- Screening tools have been developed which offer some predictive ability of patients most at risk of functional decline, although no “gold standard” tool has been established having all of the properties required to accurately measure this.1,2,3 However, it could practically be asserted that ALL patients in hospital should have their functional status optimized by inter-professional intervention. For instance, patients who are already independent in mobility and ADLs can be encouraged by the health care team to ambulate regularly and to independently perform their own ADLs to the greatest extent while in hospital.
70-74 – 23% experience loss of ADL function
75-79 – 28%
80-84 – 38%
85-90 – 50%
90+ – 63%
- Functional status is highly correlated with health and illness in older adults. It is also a predictor of mortality, hospital length of stay, discharge destination, and readmission rate.15 Routine monitoring, documentation, and communication of a patient’s functional status are important practices in planning for their care during and after hospitalization.
- Functional status includes the patient’s performance in mobility, basic ADLs (e.g. bathing, dressing, toileting), and Instrumental ADLs (e.g. medication administration, shopping, finances).
- There are many tools used to measure mobility and ADL performance. No single instrument appears to adequately measure all dimensions of mobility and ADL performance over the wide range of functional abilities of older patients.16 Therefore a number of instruments are included in this toolkit. The choice of tool may depend on its applicability to your patient population and its feasibility of use within your institution.
1 Hoogerduijn JG, MJ Schuurmans, MSH Duijnstee, SE de Rooij, and MFH Grypdonck (2006). A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. Journal of Clinical Nursing 16: 46-57.
2 Sutton M, K Grimmer-Somers, and L Jeffries (2008). Screening tools to identify hospitalized elderly patients at risk of functional decline: a systematic review. International Journal of Clinical Practice 62(12): 1900-1909.
3 de Saint-Hubert M, D Schoevaerdts, P Cornette, W D’Hoore, B Boland, and C Swine (2010). Predicting functional adverse outcomes in hospitalized older patients: A systematic review of screening tools. The Journal of Nutrition, Health and Aging 14(5): 394-399.
4 Covinsky KE, E Pierluissi, and CB Johnston (2011). Hospitalization-Associated Disability – “She Was Probably Able to Ambulate, but I’m Not Sure.” Journal of the American Medical Association 306(16): 1782-1793.
5 Covinsky KE, RM Palmer, RH Fortinsky, SR Counsell, AL Stewart, D Kresevic, CJ Burant, and CS Landefeld (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society 51(4): 451-458.
6 Sager MA, MA Rudberg, M Jalaluddin, T Franke, SK Inouye, CS Landefeld, H Siebens and CH Winograd (1996). Hospital Admission Risk Profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization. Journal of the American Geriatrics Society 44: 251-257.
7 Wu AW, Y Yasui, C Alzola, AN Galanos, J Tsevat, RS Phillips, AF Connors Jr, JM Teno, NS Wenger, and J Lynn (2000). Predicting functional status outcomes in hospitalized patients aged 80 years and older. Journal of the American Geriatrics Society 48: S6-S15.
8 Sands LP, K Yaffe, K Covinsky, MM Chren, S Counsell, R Palmer, R Fortinsky, and CS Landefeld (2003). Cognitive screening predicts magnitude of functional recovery from admission to 3 months after discharge in hospitalized elders. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58(1): 37-45.
9 Mahoney JE, MA Sager, and M Jalaluddin (1999). Use of an ambulation assistive device predicts functional decline associated with hospitalization. The Journal of Gerontology, Series A, Biological Sciences and Medical Sciences 54: M83-M88.
10 Lindenberger EC, CS Landefeld, LP Sands, SR Counsell, RH Fortinsky, RM Palmer, DM Kresevic, and KE Covinsky (2003). Unsteadiness reported by older hospitalized patients predicts functional decline. Journal of the American Geriatrics Society 15(5): 621-626.
11 Murray AM, SE Levokff, TT Wetle, L Beckett, PD Cleary, JD Schor, LA Lipsitz, JW Rowe, and DA Evans (1993). Acute delirium and functional decline in the hospitalized elderly patient. Journal of Gerontology 48: M181-M186.
12 Inouye SK, JT Rushing, MD Foreman, RM Palmer, and P Pompei (1998). Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of General Internal Medicine 13(4): 234-242.
13 Covinsky KE, RH Fortinsky, RM Palmer, DM Kresevic, and CS Landefeld (1997). Relation between symptoms of depression and health status outcomes in acutely ill hospitalized older persons. Annals of Internal Medicine 125: 417-425.
14 Sager MA, T Franke, SK Inouye, CS Landefeld, TM Morgan, MA Rudberg, H Sebens, and CH Winograd (1996). Functional outcomes of acute medical illness and hospitalization in older persons. Archives of Internal Medicine 156(6): 645-652.
15 Campbell SE, DG Seymour, WR Primrose, and ACMEPLUS Project (2004). A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age and Ageing 33: 110–115.
16 de Morton NA, DJ Berlowitz, and JL Keating (2008). A systematic review of mobility instruments and their measurement properties for older acute medical patients. Health and Quality of Life Outcomes 6:44.