CONSIDER: FUNCTION
Definitions
Functional capacity - generally refers to a person's ability to perform the daily tasks that enable him or her to live and function or ability to perform activities of daily living (ADL).
Activities of Daily Living (ADL) - basic functional activities required for daily living, including bathing, dressing, toileting, transferring and feeding.
Instrumental Activities of Daily Living (IADL) - the ability to perform the following daily activities required to live independently: use telephone, prepare meals, go shopping, prepare food, perform housekeeping, transportation, administer medications and handle finances.
Assessment/Screening Tools
- Try This Issue 2 - Katz Index of Independence in Activities of Daily Living (ADL)
- Try This Issue 23 - The Lawton Instrumental Activities of Daily Living(IADL)Scale
- Try This Issue 8 - Fall Risk Assessment
- Functional Independence Measure™ and Functional Assessment Measure
Atypical Presentation
A change in physical functioning and/or falls can represent the onset of an acute medical problem or exacerbation of a chronic medical problem in older adults. It may be an early or only presenting symptoms in frail elders. As evidenced in the chart below, change in function, where there is no apparent reason for such change (e.g. a fall), may herald an upper respiratory or urinary tract infection or cardiac disease, such as congestive heart failure.
Assessment
"Assessment of function includes a systematic process of identifying older person's physical abilities and need for help" (Kresevic & Mezey, p 32). Standard functional assessment tools are used as a common language to communicate functional status between care providers.
Acute Change in Function
A sudden change in function may indicate a new onset of an acute illness or exacerbation of a chronic illness. These changes are usually reversible if properly identified and treated. The following table outlines potential acute or chronic illnesses that may present as a sudden change or decline in function.
| Acute Change in Function: Potential causes, Assessment, and Interventions | ||
| Potential Causes | Assessment & Interventions | |
Infection
Dehydration Electrolyte imbalance New CVA or TIA(TIA resolves in 24 hours) Medications Delirium: Acute Change in Cognition Exacerbation of Chronic Illness:
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Check for signs and symptoms of acute infection Check vital signs
Check for Foley catheter (increases UTI risk) - change or dc Foley prior to obtaining specimen Change in mental status (see Delirium Topic and Atypical Presentation Topics) Check for dehydration (particularly if on diuretics or infection suspected, poor intake, or dysphagia (on thickened liquids)
Suspect if on diuretics, cathartics, or GI loss (NG tube, vomiting, or diarrhea) Check electrolytes, BUN creatinine Monitor mental status, vital signs Assess those with a past history of CVA/TIA and those at risk. Assess neurological status: change in mental status, ability to talk, swallow, or function; symmetry of muscle strength in upper and lower extremities, cranial nerve deficits Monitor for choking with thin liquids or food Monitor B/P Review medication list for new medications or medications that may contribute to functional decline:
See Delirium Topic Assess for signs and symptoms of exacerbation of chronic illness(es), e.g., breath sounds in COPD, glucose level in diabetes, heart/pulse irregularity; Monitor dietary intake/calorie count x 3 days, check serum albumin in malnutrition General interventions Institute fall precautions Maintain activity/mobility as tolerated and appropriate to condition Avoid physical restraints |
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Last updated - January 2005
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