1. UMMS CRIT Module III: Functional Assessment of Older Adults Gerry Gleich, MD University of Massachusetts Division of Geriatrics

2. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Functional Status Important predictor of morbidity and mortality Important predictor of institutionalization

3. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Functional Status Tell me about function before anything else If you must tell me about an elderly person’s age, gender, and medical problems first… Tell me about their functional status next

4. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation What should you tell me? ADLs – self care IADLs – ability to live independently

5. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Activities of Daily Living (ADL) D Dressing E Eating A Ambulation T Transfers T Toileting H Hygiene –Grooming –Bathing

6. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Instrumental Activities of Daily Living (IADL) S Shopping H Housekeeping –Cleaning –Laundry A Accounting = $ F Food Preparation T Telephone T Transportation T Taking Medications

7. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Medicare Current Beneficiary Survey www.cms.hhs.gov/mcbs Functional Status of US Elderly, 2002

8. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Inouye. JAMA 1998; 279:1187-1193 Predictive Value of Function

9. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Functional Status at Age 70 Life Expectancy (in years) Annual Health Care Costs Independent14.3$4,600 IADL Deficit Only12.4$8,500 1 + ADL Deficit11.6$14,000 Predictive Value of Function Lubitz. NEJM 2003; 349:1048-55

10. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Functional decline in the elderly Final common pathway of many problems

11. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Functional Decline Cognitive Medical Nutrition Incontinence Environmental Special senses Social support Polypharmacy

12. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Assess Function ADL, IADL - Self-Report, Surrogate Report Direct Observation –“Get up and go” test Office Bedside –Home Safety Assessment – Physical therapy –Nutritional Assessment

13. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Assess Cognitive Impairment Mini-Mental State Exam Mini-Cog Don’t forget to do it

14. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Set Functional Goals Optimize Independence –Treat Impairments –Apply Adaptive Strategies Support ADL & IADL Needs Least Restrictive Setting

15. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Reaching Functional Goals Teamwork –Care Givers –Community resources for IADL assistance –Physical therapist –Occupational therapist –Speech therapist –Social work –Nutritionist –Pharmacist

16. UMMS CRIT 2010 Module III: Functional Assessment Advancing Geriatrics Education (AGE) A UMMS initiative funded by the Donald W. Reynolds Foundation Summary: AMP UP Function When caring for older adults… –A ssess Function –M aximize Function –P revent Functional Decline –U se a team approach –P atient-Centered Goals