Functional Assessment Essay

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Functional
Assessment

The quality of life is determined by its activities. Aristotle

Functional Screening is important because…
• Chronological age is poor indicator of ability. • Hospitalized older adults are at high risk for loss of function skills.
– Environmental constraints
(IV’s, catheters, side rails)
– Decreased expectations for performance (ageism)
– New disabilities or illness

• Loss of functional abilities is a major cause of institutionalization.

What do you think?
What would be your first impression of this man if the first time you met him he was in a gown, lying in a hospital bed, trying to pull out his IV, and was confused? What if you knew he was 70 years old?
What would you assume about his level of function?

What if…..? you knew he was a regular surfer and ran a multi-million dollar company?
Would that change your expectations of his function?
Why or why not?

The goal of a functional assessment is to…
screening
restore or improve health monitor changes enhance independence identify disabilities screen for issues needing further assessment and referral
 evaluate the need for community resources and equipment





Environmental
Communit
y

Physical
Extended family

Living environme nt

Psychological

Socioeconomical

Functional assessment includes all of these components. Functional Assessment
Screening
•

A systematic review of these areas

•
•
•
•
•
•
•
•
•

Vision / Hearing
Mobility (arms, legs)
Oral / Nutrition
Elimination
Cognitive
ADL and IADL*
Home Environment
Social Support
Chronic Pain
Medications

* ADL: Activities of Daily Living; IADL: Independent Activities of
Daily Living

When doing an assessment… • Assess, don’t assume.
• Watch, don’t just ask.
• Obtain baseline information: it is important to know what is normal for this individual.
• Identify what helpers, equipment, and supports make doing activities of daily life possible.

Vision Screening
• Condition of glasses

• Snellen chart
• When was the last eye exam?
Minimum is every two years. If diagnosed with diabetes or an eye condition such as glaucoma, eye exams could be as frequent as every 6-12 months.

Hearing
• Whisper test

(Stand behind the person and whisper a word in each ear.)

• Finger rub
(Stand behind the person and rub two fingers together by each ear.)
Keep going, there is more

Hearing
• Cerumen
– Build up interferes with the conduction of sound.

• Hearing aids
Cerume
n

– Check batteries frequently; they last anywhere from less than a week to less than a month.
– Can cause an increase of cerumen impaction.

Upper Extremities
Can the individual…
• touch the palms of the hands to back of the head?
• reach up over the head? • touch the hands together behind the waist?

Upper Mobility is needed for…
• Combing and washing hair • Getting items off a shelf • Putting on a shirt

What other activities require upper mobility?

Lower Extremities
• “Get Up and Go” Test
–
–
–
–

Get up from a chair
Walk 10 feet
Turn around and walk back
Sit down again

• Problems with the above correlate with abnormal gait and increased risk of falling.

Oral Screening
Inspect the oral cavity and check …
– the condition of teeth
– the condition and fit of dentures – for oral lesions or infections such as candidiasis

Ask…
• Do you have any problems eating or swallowing?
• When was your last dental appointment? Quadruple A’s of
Nutrition

• Appearance
Does the person look well nourished? • Appetite
How is the person’s appetite?

• Access
Does the person have access to funds to buy food? Get to the store?

• Ability
For more information: DETERMINE nutrition screen for older adults in
Optimal Aging Competency

Can the person prepare own meals? Open cans? Cook safely? Elimination:
“DRIP”
D

- Delirium, Depression,

R

- Retention, Restricted mobility

Dementia and/or environment

I

- Infection, Inflammation,

Impaction

P

- Pharmaceuticals, Polyuria

If incontinence is a new problem, it must be
Show More

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