logging in or signing up Functional Problems and Assessmen MariaOlvers Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Copy Does not support media & animations WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 1184 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: May 04, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: wolfepete (31 month(s) ago) This was a very interesting and well documented presentation that I happened upon while researching standardized testing and norms for geriatric rehab. I have not seen normative values assigned to the Physical Performance Test (7 question) previously and wondered if you could possibly indicate a source of publication of those values. Thank you! Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Gerontology : Gerontology Common Functional Problems in the Elderly Geriatric Assessment Objectives : Objectives Describe common functional problems of elderly patients. Identify methods to measure ADL and IADL independence. Discuss the appropriateness of specific evaluations in various clinical situations. Identify practical suggestions for ADL problems. Interpret test/measures results. Geriatric Assessment : Geriatric Assessment The comprehensive geriatric assessment is designed to Evaluate the multiple problems of older persons Assess their personal resources and strengths Determine service needs Develop coordinated care plans to focus interventions on individual problems Components of Comprehensive Geriatric AssessmentDarryl Wieland, PhD, MPH; Victor Hirth, MD, MHAwww.medscape.com : Components of Comprehensive Geriatric AssessmentDarryl Wieland, PhD, MPH; Victor Hirth, MD, MHAwww.medscape.com Commonly Used Tools : Commonly Used Tools Cognitive – MMSE, Mini-Cog, MOCA Affective – Geriatric Depression Scale Nutrition – Mini Nutritional Assessment Mobility – Gait and balance measures Functional status – ADL instruments Health and Functional Independence : Health and Functional Independence Health status is often reflected in the degree of functional capacity in the elderly. Two categories of activities of daily living: Basic ADL (self-care) Instrumental ADL (more complex) IADL functions typically decline first. Intervention with social support, assistive devices, and/or environmental modifications may enable elders to maintain a higher level of independence and remain in the community longer. Functional Independence : Functional Independence Basic ADL – DEATH D – dressing E – eating A – ambulation T – toileting H - hygiene Instrumental ADL – SHAFT S - shopping H – housekeeping A – accounting F – food preparation T - transportation Slide 9: Difficulty with ADLs and IADLs by Age US Census Bureau, 1990 Functional Independence : Functional Independence Two major influences in the elderly: Motivation Environment Elderly perceive they need more assistance than their therapists think they do. Therapists need to consider patient’s goals to improve motivation and provide a sense of control over their rehabilitation. Measuring Independence : Measuring Independence Three methods used to measure functional independence: Self-reports Ratings based on observations by family, attendants, caregivers, others Direct examination by a trained professional Measuring Independence : Measuring Independence Self-report Assessment Easy and quick to administer Requires less expertise and training Information may not be objective May report what they wish were true May want to remain dependent Fear that responses may affect services or lead to institutionalization Influenced by cognitive and psychological states Self-report Instruments : Self-report Instruments RAND Medical Outcomes Study 36 item short form questionnaire http://www.rand.org/health/surveys_tools/mos Geriatric Health Questionnaire Jogerst G. Geriatric Health Questionnaire. University of Iowa Hospitals and Clinics. Iowa City, IA Older American Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire ADL Scale – 8 areas IADL Scale – 7 areas http://www.geri.duke.edu/service/oars.htm Self-report Instruments : Self-report Instruments UAB Life-Space Assessment Mobility in/around home and in community Activities-specific Balance Confidence (ABC) Scale Level of confidence in maintaining balance while doing 16 activities 0-100% Total ratings and divide by 16 to get overall score Powell, LE and Myers AM, 1995 ABC Norms : ABC Norms <50 indicates low level of physical functioning and has been correlated to being homebound in older adults 51-80 indicates moderate level of functioning >80 indicates high level of functioning (Myers AM et al, 1998) < 67% = older adults at risk for falling; predictive of future fall (LaJoie Y, 2004) Self-Report Instruments : Self-Report Instruments Lawton IADL 9 items: Financial management, shopping, transportation use, telephoning, medication use, housekeeping, cooking, laundry 3 points each for a total of 27 Community dwelling 24.5 Public housing 25.2 In-Home 19.9 LTC 18.2 Lawton and Brody, 1969 Observation Ratings : Observation Ratings Revised Parachek Geriatric Behavior Rating Scale 10 items grouped in 3 categories (physical capabilities, self-care, and social interactions) Miller ER, and Parachek, JF. J Am Geriatr Soc 22:278, 1974. Frail Elderly Functional Assessment Questionnaire (FEFA) 19 items Watson, GF, et al. Am J Phys Med and Rehab, 74(1), 1995. What is frailty? : What is frailty? Direct Examination : Direct Examination Barthel Index (BI) 10 activities, scored 0,5,10,15 Scores: >60 capable of living independently <60 require daily assistance, institutionalization Mahoney, FL, and Barthel, DW: Functional evaluation: Barthel Index. Md State Med 14:61, 1965 Katz Index of ADL 6 areas: bathing, dressing, toileting, transferring, continence, and feeding Katz, S, et al: The index of ADL. JAMA 185:914, 1963. Direct Examination : Direct Examination Functional Independence Measure (FIM) Measures disability in ADL, cognitive function, and communication Valid and reliable when clinicians are trained Divided into motor and cognitive parts Motor part has 4 sub-areas and 13 items Self-care Sphincter control Mobility Locomotion Granger, CV, and Hamilton, BB: Uniform data set for medical rehabilitation. J Clin Epidemiol 42:703, 1989. Direct Examination : Direct Examination Physical Performance Test Assesses multiple dimensions of physical function Items mimicking basic and complex ADL tasks Scored by timing the completion of a task Concurrent validity with other functional performance measures, such as the Katz ADL scale Test of choice to use as a predictor of physical decline because of its strong psychometric properties and ease of completion in a clinic Reuben DB, Siu AL, Kimpau S. The predictive validity of self-report and performance-based measures of function and health. J Gerontol. 1992;47:M106–M110. Physical Performance Test : Physical Performance Test 7 Items (0-28 scale) Writing a sentence Simulated eating Lifting a book and placing it on a shelf Donning and doffing a jacket Picking up a penny from the floor Turning 360 degrees while standing Walking 50 ft (15.2 m) Physical Performance Test : Physical Performance Test 9 Items (0-36 scale) adds 2 stair climbing tests Time to ascend one flight Number of flights climbed up and down Scoring (7 Item) 25-28 Independent 16-24 Modified independence <15 Predictive for dependence Common Functional Problems in the Elderly : Common Functional Problems in the Elderly Pathology superimposed on general decline in function can lead to disability Reduced strength and endurance Muscle weakness is associated with dependency Critical levels for disability in ADL may be related to knee extensor strength and maximum walking speed Sonn, U, et al: Scand J Rehabil Med 27:119, 1995. “Walking Speed: the Sixth Vital Sign” : “Walking Speed: the Sixth Vital Sign” A reliable, valid, sensitive, and specific measure Correlates with functional ability and balance confidence Has potential to predict future health status and functional decline, including hospitalization, discharge location, and mortality An increase or decrease of 0.1 m/s is a useful predictor (Fritz S, Lusardi M. Journal of Geriatric Physical Therapy Vol 32:2:09) Gait Speed Norms : Gait Speed Norms Gait Speed Norms : Gait Speed Norms <1.0 m/s identifies elders at high risk of health-related outcomes 1.2 – 1.4 m/s usual adult walking speed Quick and easy assessment Stop watch, markers (eg. tape), and walking space Self-selected speed Mean of 3 trials with rests between Common Functional Problems in the Elderly : Common Functional Problems in the Elderly Decreased joint mobility Pain and stiffness Joint protection principles Increased danger of accidents Combination of joint LOM, slowed reaction time, decreased vision, hearing, strength and endurance Hazardous areas: slippery or uneven surfaces, stairs, kitchen and bathroom Interventions for Functional Problems : Interventions for Functional Problems Elderly prefer enabling environment over human support Values, lifestyle, cost, and degree of disability all must be considered Assistive devices Environmental modifications Security Fire safety Accident prevention Accessibility Working With the Elderly to Improve Functional Independence : Working With the Elderly to Improve Functional Independence Evaluate the patient to determine the safest method for performing the activity. Independent Supervision Assistance Give training in the correct and safe use of equipment. More Geriatric Assessment Tools : More Geriatric Assessment Tools For Balance, Gait, and Fall Risk Single leg stand Tandem stand Functional reach (FR) Four square step test (FSST) Sit to Stand (X10) Timed Up and Go (TUG) Tinetti (POMA) Berg Balance Scale (BBS) Dynamic Gait Index Four Square Step Test : Four Square Step Test The FSST revealed a sensitivity of 85%, a specificity of 88% to 100%, and a positive predictive value of 86% Score of >12 sec indicates increased risk for falls Dite W, Temple VA. Arch Phys Med. 2002 Nov;83(11):1566-71. More Geriatric Assessment Tools : More Geriatric Assessment Tools Strength Screen UE – grip strength or biceps curls (F 5#, M 8#) LE – STS test Observation of performance of functional tasks more realistic than MMT Posture Cardiopulmonary 6 Minute Walk Test 2 Minute Step Test Vital signs at rest and responses to activity More Geriatric Assessment Tools : More Geriatric Assessment Tools Flexibility Screen Back scratch test Neck rotation (>45 deg) Single leg sit and reach Ankle dorsiflexion (>8 deg) Integument – Risk for Pressure Sores Braden Scale Geriatric Examination Tool Kit : Geriatric Examination Tool Kit http://web.missouri.edu/~proste/tool/ Slide 36: You are as young as your faith, as old as your doubt; as young as your self-confidence, as old as your fear; as young as your hope, as old as your despair. ~Douglas MacArthur You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.