
c) allows for monitor over time
d) identifies needs & elgibility for services
e) helps determine appropriate living situation
f) facilitates communication between professionals
2) disadvantages
a) may dehumanize the evaluation
b) can oversimplify complex situations
c) can be time consuming
3) issues of efficiency
a) target to appropriate patients
b) use brief screening measures
c) use self-assessment measures if appropriate
d) use office staff or other personnel
e) use key informants (family/friends), particularly if cognitive impairment is present
4) issues in measurement
a) picking 'cutoffs' & normal vs abnormal
b) cultural & ethnic factors
c) gender differences
d) characteristics of measure
e) purpose of measurement
1] screening
2] comprehensive assessment
f) source(s) of information
g) 'Do you do?' vs 'Can you do?'
brief assessment includes:
1) visual assessment
- near visual acuity < 20/40 with correction suggests significant visual impairment [1]
2) hearing assessment*
3) gait evaluation - normal gait speed > ~0.9 meters/second
4) cognitive assessment [1]
* remove impacted cerumen & retest prior to sending patient to audiology if hearing impairment noted [1]
Notes:
- the get-up & go test* can be use to assess multiple skills including lower-extremity strength, balance & to a lesser extent walking speed [1]
* may be preferred functional assessment tool in patients with Parkinson's disease [1]
Related
functional improvement
functional status; performance status
performance scale
Specific
5-times sit-to-stand test (5xSST)
activities of daily living (ADL)
balance evaluation
Barthel index
functional assessment staging (FAST)
functional independence measure (FIM)
gait evaluation
Karnofsky performance index (palliative performance scale)
Pfeiffer functional activities questionnaire (FAQ)
physical performance testing
WHO/EGOG performance scale; Zubrod score
General
assessment; evaluation
References
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016