1. Functional Assessment of the Frail Elderly  Determine is this appropriate, ie. too frail?  Often only the initial phase of rehabilitation but holistic approach critical.  Unfortunately, in acute care, facility-centred as opposed to fully client-centred. Much better in RCU/PCU/Rehab.  Often the rehabilitation process is completed as outpatient and/or in the client’s home.

2. Functional Assessment cont’d  Cognition – MMSE, FAB, MOCA  Functional Pain Control – meds. vs. function  Role Blurring – multi-disciplinary team approach  Collateral, collateral, collateral

3. Typical Occupational Performance Issues ADL Assess but minimal opportunity to address in acute care Assess but minimal opportunity to address in acute care  A few basic dressing/washing tips A few basic dressing/washing tips Primarily identify limitations being specific as possible Primarily identify limitations being specific as possible Often important for client to do as much for themselves as possible Often important for client to do as much for themselves as possible Key issue is often toileting – effects on skin integrity Key issue is often toileting – effects on skin integrity

4. Typical Occupational Performance Issues cont’d IADL  Again identify deficits/limitations/unmet needs  Very limited opportunity to address in acute care  Usually provide input home care needs following assessment using a representative task (look at mobility, balance and endurance performing task as well as processing skills.

5. Ramps – very expensive and often big. Ramps – very expensive and often big. Typical Occupational Performance Issues cont’d Home Access Stairs into home – outside, inside, railings Stairs into home – outside, inside, railings Ramp versus porch-lift – greater than 4 steps, recommend porch-lift Ramp versus porch-lift – greater than 4 steps, recommend porch-lift Provide ramp specifications as appropriate Provide ramp specifications as appropriate Often look at acceptable risk given situation – house-trapped vs. contracting infection in nursing home. (1, 2). Psychological impact and affects on confusion. Often look at acceptable risk given situation – house-trapped vs. contracting infection in nursing home. (1, 2). Psychological impact and affects on confusion.

6.  Balance / deconditioning Typical Occupational Performance Issues cont’d Transfers  Fear of falling can often be as debilitating as actual fall  Frail elderly twice as likely to fall, slightly over half the falls occur in the elderly occur outside the home and of those in the home many occur at night and in or on the way to the bathroom.(3,4,5)

7. Typical Occupational Performance Issues cont’d Transfers continued: Equipment – consider factors affecting use (6) Equipment – consider factors affecting use (6)  Toilet – safety frame vs. bar and/or RTS  Tub/shower – bath board, chair or bench, bars, hand-held shower. Lift - $$$$.  Commode – regular vs. drop-arm  Superpole  Wiping aid, mechanical cleaning seat

8. Cane, 2ww, 4ww, wheelchair Cane, 2ww, 4ww, wheelchair Typical Occupational Performance Issues cont’d Mobility – in conjunction with PT Need to consider need to carry items Need to consider need to carry items Home setup critical to usage as is client’s ability and willingness to learn to do things in a different way Home setup critical to usage as is client’s ability and willingness to learn to do things in a different way

9. Typical Occupational Performance Issues cont’d Mobility continued: If wheelchair – realistically usable and user friendly (for client and/or care-giver) If wheelchair – realistically usable and user friendly (for client and/or care-giver) Arm style Arm style Swing-away detachable footrests Swing-away detachable footrests Light-weight Light-weight Rear wheel location, wheel type and castor style Rear wheel location, wheel type and castor style Seating features Seating features

10. Conclusion  Need to look at the overall goals of care first  Inceased awareness of when referral to an occupational therapist and geriatric team can help your aging clients to maintain independence and remain at home as they become more frail.  Greater appreciation of the complexity and detail needing to be attended tp when looking at functional issues, how they are addressed and their impact on a patient’s overall health.

11. References 1. Haley RW, Culver DH, White JW, Morgan WM & Emeri TG. The nationwide nasocomial infection rate – a need for vital statistics. American Journal of Epidemiology 1985; 121: 159-167. 2. Nicolle LE, Garibaldi R, Strausburgh LJ. Infections and antibiotic resistance in nursing homes. Clinical Microbiology Review 1996; 9: 1-17. 3. Northridge ME, Nevitt MC, Kelsey JL and Link B. Home hazards and falls in the elderly: the role of health and functional status. American Journal of Public Health 1995; 85: 509-15. 4. Bergland A, Jarnlo G & Laake K. Predictors of falls in the elderly by location. Aging Clinical and Experimental Research 2003; 15: 43-50. 5. Bleijlevens MH, Diedericks JP, Hendricks MR, van Haastreqt JC, Crabolder HF & van Eijk VT. Relationship between location and activity in injurious falls: an exploratory study. Published online BMC Geriatrics 2010; 10:40 (18 June 2010). 6. Kraskowsky LH & Finlayson M. Factors affecting older adults’ use of adaptive equipment: review of the literature. American Journal of Occupational Therapy 2001; 55(3): 303-10.

12. Questions Contact information: Greg Parsons 473 – 2729 greg.parsons@cdha.nshealth.ca