Warning Signs along the Road to Functional Dependency

Editorials15 January 1998Warning Signs along the Road to Functional DependencyDavid B. Reuben, MDDavid B. Reuben, MDUniversity of California, Los Angeles; Los Angeles, CA 90095-1687Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-2-199801150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the general community-dwelling population of older persons, dependence in basic self-care tasks, the “activities of daily living” (ADL), is uncommon. According to most studies, fewer than 10% of these persons need assistance with such tasks as bathing, dressing, transferring from bed to chair, feeding, grooming, and using a toilet [1]. Nevertheless, older persons with such functional dependency incur high health care costs [2]. Older persons with ADL dependency are also costly to society in other respects; for example, they place a burden on their families, who must use personal resources and often relinquish other responsibilities to care for them.... References1. Wiener JM, Hanley RJ, Clark R, Van Nostrand JF. Measuring the activities of daily living: comparisons across national surveys. J Gerontol. 1990; 45:S229-37. Google Scholar2. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med. 1997; 4:203-8. Google Scholar3. Taffet GE. Age-related physiologic changes. In: Reuben DB, Yoshikawa TT, Besdine RW, eds. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. 3d ed. Dubuque, IA: Kendall/Hunt; 1996:11-24. Google Scholar4. Gill TM, Robison JT, Tinetti ME. Difficulty and dependence: two components of the disability continuum among community-living older persons. Ann Intern Med. 1998; 128:96-101. Google Scholar5. Jette AM, Davies AR, Cleary PD, Calkins DR, Rubenstein LV, Fink A, et al. The Functional Status Questionnaire: reliability and validity when used in primary care. J Gen Intern Med. 1986; 1:143-9. Google Scholar6. Reuben DB, Rubenstein LV, Hirsch SH, Hays RD. Value of functional status as a predictor of mortality: results of a prospective study. Am J Med. 1992; 93:663-9. Google Scholar7. Reuben DB, Siu AL, Kimpau S. The predictive validity of self-report and performance-based measures of function and health. J Gerontol. 1992; 47:M106-10. Google Scholar8. Williams ME, Gaylord SA, Gerrity MS. The timed manual performance test as a predictor of hospitalization and death in a community-based elderly population. J Am Geriatr Soc. 1994; 42:21-7. Google Scholar9. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332:556-61. Google Scholar10. Gill TM, Williams CS, Tinetti ME. Assessing risk for the onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc. 1995; 43:603-9. Google Scholar11. Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc. 1997; 45:92-100. Google Scholar12. Reuben DB. Pre-visit questionnaire. In: Reuben DB, Yoshikawa TT, Besdine RW, eds. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. 3d ed. Dubuque, IA: Kendall/Hunt; 1996:379-94. Google Scholar Author, Article, and Disclosure InformationAuthors: David B. Reuben, MDAffiliations: University of California, Los Angeles; Los Angeles, CA 90095-1687Corresponding Author: David B. Reuben, MD, Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles, 10945 Le Conte Avenue, Los Angeles, CA 90095-1687. 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