Clinical Review

Functional assessment in older people

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4681 (Published 22 August 2011) Cite this as: BMJ 2011;343:d4681
  1. T J Quinn, lecturer in geriatric medicine1,
  2. K McArthur, research fellow1,
  3. G Ellis, consultant physician2,
  4. D J Stott, professor of geriatric medicine1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2Department of Medicine for the Elderly, Monklands Hospital, Airdrie, UK
  1. Correspondence to: T Quinn, Department of Academic Geriatric Medicine, Glasgow Royal Infirmary, Glasgow G4 0SF, UK terry.quinn{at}glasgow.ac.uk

Summary points

  • In older adults functional decline is a common presentation of many disease states

  • Causes and consequences are diverse, so functional assessment is not suited to a traditional medical model of system based history and examination

  • Consider functional assessment “screening”: where illness has caused change in function; before considering long term care; and when planning major elective procedures in older adults

  • Validated scales for assessing basic and extended activities of daily living can help inform and focus history taking

  • Key elements of the physical examination include subjective “end of the bed” assessment; upper and lower limbs; vision; hearing; and the patient’s environment

  • Functional decline is rarely related to a single problem, a problem list can guide intervention

  • When functional change is evident, referral for multidisciplinary, comprehensive geriatric assessment is often needed

Older people often present to healthcare services with acute and chronic problems that act together to adversely affect function. A common pathway comprises functional decline, followed by loss of independence and need for institutional care. However, this process is not necessarily inevitable or irreversible. Timely recognition of functional difficulties can lead to interventions that may prevent or arrest the decline. This article focuses on the functional assessment of older adults by generalist clinicians (see box 1 for terminology used in this broad field).

In this video, filmed in Australia, Dr Kurrle performs a functional assessment of an older adult in the home. We show some of the basic components of functional assessment that it is important for a doctor to know, some of which may be used in other settings, such as the GP surgery or on a hospital ward. In many settings an occupational therapist would provide a detailed assessment of the patient's home and their activities of daily living.

Sources and selection criteria

This review is based on the authors’ clinical and research experience and is informed by a search of published literature. We searched electronic databases (Medline and Embase) from inception to December 2010 inclusive, using truncated keywords based on National Library of Medicine, medical subject headings: “aged” OR “aged, 80 or over”, “rehabilitation”, and “geriatric assessment”. In addition, key reference works and national and international guidelines were searched for relevant papers. Particular attention was given to systematic reviews and meta-analyses. For this manuscript the intention was not to …

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