Comprehensive Functional Assessment for Elderly Patients

Position Paper1 July 1988Comprehensive Functional Assessment for Elderly PatientsHealth and Public Policy CommitteeHealth and Public Policy CommitteeSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-109-1-70 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe American College of Physicians believes that maintenance of patients' functional well-being is a fundamental goal of medical practice. Assessment of the impact of illness on physical, mental, and psychosocial functioning is an essential element of clinical diagnosis, a major determinant of therapeutic choices, a measure of their efficacy, and a guide in the planning of long-term care for the dependent elderly.Although most elderly noninstitutionalized adults are functionally competent, the percentage who need help doing everyday activities doubles with each successive decade up to age 84, and triples between ages 85 and 94 (1). Although physicians may identify these...References1. Feller B. Americans Needing Help to Function at Home. National Center for Health Statistics Advancedata No. 92, Hyattsville, Maryland; 1983. Google Scholar2. Rubenstein L. The clinical effectiveness of multidimensional geriatric assessment. J Am Geriatr Soc. 1983;31:758-62. CrossrefMedlineGoogle Scholar3. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31:721-7. CrossrefMedlineGoogle Scholar4. WilliamsWilliams MT. Evaluation of older persons in the ambulatory setting. J Am Geriatr Soc. 1986;34:37-43. CrossrefMedlineGoogle Scholar5. Geriatric Assessment Methods for Clinical Decision Making. NIH Consensus Development Conference Statement, v 6, number 13, October 19-21, 1987. Google Scholar6. KaneKane RR. Assessing the Elderly. Lexington, Massachusetts: Lexington Books; 1981. Google Scholar7. McDowellNewell IC. Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press; 1987. Google Scholar8. RubensteinCampbellKane LLR. Geriatric assessment, v 3, number 1. In: Clinics in Geriatric Medicine. Philadelphia: WB Saunders Co.; 1987. Google Scholar9. RubensteinJosephsonWielandEnglishSayreKane LKGPJR. Effectiveness of a geriatric evaluation unit: a randomized clinical trial. N Engl J Med. 1984;311:1664-70. CrossrefMedlineGoogle Scholar10. LiemChernoffCarter PRW. Geriatric rehabilitation unit—a 3-year outcome evaluation. J Gerontol. 1986;41:44-50. CrossrefMedlineGoogle Scholar11. BergnerBobbittPollardMartinGilson MRWDB. The sickness impact profile: validation of a health status measure. Med Care. 1976;14:57-67. CrossrefMedlineGoogle Scholar12. BrookRogersWilliams RWK. Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Volume III: Mental Health. Santa Monica, California: The Rand Corporation; 1979. Google Scholar13. StewartWareBrook AJR. Construction and Scoring of Aggregate Functional Status Measures. Volume I. Santa Monica, California: The Rand Corporation; 1982. Google Scholar14. Fillenbaum G. Screening the elderly: a brief instrumental activities of daily living measure. J Am Geriatr Soc. 1985;33:698-706. CrossrefMedlineGoogle Scholar15. JetteDaviesCleary AAP. The Functional Status Questionnaire: reliability and validity when used in primary care. J Gen Intern Med. 1986;1:143-9. CrossrefMedlineGoogle Scholar16. WilliamsHadlerEarp MNJ. Manual ability as a marker of dependency in geriatric women. J Chronic Dis. 1982;35:115-22. CrossrefMedlineGoogle Scholar17. NelsonWassonKirk EJJ. Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chronic Dis. 1987;40(Suppl 1):55S-69S. CrossrefMedlineGoogle Scholar18. See reference 6, p. 285. Google Scholar19. FeinsteinJosephyWells ABC. Scientific and clinical problems in indexes of functional disability. Ann Intern Med. 1986;105:413-20. LinkGoogle Scholar20. Applegate W. Use of assessment instruments in clinical settings. J Am Geriatr Soc. 1987;35:45-50. CrossrefMedlineGoogle Scholar21. LawtonBrody ME. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179-86. CrossrefMedlineGoogle Scholar22. KatzFordMoskowitzJacksonJaffe SARBM. Studies of illness in the aged. The index of ADL: a standardized measure of biological and social function. JAMA. 1963;185:914-9. CrossrefMedlineGoogle Scholar23. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23:433-41. CrossrefMedlineGoogle Scholar24. FolsteinFolsteinMcHugh MSP. "Mini-Mental State": a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res. 1975;12:189-98. CrossrefMedlineGoogle Scholar25. RovnerFolstein BM. Mini-mental state exam in clinical practice. Hosp Pract. 1987;22:99-110. Google Scholar26. NorrisGallagherWilsonWinograd JDAC. Assessment of depression in geriatric medical outpatients: the validity of two screening measures. J Am Geriatr Soc. 1987;35:989-95. CrossrefMedlineGoogle Scholar27. MoloneyRogers TD. Medical technology—a different view of the contentious debate over costs. N Engl J Med. 1979;301:1413-9. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: American College of Physicians*This paper was authored by Thomas P. Almy, MD, MACP, and was developed for the Health and Public Policy Committee by the Subcommittee on Aging: Michael A. Nevins, MD, FACP, Chairman; John C. Beck, MD, MACP; William A. Godfrey, Jr., MD, FACP; David H. Law, MD; Joanne Lynn, MD. Members of the Health and Public Policy Committee were: Richard G. Farmer, MD, FACP, Chairman; John M. Eisenberg, MD, FACP; Donald L. Feinstein, MD, FACP; Paul F. Griner, MD, FACP; Joseph E. Johnson III, MD, FACP; Charles E. Lewis, MD, FACP; Malcolm L. Peterson, MD, FACP; C. S. Lewis, Jr., MD, MACP; Steven A. Schroeder, MD, FACP; Quentin D. Young, MD, FACP. This paper was approved by the Board of Regents on 15 January, 1988. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byComprehensive Geriatric AssessmentExploring the implementation of patient-reported outcome measures in cancer care: need for more real-world evidence results in the peer reviewed literaturePatient-reported Functional Health and Well-Being Outcomes With Drug TherapyApproach to the older patient with cancerFeminization of Disease and Disability Association in Six Low and Middle Income Countries: Evidence from the Study of Global Ageing and HealthQuality of Life Well-Being in General Medicine, Mental Health and CoachingL’indice di Flugelman per individuare pazienti complessi e di difficile dimissioneFrailty and disability in the elderly: A diagnostic dilemmaSelf-administrated test based on the Marigliano-Cacciafesta Polypathological Scale (MCPS), as a screening tool for early identification of frailty in the elderly: A cohort studyMaintaining independence in older peopleDrug–Nutrient Interactions in the ElderlyLogistic feasibility of health related quality of life measurement in clinical practice: results of a prospective study in a large population of chronic liver patientsThe Marigliano–Cacciafesta polypathology scale (MCPS): A tool for predicting the risk of developing disabilityApplying Quality-of-Life Data Formally and Systematically Into Clinical PracticeReliability of the original and revised versions of the Assessment of Living Skills and ResourcesHealth-Related Quality of Life of Heart Failure and Coronary Artery Disease Patients Improved During Participation in Disease Management Programs: A Longitudinal Observational StudyUsing health-related quality of life to predict and manage pediatric healthcareRelationship Between the Clinical-Neurophysiologic Pattern, Disability, and Quality of Life in Adolescents With Spina BifidaThe Relationship Between Functional Disability and Depressive Mood in Japanese Older Adult InpatientsPreventive Health Care in the Elderly Population: A Guide for Practicing PhysiciansDrug-Nutrient Interactions in the ElderlyConcordance of four methods of disability assessment using performance in the home as the criterion methodA Qualitative Study of Patients’ and Physicians’ Views about Practice-Based Functional Health AssessmentHealth-related quality of life and disability in young patients with spina bifidaImproving mental and physical health care through Quality of Life Therapy and assessmentAtención sanitaria al anciano frágil: de la teoría a la evidencia científicaQuality of life as an instrument for need assessment and outcome assessment of health care in chronic patientsChronic Care Clinics: Why Don't They Work?Measuring Quality of Life in Back PatientsAssociation of Comorbidity with Disability in Older WomenSF-36 Health Profiles of Recently Discharged Hospital Patients in AustraliaComprehensive geriatric assessmentQuality of life therapy and assessment in health care.DepressionSurrogate assessment of coronary artery disease patients' functional capacityChronic Fatigue Syndrome in the ElderlyClinical Approach: An OverviewDisability in Older Adults: Evidence Regarding Significance, Etiology, and RiskFunctional assessment in older patientsScreening for common problems in ambulatory elderly: Clinical confirmation of a screening instrumentGeriatric Health MaintenanceCross-Sectional Psychometric Assessment of the Functional Status Questionnaire: Use with Geriatric versus Nongeriatric Ambulatory Medical PatientsHealth and functional status in elderly patients living in nursing homesA comprehensive system for quality improvement in ambulatory care: assessing the quality of diabetes carePractical Functional Assessment of Elderly Persons: A Primary-Care ApproachPractical Functional Assessment of Elderly Persons: A Primary-Care ApproachAutoperception and satisfaction with health: Two medical care markers in elderly hospitalized patients. Quality of life as an outcome estimate of clinical practiceDevelopment of a hierarchical activities of daily living scale for Chinese stroke patients in geriatric day hospitalsUse of a nursing intensity system as a measure of patient functionFunctional disability screening of ambulatory patientsThe comprehensive assessment of community dwelling elderly: Why functional status is not enoughThe SF-36 Health Survey: Development and Use in Mental Health Research and the IQOLA ProjectLinking Outcomes Measurement to Continual Improvement: The Serial “V” Way of Thinking About Improving Clinical CareNutrition and Function: Is There a Relationship Between Body Mass Index and the Functional Capabilities of Community-Dwelling Elderly?Exercise and aging: Issues for the PractitionerThe Plausibility of Quality-of-Life Measures in Different Domains of Health CareCommentary on ‘A Critical Evaluation of the Barthel Index’Measurement of Activities of Daily Living in Hospitalized Elderly: A Comparison of Self-Report and Performance-Based MethodsGeriatric Preventive Care: Counseling Techniques in Practice SettingsUse of Non-Physician Professionals in Teaching Geriatrics to Internal Medicine and Family Practice ResidentsGeriatric Evaluation and Management Units: Experimental Methods for Evaluating EfficacyUnderestimating DisabilityAnthony N. Galanos, MDRecognising disabilityAn Evaluation of a Brief Health Status Measure in Elderly VeteransPreventive Care Guidelines: 1991Robert S. A. Hayward, MD, Earl P. Steinberg, MD, MPP, Daniel E. Ford, MD, MPH, Michael F. Roizen, MD, Keith W. Roach, MDFailure of Physicians To Recognize Functional Disability in Ambulatory PatientsDavid R. Calkins, MD, MPP, Lisa V. Rubenstein, MD, Paul D. Cleary, PhD, Allyson R. Davies, PhD, Alan M. Jette, PhD, Arlene Fink, PhD, Jacqueline Kosecoff, PhD, Roy T. Young, MD, Robert H. Brook, MD, Thomas L. Delbanco, MDFunctional assessment in spinal cord injury: a comparison of the Modified Barthel Index and the 'adapted' Functional Independence MeasureAspiration and the elderlyWhy Screen for Functional Disability in Elderly Persons?Mark E. Williams, MDA Simple Procedure for General Screening for Functional Disability in Elderly PatientsMark S. Lachs, MD, Alvan R. Feinstein, MD, Leo M. Cooney Jr., MD, Margaret A. Drickamer, MD, Richard A. Marottoli, MD, Fitzhugh C. Pannill, MD, Mary E. Tinetti, MDMultidimensional Assessment Of the ElderlyIntegrating Practice Guidelines with Financial IncentivesPsychometric Considerations in Functional Status InstrumentsClinical Evaluation of the PatientThe prescription of assistive devices for the elderlyHealth status reports in the care of patients with rheumatoid arthritisImproving Patient Function: A Randomized Trial of Functional Disability ScreeningLisa V. Rubenstein, MD, David R. Calkins, MD, Roy T. Young, MD, Paul D. Cleary, MD, Arlene Fink, PhD, Jacqueline Kosecoff, PhD, Alan M. Jette, PhD, Allyson R. Davies, PhD, Thomas L. Delbanco, MD, Robert H. Brook, MD, ScDRational Home Care Based on The Disability ModelClinical Approach to the Older Patient: An Overview 1 July 1988Volume 109, Issue 1Page: 70-72KeywordsAgingElderlyLong-term careMental functioningPrevention, policy, and public healthPublic policy ePublished: 1 December 2008 Issue Published: 1 July 1988 Copyright & Permissions© 1988 American College of PhysiciansPDF downloadLoading ...